Did Spironolactone Help Your Hair Regrowth

Excessive hair: when hair growth becomes a problem

In contrast to the fur of animals, human hair no longer fulfills indispensable physiological tasks. People with alopecia areata totalis, the complete loss of all body hair, do not have to fear any health restrictions as a result.

Nevertheless, the scalp hair has an important symbolic power in terms of beauty, youth and health, so that people with hair loss can be exposed to high levels of suffering. But the opposite is not always desirable either. If the man's lush chest hair is still a matter of taste or fashion, thick hair on the back, as is often the case with the Pyknic male type, is considered a nuisance. But mostly it is women who suffer from hair growth in the wrong places.

Hair is an appendage to the skin. The fine, unpigmented lanugo hair that the unborn child already has, turns into somewhat thicker vellus hairs all over the body after birth, which can be fine, marrowless and already pigmented. Terminal hairs develop in the scalp, eyebrows, eyelashes and, depending on the sex hormones, in the beard, armpit, chest and pubic area, as well as in the external auditory canal and at the nasal entrance, which are thick, myelinated and more pigmented. Changes in the physiological hair pattern result from the increased conversion of less conspicuous, non-pigmented vellus hair into conspicuous, pigmented terminal hair.

Hypertrichosis

Hypertrichosis is non-androgen-dependent increased hair growth that does not match age, gender, or race. A distinction is made between congenital and acquired hypertrichoses, as well as generalized or circumscribed hypertrichoses according to localization. With acquired hypertrichosis, the anagen phase of the hair cycle is induced.

The causes can be very diverse. Localized hypertrichoses occur in chronic porphyry syndrome on areas of skin exposed to light, in scleroderma and in myxedema due to an underactive thyroid. After traumatic brain injuries, hirsutism can develop after two to four months and last for up to a year. Repeated fractures and nerve injuries can also be associated with increased hair growth.

Severe malnutrition in anorexia nervosa (anorexia) or malignancy are rare causes. Trichomegaly, an eyelash hypertrichosis, is very rare in AIDS patients. In newborns, moles with hair like animal skin can appear, in neurodermatitis the hairline sometimes looks like a fur cap. Increased hair growth also occurs as a result of fetal alcohol syndrome.

Ponytail-like hypertrichia on the lower back is a clear indication of an underlying malformation of the spine. Chromosomal abnormalities such as trisomy 18, which leads to Edwards syndrome with complex malformations, are also associated with increased hair growth.

A very rare congenital form is hypertrichosis lanuginosa, in which the downy hairs of the fetus are not replaced by other hair types. The entire body of the newborn is then covered by these so-called lanugo hairs, which later grow into about ten centimeters long, silvery fine hair. A historical example of a so-called hair man can be found in the painting collection of Ambras Castle in Tyrol. The portrait from 1580 shows the completely hairy face of Petrus Gonsalvus, who lived as an attraction at several European courts and was examined by many doctors and naturalists. The disease is inherited as an autosomal dominant trait, so that two of the four children of the Hair Man had the same abnormality.

Hair growth as an undesirable drug effect

Hypertrichosis can also be triggered iatrogenically by drugs. When using Minoxidil (Lonolox®) to lower blood pressure and the 5-alpha reductant inhibitor finasteride (Proscar®) against prostate cancer, increased hair growth was observed in patients. This drug-induced hypertrichosis led to the development of new hair restorers. Minoxidil is used externally as a finished medicinal product under the name Regaine® and in formulations, while finasteride has established itself as an effective hair restorer for systemic use in men under the trade name Propecia®.

The active ingredients that can cause hypertrichosis as an undesirable effect also include vitamin D2, streptomycin, ciclosporin A, diazoxide, psoralens, phenytoin and thioridazine. Neuroleptics, anabolic steroids, and glucocorticoids also lead to increased hairiness, which, however, corresponds more to the male distribution type. If this form of localized hypertrichosis occurs in women, it is known as hirsutism.

Hirsutism

Women from southern regions in particular tend to have increased hair growth according to the male pattern in the genital area, chest and face. The risk of androgenetic hair loss, menstrual irregularities, and acne is also increased in these women. Genetically determined hirsutism begins during puberty and is probably due to an increased sensitivity of the hair follicles to male hormones.

