The eternal problem of male baldness, impossible to deal even for the heir of the British kingdom, received a new and positive step towards the prospect of treatment in 2012. American scientists cited by Helen Briggs, the Health editor in the BBC News website, pinpointed a protein that triggers hair loss in a report in the journal Science Translational Medicine. This could result in a cream to treat baldness. Most men start to go bald in middle age; 80% have some hair loss by 70; some, like Prince William and many in my family, start in the 20s and 30s, when testosterone achieves high concentrations in the blood, along with other genetic characteristics. Whatever the age, hair follicles go into a state of atrophy, and baldness ensues.

Prof George Cotsarelis, of the department of dermatology at the University of Pennsilvania, said: “Essentially we showed that prostaglandin protein was elevated in the bald scalp of men and that it inhibited hair growth. So we identified a target for treating male-pattern baldness.”The next step would be to screen for compounds that affect this receptor and to also find out whether blocking that receptor would reverse balding or just prevent balding – a question that would take a while to figure out.”

The researchers found levels prostaglandin D synthase elevated in the cells of hair follicles located in bald patches on the scalp, but not in hairy areas. Mice bred to have high levels of the protein went completely bald, while transplanted human hairs stopped growing when given the protein, according to the BBC health editor. The inhibition of hair growth is triggered when the protein binds to a receptor on the cells of hair follicles, said Prof Cotsarelis.

Several known drugs that target this pathway have already been identified, he added, including some that are in clinical trials, with potential for developing a treatment for baldness that can be applied to the scalp to prevent baldness and possibly help hair grow again once it is lost. This is unlikely to be the whole problem, of course. In fact, since 2012 we have not heard a follow-up of this paper, and Prince William is living proof that there is no active treatment in the market.

At our clinic we have used a baldness shampoo for a couple of decades that eliminates oil from the scalp, making hair really dry, and in this manner we eliminate the seborrhoeic dermatitis and dandruff that complicate hair loss in a great number of men and women of any age. Although dermatologists have known this for a long time, the actual fungus responsible for this infection, Malassezia globosa, which thrives in fat in the face, sclap, and produces dandruff and leads to all these problems, was finally isolated in France in 2007. So, the indications for oral treatment and the use of specialized shampoos, that is, when people should look for doctors rather than hairdressers, are still evolving. With the baldness shampoo and a number of recommendations, we have been able to stop hair loss in men, and reverse and recover in women. Perhaps with the prostaglandin cream we may achieve greater progress.

Finally, there are more dramatic forms of therapy, of course, available.

Prof. Dr. Paulo Bittencourt, PhD, FAAN

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