Topical Retinoids and hair loss

Hi everyone.. I've been interested in the research on this forum for a long time - I am happy to find discussions based around scientifically backed articles and people willing to take the time to discuss individual topics/naturals,etc. I'm not sure if I am one of the few females on here or not, but I'd like to take the time to see if anyone else has a similar experience to mine.

So.. My hair loss began as a TE last June (June 2010 - handfuls of hair loss at a time, all with the bulbs attached) and has seemed to progress into a longer lasting CTE with diffuse and sometimes painful hair loss - not usually with visual inflammation. I had a dermatologist do a scalp biopsy in December, closer to the back of my head - result of biopsy: increased hairs in telogen... Not very descriptive.

Looking back, I had begun using moderate topical acne medications which contained various retinoids. In fact, in the past 10 months (wow, has it been that long?) I have used Epiduo, Differin, Duac, and Ziana - in various combinations. I had also begun Epiduo approximately 2-3 months before my handfuls of TE shedding.. And didn't begin to draw a link until recently.
Apparently, the topical retinoids in the medicines (Adapalene in Epiduo&Differin and tretinoin in Ziana) have reportedly led to hair loss in some people, and possibly not via overabsorbtion of topical A, as I suspected, but through means of upregulation of TGF-beta2:

Towards dissecting the pathogenesis of retinoid-induced hair loss: all-trans retinoic acid induces premature hair follicle regression (catagen) by upregulation of transforming growth factor-beta2 in the dermal papilla.

"Abstract
Diffuse hair loss ranks among the most frequent and psychologically most distressing adverse effects of systemic therapy with retinoids, which severely limits their therapeutic use even where clinically desired. Since the underlying mechanisms of retinoid-induced effluvium are as yet unknown, we have investigated the influence of the prototypic retinoid all-trans retinoic acid (ATRA, tretinoin) on the growth of human scalp hair follicles (HF) in culture. HF in the anagen VI stage of the hair cycle were cultured in the presence of 10 ( -8 ) or 10 ( -10 ) M ATRA. Compared with controls, hair shaft elongation declined significantly already after 2 d in the ATRA-treated group, and approximately 80% of the ATRA-treated HF had prematurely entered catagen-like stage at day 6, compared with 30% in the control group. This corresponded to an upregulation of apoptotic and a downregulation of Ki67-positive cells in ATRA-treated HF. Since transforming growth factor (TGF)-beta has been implicated as a key inducer of catagen, we next studied whether ATRA treatment had any effect on follicular expression. TGF-beta2 immunoreactivity was detected in the outer root sheath of anagen VI scalp HF. In catagen follicles, TGF-beta2 was also expressed in the regressing epithelial strand. After 4 d of ATRA treatment, TGF-beta2 was significantly upregulated in anagen HF in the dermal papilla (DP) and the dermal sheath, 7, and TGF-beta neutralizing antibody partially abrogated at RA induced hair growth inhibition. Real-time PCR confirmed a significant upregulation of TGF-beta2 transcripts in ATRA-treated hair bulbs. This study is the first to provide direct evidence that ATRA can indeed induce a catagen-like stage in human HF and suggests that this occurs, at least in part, via upregulation of TGF-beta2 in the DP. Therefore, topical TGF-beta2/TGF-beta receptor II antagonists deserve to be explored for the prevention and management of retinoid-induced hair loss."


My hormones may have been wacky from stress (college graduation, moving to a new state, being close to underweight, too much exercise/soccer), but just want all of your opinions on this - I am wondering if this could have contributed to my very chronic diffuse hair loss and I stopped these topicals a week ago.. I will note if significant improvements come of it.

CS - what are some known internal and/or topical TGF-beta2/TGF-beta receptor II antagonists?

Oct 2010 to February 201I went through very difficult and lengthly family member death, and had two car accidents during this time due to lack of concentration and worry. Once everying was over, I went to the doctor for a check up and amongst other things, asked for Retin A for my skin. 2-1/2 months after my dad's death and approx. 2 months after starting Retin A, l began massive shedding. I was told by my doctor that it could not be the topical retin A so I continued with it. I was told the stress and car accidents were the culprit. In Feb 2011, my hair was thinning even more, so I started weaning off the Retin A reluctantly because I loved what it did for my skin. It is now just over one year since my massive shedding began and two months since stopping retin a and still very thin on top and front (bangs). Not sure if it is growing in properly. Sometimes I can see it, and sometimes I think it looks worse. I am 47 yr. old woman and could be premenaupausal as well. No baldness on either of my parents side. I feel stubble on the top of my head, but still see lots of spaces where there is not hair growing. I was wondering if anyone else experienced something similar. My derm has told me to start rogaine but I do not want to do that yet. It appears from what I have read, that most derms know little about hair loss and throw the "rogaine" solution out there even when it may not warrant it. Anyone have any thoughts or experienced similar?

Yes! It's true just as you suspect.

I've used .025 Retin A for years with no apparent issue, although, perhaps I had some thinning and didn't put it together.

January 2010 a derm increased my dose of Retin A to .1 mg strength. I used a tiny amount, but was told I would get better absorption if I exfoliated beforehand. This was indeed true! Right away I started to feel some scalp pain, but didn't put it together. Bang hairs seemed to shed more with greater loss from the top of my head as well. Sadly, it took me 6 months of intermittent use and escalating hair loss to get the reality- eyes and inside my nose drying out, vision blurry, a depression for no reason....... After jumping off the retin A in July, I got a liver Vit A test two months later- out of range high Vit A levels.

After digging deep for any information or personal stories on Retin A hair loss, I didn't find much, but found that my pattern of loss fit Accutane type loss- male pattern, rapid extravagant thinning, depression, dry mucus membranes, and regrowth that was stunted, kinked and wiry. The huge shedding from the Retin A lasted about 8 months, non-stop, relentless. Nasty, painful loss. My bangs, temples and crown most noticeably hit.

Presently, I have a ratio of 1:5 terminal to stunted shed hairs. The bang area is not good- see through. The prognosis for this type of loss isn't clear at all. We can compare it to Accutane stories- some make it fully back, other's don't. Some people talk about having long term health issues as a result of very brief use. Apparently the effects of Accutane on the follicle's oil gland extend to the digestive track and elsewhere. This is major trouble for some. I can't say I have anything lasting from this internally, but my hair is strange almost a year after going off. It's not 'my hair'. One person's post from going off Accutane said that it took an average of 2 years for most people posting on a hair loss board to return to normal.

My hair shedding as I mentioned, is bizarre. I have extensive kinked, dry and curled hairs. On some terminal hairs these textures are "grafted" at the end of my terminal hairs that correspond to the last year of growth, which is about 6 inches. I look at these hairs and think they look like my old hair, which was fine and bone straight, was grafted to someone else's hair. I still shed a ton of new, short hairs from all over and am inclined to shed hair without much provocation. I use Men's Rogaine Foam 5% and think for sure this has sma. I take a ton of vitamins and polyphenols for the antioxidant effect. Who knows if the "nuked" hair follicles will ever return to healthy or not?!

The question is, Does tretinoin have a permanent effect on the oil gland? One encouraging tidbit I read was that for some on Accutane it took a year for their acne to return.

CF

This is really strange, so Retin-A is actually harmful to hair, because of increasing tgf-b? How come it helped so many people regrow their hair?

Vitamin A (ATRA) was only positive for me. I think the problem with this study and people loosing hair with Tretinoin creams is that they didn't balance it with adequate Vitamin D3 and where also using too strong formulations.