Evaluation of a Therapeutic Alternative for Telogen Effluvium: A Pilot Study

Alfredo Rossi, Lara Priolo, Alessandra Iorio, Enrica Vescarelli, Martina Gerardi, Daniele Campo, Donato Di Nunno, Simona Ceccarelli, Stefano Calvieri, Antonio Angeloni, Cinzia Marchese

Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy..
Italian Orthodermic Institute, Rome, Italy.

DOI: 10.4236/jcdsa.2013.33A1002                

Abstract

Background/Aim: Telogen effluvium (TE) is a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase. Nigella sativa (NS) is a dicotyledonous belonging to the Ranunculacae family. It has been shown that its major constituent, tymoquinon (TQ), exerts anti-oxidant and anti-inflammatory effects by inhibiting pro-inflammatory mediators, such as cyclooxygenase and prostaglandin D2. The aim of this study is to evaluate the efficacy of NS essential oil as a potential treatment for TE, a pathology characterized by a significant inflammatory component. Study Design/Methods: Twenty patients affected by TE for this double-blind, placebo controlled and randomized study were enrolled. Ten of these patients were treated with a scalp lotion containing 0.5% NS, daily for 3 months, while the other ten patients were treated with placebo daily for 3 months. Videodermatoscopic analysis (Trichoscan Dermoscope Fotofinder?) and evaluation of three independent dermatologists were performed before treatment (T0), after 3 months of treatment (T3) and at the 6 months follow-up (T6). Results: The results showed a significant improvement in 70% of patients treated with NS. Videodermatoscopic analysis showed a significant increment of hair density and hair thickness in patients treated with NS. NS was also able to reduce the inflammation observed in the majority of patients affected by TE. Conclusions: The results of this study suggest that NS can be considered potentially useful for the treatment of TE.