Serum levels of testosterone and dehydroepiandrosterone (DHAES) are only actually increased in ten percent of cases. The most common is the so-called "lady's beard", a form of hirsutism on the face. A hair removal technique that is quick and inexpensive is shaving, which, however, has to be done daily.

Longer - over a few weeks - the effect of hair removal including hair roots with wax or epilators lasts. Only in the next anagen phase does a new hair sprout, which then often appears even stronger. This painful method of mechanical hair removal is only possible to a limited extent in the facial and intimate areas.

Depilatory or bleaching creams are used there. These contain thioglycolates, hydrogen peroxide in a concentration of up to 20 percent or diluted ammonia. The success of the epilation creams lasts up to two weeks, but they can cause skin irritation.

Eliminate unwanted hair

Epilation using the photoderm method or ruby ​​laser is very effective. High-energy flash light, which is preferably absorbed by the melanin of pigmented hair shafts, destroys the follicle. Dark pigmented, thick hair responds best to the treatment with light skin types. Four to eight attempts at epilation are necessary to completely destroy the hair follicles.

While in men the intolerable systemic side effects only allow local therapy, in women there is the possibility of suppressing unwanted hair growth using antiandrogenic substances. Usually the dose contained in the corresponding contraceptives is 2 mg cyproterone acetate (in Diane 35® combined with 0.035 mg ethinylestradiol) or 2 mg chlormadinone (in Gestamestrol® N with 0.05 mg mestranol or in Neo-Eunomin® with 0.05 mg ethinylestradiol ) sufficient. 50 to 60 percent of the patients respond to the therapy. If higher doses are required, the reverse sequence principle is used and Androcur® 10 with 10 mg cyproterone acetate is also taken from the first to the fifteenth day of the cycle. Common side effects are a feeling of tightness in the chest and menstrual disorders.

Antiandrogenic therapy can also be carried out with low-dose glucocorticoids or, in rare cases, with spironolactone. The potassium-sparing diuretic acts both as an antagonist on the aldosterone receptor and on the 5-alpha-dihydrotestosterone receptor. Systemically, it is recommended in a dosage of 25 mg twice a day for androgenetic hair loss, acne and hirsutism. Optimal results were measured with 150 to 200 mg spironolactone daily, although undesirable diuretic, neurological and gastrointestinal side effects are to be expected.

In a study with 50 mg spironolactone daily, the hair shaft diameter was reduced by 40 percent after six months and by 83 percent after twelve months and the hair density by 40 to 60 percent. In contrast to cyproterone acetate and chlormadinone, both spironolactone and its main metabolite canrinone are also suitable for topical use in hirsutism.

Treatment with antiandrogens is contraindicated in women with a history of thrombosis or embolism. A possible carcinogenic effect, which has so far only been seen in animal experiments, limits long-term therapy. The regression of the unwanted hair growth often takes months to years, in some cases only the progression of the excessive hair growth can be prevented.

Hair growth as a symptom of disease

A careful endocrinological examination should always precede the anti-androgen treatment, because virilizing tumors, Cushing's syndrome, disorders of the thyroid and sugar metabolism and other endocrine disorders can also be responsible for hirsutism. An excess of somatotropin in the clinical picture of acromegaly is also associated with increased hair growth according to the male distribution pattern.

The function of the pituitary-adrenal axis, thyroid gland and ovaries should be carefully checked. The diagnosis includes not only the determination of testosterone and DHEAS levels, but also the relationship between the luteinizing and follicle-stimulating hormone, estradiol and its 3-alpha-glucuronide, somatotropin, steroid hormone-binding globulin and the thyroid hormones. Hirsutism combined with androgenetic alopecia can also be an expression of hyperprolactinemia due to neuroleptics, pituitary adenoma or polycystic ovaries.

If the hirsutism is based on an endocrinological disease, it disappears with its treatment. In the case of a strong androgen excess, as occurs in hormone-producing tumors, hirsutism changes into the clinical picture of virilism. Here there are further signs of masculinization. There are changes in the primary female sexual characteristics such as clitoral hypertrophy and menstrual disorders. In addition, a deeper voice, changed posture and breast shape, psychological changes and loss of libido can occur.