12 leucine-rich repeats and a glycosaminoglycan chain. Decorin is documented to play a pivotal role in hair biology, as studies suggest its ability to modulate cycling and morphogenesis of the hair follicle, as well as acting as an anagen inducer.31,32
Although the hair follicle normally functions as a well-balanced biological system, it can become destabilised due to a range of internal and external factors and stimuli.33 Specifically, high concentrations of cortisol in the body are known to have a damaging effect on proteoglycans in and around the hair follicle.10,18
Treating Stress-Related Hair Loss
Of late, new pharmacological solutions are becoming increasingly recognised as serious treatments for stress-related disorders in the body.
When available, certain corticotropin-releasing hormone receptor antagonists could provide a treatment solution to skin conditions induced or aggravated by stress. However, inhibiting the activation of mast cells is considered a more promising approach in the literature. In this connection only a few clinically available molecules are known to be effective, although recent studies have shown that some flavonols, specifically quercetin, can inhibit both newly synthesised and pre-stored mediators from mast cells in humans.34 One study has already demonstrated synergistic efficacy between such flavonoids and chondroitin sulphate proteoglycans to inhibit both the activation and secretion of mast cells.35
It is further argued in the literature that to treat stress-triggered telogen effluvium, for example, effective pharmacological treatment should entail prolonging the anagen phase of the hair growth cycle.34 Anagen phase prolongation would help prevent the onset of early catagen, which is crucial, as this is the central mechanism of the telogen effluvium condition.
To achieve this effect, a number of approaches exist which range from the traditional to the more alternative. Popular, traditional treatments for hair loss such as applying minoxidil to the scalp, can achieve anagen prolongation via the opening of potassium channels.36
On the other end of the spectrum, alternative therapies such as ‘music listening’ have also been shown to significantly reduce chronic stress levels by measuring the presence of cortisol in the hair.37 Yet as recent research indicates, the presence of certain proteoglycans represent a constant element in a stable, well-functioning hair follicle. Naturally, the relationship between proteoglycans and the hair follicle represents a potential treatment which falls between the traditional and the alternative, and which appears to be both novel and effective.
Producing a viable pharmacological treatment in this connection would require the uptake and distribution of proteoglycans in the body after oral intake, which has been demonstrated in two studies.38,39 Thus, the intake of specific proteoglycans as a ‘proteoglycan replacement therapy’ via oral supplementation is a logical and promising approach to improve the function and cycling of the hair follicle.
Not only has it been shown that versican is able to protect cells from oxidative stress-induced apoptosis, but decorin has also been recognised for its anagen inducing properties.40 According to a recent publication, it was concluded that supplements containing specific bioavailable proteoglycans to revitalise dysfunctional hair follicles have opened a new era on nutritional factors that influence hair loss. In this connection it was recommended that a specific proteoglycan replacement treatment (Nourkrin® with Marilex® from Pharma Medico) containing specific lectican, leucine versican, and decorin, is beneficial as a baseline treatment for all hair loss types. This treatment is recommended both as a prophylactic and a therapy, and especially in connection to stress-related hair loss cases.41,42
Stress can have a detrimental effect on intricate microbiological systems in the body, and especially in relation to the hair follicle. As a response to internal and external stressors, cortisol is released in the body and can eventually build up to excess levels, and studies have demonstrated the ability of cortisol to degrade integral substances in the skin and extracellular matrix, namely hyluronan and proteoglycans.
In this way, excess cortisol is therefore able to exert a disruptive effect on the fine-tuned mechanism of the hair follicle, leading to the development of hair growth disorders such as androgenetic alopecia, alopecia areata and telogen effluvium.
These causal relationships have led to a new focus on developing pharmacological treatments for hair growth disorders based on a proteoglycan replacement methodology. A proteoglycan supplementation replacement treatment (Nourkrin® with Marilex® from Pharma Medico) featuring versican and decorin specifically, can play a pivotal role in the induction and prolongation of the anagen phase of the hair growth cycle. In addition, these lectican and leucine proteoglycans have been demonstrated to protect from stress-induced apoptosis as well as to exert a synergistic effect to inhibit the activation and secretion of mast cells in combination with certain flavonoids.
In fact, a specific proteoglycan replacement therapy3 has been definitively categorised as opening a new era on nutritional factors that influence the Hair Growth Cycle and hair loss. However going forward people suffering from hair growth disorders will still require complex, comprehensive and careful management beyond pharmacological treatment to alleviate clinical symptoms.