Keywords

Telogen Effluvium; Nigella sativa; Hair Density; Hair Thickness

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. M. Kligman, “Pathologic Dynamics of Human Hair Loss: Telogen Effluvium,” Archives of Dermatology, Vol. 83, 1961, pp. 175-198. doi:10.1001/archderm.1961.01580080005001
[2]	J. T. Headington, “Telogen Effluvium,” Archives of Dermatology, Vol. 129, No. 3, 1993, pp. 356-363. doi:10.1001/archderm.1993.01680240096017
[3]	A. Rebora, “Telogen Effluvium: An Etiopathogenetic Theory,” International Journal of Dermatology, Vol. 32, No. 5, 1993, pp. 339-340. doi:10.1111/j.1365-4362.1993.tb01468.x
[4]	D. Whiting, S. F. Templeton and A. R. Solomon, “Disorders of Cutaneous Appendages,” In: R. L. Barnhill, Ed., Textbook of Dermatopathology, McGraw-Hill, New York, 1998, pp. 201-223.
[5]	G. Eudy and A. R. Solomon, “The Histopathology of Noncicatricial Alopecia,” Seminars in Cutaneous Medicine and Surgery, Vol. 25, No. 1, 2006, pp. 35-40. doi:10.1016/j.sder.2006.01.005
[6]	D. A. Whiting, “Chronic Telogen Effluvium: Increased Scalp Hair Shedding in Middle Aged Women,” Journal of the American Academy of Dermatology, Vol. 35, No. 6, 1996, pp. 899-906. doi:10.1016/S0190-9622(96)90113-9
[7]	P. C. Arck, A. Slominski, T. C. Theoharides, E. M. Peters and R. Paus, “Neuroimmunology of Stress: Skin Takes Center Stage,” Journal of Investigative Dermatology, Vol. 126, No. 8, 2006, pp. 1697-1704. doi:10.1038/sj.jid.5700104
[8]	N. Ito, T. Ito, A. Kromminga, A. Bettermann, M. Takigawa, F. Kees, R. H. Straub and R. Paus, “Human Hair Follicles Display a Functional Equivalent of the Hypothalamic-Pituitaryadrenal Axis and Synthesize Cortisol,” FASEB Journal, Vol. 19, No. 10, 2005, pp. 1332-1334.
[9]	E. M. Peters, P. C. Arck and R. Paus, “Hair Growth Inhibition by Psychoemotional Stress: A Mouse Model for Neural Mechanisms in Hair Growth Control,” Experimental Dermatology, Vol. 15, No. 15, 2006, pp. 1-13. doi:10.1111/j.0906-6705.2005.00372.x
[10]	A. Slominski, J. Wortsman, A. Pisarchik, B. Zbytek, E. A. Linton, J. E. Mazurkiewicz and E. T. Wei, “Cutaneous Expression of Corticotropin-Releasing Hormone (CRH), Urocortin, and CRH Receptors,” FASEB Journal, Vol. 15, No. 10, 2001, pp. 1678-1693. doi:10.1096/fj.00-0850rev
[11]	X. Zhang, M. Yu, W. Yu, J. Weinberg, J. Shapiro and K. J. McElwee, “Development of Alopecia Areata is Associated with Higher Central and Peripheral Hypothalamicpituitary-Adrenal Tone in the Skin Graft Induced C3H/HeJ Mouse Model,” Journal of Investigative Dermatology, Vol. 129, No. 6, 2009, pp. 1527-1538. doi:10.1038/jid.2008.371
[12]	M. Baldari, M. Montinari, M. Guarrera and A. Rebora, “Trichodynia is a Distinguishing Symptom of Telogen Effluvium,” Journal of the European Academy of Dermatology and Venereology, Vol. 23, No. 6, 2009, pp. 733-734. doi:10.1111/j.1468-3083.2009.03201.x
[13]	Y. Q. Cao, P. W. Mantyh, E. J. Carlson, A. M. Gillespie, C. J. Epstein and A. I. Basbaum, “Primary Afferent Tachykinins Are Required to Experience Moderate to Intense Pain,” Nature, Vol. 392, No. 6674, 1998, pp. 390-394. doi:10.1038/32897
[14]	R. Amann, R. Schuligoi, P. Holzer and J. Donnerer, “The Non-Peptide NK1 Receptor Antagonist SR140333 Produces Long-Lasting Inhibition of Neurogenic Inflammation, But Does Not Influence Acute Chemoor Thermonociception in Rats,” Naunyn-Schmiedeberg’s Archives of Pharmacology, Vol. 352, No. 2, 1995, pp. 201-205. doi:10.1007/BF00176775
[15]	Y. Akasaka, K. Abe, T. Sato and H. Inoue, “Regulation of Neurokinin-1 Receptor Messenger RNA Expression in Synovial Fibroblasts of Patients with Rheumatoid Arthritis,” Neuropeptides, Vol. 39, No. 5, 2005, pp. 467-474. doi:10.1016/j.npep.2005.07.005
[16]	S. Simeonidis, I. Castagliuolo, A. Pan, J. Liu, C. C. Wang, A. Mykoniatis, A. Pasha, L. Valenick, S. Sougioultzis, D. Zhao and C. Pothoulakis, “Regulation of the NK-1 Receptor Gene Expression in Human Macrophage Cells via an NF-Kappa B Site on Its Promoter,” Proceedings of the National Academy of Sciences of the United States of America, Vol. 100, No. 5, 2003, pp. 2957-2962. doi:10.1073/pnas.0530112100
[17]	P. C. Arck, B. Handjiski, E. Hagen, R. Joachim, B. F. Klapp and R. Paus, “Indications for a ‘Brain-Hair Follicle Axis (BHA)’: Inhibition of Keratinocyte Proliferation and Up-Regulation of Keratinocyte Apoptosis in Telogen Hair Follicles by Stress and Substance P,” The EMBO Journal, Vol. 5, No. 13, 2001, pp. 2536-2538.
[18]	R. Ruckert, G. Lindner, S. Bulfone-Paus and R. Paus, “High-Dose Proinflammatory Cytokines Induce Apoptosis of Hair Bulb Keratinocytes in Vivo,” British Journal of Dermatology, Vol. 143, No. 5, 2000, pp. 1036-1039. doi:10.1046/j.1365-2133.2000.03784.x
[19]	H. Gali-Muhtasib, A. Roessner and R. Schneider-Stock, “Thymoquinone: A Promising Anti-Cancer Drug from Natural Sources,” International Journal of Biochemistry and Cell Biology, Vol. 38, No. 8, 2006, pp. 1249-1253. doi:10.1016/j.biocel.2005.10.009
[20]	D. R. Worthen, O. A. Ghosheh and P. A. Crooks, “The in vitro Anti-Tumor Activity of Some Crude and Purified Compounds of Black Seed, Nigella sativa L,” Anticancer Research, Vol. 18, No. 3A, 1998, pp. 1527-1532.
[21]	F. M. Al-Awadi and K. A. Gumma, “Studies on the Activity of Individual Plants of an Antidiabetic Plant Mixture,” Acta Diabetologica Latina, Vol. 24, No. 1, 1987, pp. 37-41. doi:10.1007/BF02732051
[22]	B. H. Ali and G. Blunden, “Pharmacological and Toxicological Properties of Nigella sativa,” Phytotherapy Research, Vol. 17, No. 1, 2003, pp. 299-305. doi:10.1002/ptr.1309
[23]	A. Mohamed, D. M. Afridi, O. Garani and M. Tucci, “Thymoquinone Inhibits the Activation of NF-kB in the Brain and Spinal Cord of Experimentally Autoimmune Encephalomyelitis,” Biomedical Sciences Instrumentation, Vol. 41, 2005, pp. 388-393.
[24]	L. A. Garza, Y. Liu, Z. Yang, B. Alagesan, J. A. Lawson, S. M. Norberg, D. E. Loy, T. Zhao, H. B. Blatt, D. C. Stanton, L. Carrasco, G. Ahluwalia, S. M. Fischer, G. A. FitzGerald and G. Cotsarelis, “Prostaglandin D2 Inhibits Hair Growth and Is Elevated in Bald Scalp of Men with Androgenetic Alopecia,” Science Translational Medicine, Vol. 4, No. 126, 2012, pp. 126-134.
[25]	R. P. Hill, J. W. Haycock and C. A. Jahoda, “Human Hair Follicle Dermal Cells and Skin Fibroblasts Show Differential Activation of NF-κB in Response to Pro-Inflammatory Challenge,” Experimental Dermatology, Vol. 21, No. 2, 2012, pp. 158-160. doi:10.1111/j.1600-0625.2011.01401.x
[26]	J. H. Han, O. S. Kwon, J. H. Chung, K. H. Cho, H. C. Eun and K. H. Kim, “Effect of Minoxidil on Profileration and Apoptosis in Dermal Papilla Cells of Human Hair Follicle,” Journal of Dermatological Science, Vol. 34, No. 2, 2004, pp. 91-98. doi:10.1016/j.jdermsci.2004.01.002
[27]	E. S. Friedman, P. M. Friedman, D. E. Cohen and K. Washenik, “Allergic Contact Dermatitis to Topical Minoxidil Solution: Etiology and Treatment,” Journal of the American Academy of Dermatology, Vol. 46, No. 2, 2002, pp. 309-312. doi:10.1067/mjd.2002.119104
[28]	D. E. Cohen, “New Vehicles for Delivery of Drugs to the Scalp,” Dermatology Focus, Vol. 25, No. 2, 2006, pp. 2-3.
[29]	A. G. Messenger and J. Rundegren, “Minoxidil: Mechanisms of Action on Hair Growth,” British Journal of Dermatology, Vol. 150, No. 2, 2004, pp. 186-194. doi:10.1111/j.1365-2133.2004.05785.x
[30]	E. S. El Daly, “Protective Effect of Cysteine and Vitamin E, Crocus sativus and Nigella sativa Extracts on Cisplatininduced Toxicity in Rats,” Journal de Pharmacie de Belgique, Vol. 53, No. 2, 1998, pp. 87-95.
[31]	T. Khanna, F. A. Zaidi and P. C. Dandiya, “CNS and Analgesic Studies on Nigella sativa,” Fitoterapia, Vol. 5, No. 1, 1993, pp. 407-410.
[32]	F. Vaillancourt, P. Silva, Q. Shi, H. Fahmi, J. C. Fernandes and M. Benderdour, “Elucidation of Molecular Mechanisms Underlying the Protective Effects of Thymoquinone against Rheumatoid Arthritis,” Journal of Cellular Biochemistry, Vol. 112, No. 1, 2011, pp. 107-117. doi:10.1002/jcb.22884
[33]	R. El Mezayen, M. El Gazzar, M. R. Nicolls, J. C. Marecki, S. C. Dreskin and H. Nomiyama, “Effect of Thymoquinone on Cyclooxygenase Expression and Prostaglandin Production in a Mouse Model of Allergic Airway Inflammation,” Immunology Letters, Vol. 106, No. 1, 2006, pp. 72-81. doi:10.1016/j.imlet.2006.04.012
[34]	N. Chehl, G. Chipitsyna, Q. Gong, C. J. Yeo and H. A. Arafat, “Antiinflammatory Effects of the Nigella sativa Seed Extract, Thymoquinone, in Pancreatic Cancer Cells,” The Official Journal of the International Hepato Pancreato Biliary Association (Oxford), Vol. 11, No. 5, 2009, pp. 373-381.
[35]	C. Deloche, O. de Lacharrière, C. Misciali, B. M. Piraccini, C. Vincenzi, P. Bastien, I. Tardy, B. A. Bernard and A. Tosti, “Histological Features of Peripilar Signs Associated with Androgenetic Alopecia,” Archives of Dermatological Research, Vol. 295, No. 10, 2004, pp. 422-428. doi:10.1007/s00403-003-0447-y
[36]	A. Steinmann, M. Schatzle, M. Agathos and R. Breit, “Allergic Contact Dermatitis from Black Cumin (Nigella sativa) oil after topical use,” Contact Dermatitis, Vol. 36, No. 5, 1997, pp. 268-269. doi:10.1111/j.1600-0536.1997.tb00219.x
[37]	S. Zedlitz, R. Kaufmann and W. H. Boehncke, “Allergic Contact Dermatitis from Black Cumin (Nigella sativa) Oil-Containing Ointment,” Contact Dermatitis, Vol. 46, No. 3, 2002, pp. 188. doi:10.1034/j.1600-0536.2002.460318.x
[38]	M. Yousefi, B. Barikbin, M. Kamalinejad, E. Abolhasani, A. Ebadi, S. Younespour, M. Manouchehrian and S. Hejazi, “Comparison of Therapeutic Effect of Topical Nigella with Betamethasone and Eucerin in Hand Eczema,” Journal of the European Academy of Dermatology and Venereology, 2012, in Press. doi:10.1111/jdv.12033