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Thread: My early-stage Rhinophyma please help, please

  1. #21
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    In case link does not work:


    TOPICAL SPIRONOLACTONE IN THE TREATMENT OF ALOPECIA
    AND INSTRUCTIONS FOR USE


    ODORLESS 5% SPIRONOLACTONE LOTION NOW AVAILABLE



    It’s been firmly established that alopecia. androgenetica, more commonly known as male pattern baldness or just pattern baldness, is initiated by dihydrotestosterone (DHT) attaching to the receptor sites on the hair follicles [1.2.3.4.].

    Genetically, only the follicles on the top of the scalp are encoded with the receptor sites [5.6.24.], which explains why hair follicles along the side of the head and in the back of the head do not atrophy. The attached DHT on the receptor sites is perceived as a foreign body and the immune system begins to destroy the hair follicle, shortening the growth phase and causing the hair shaft to become progressively finer in texture [6]. In extreme cases, only a microscopic vellus hair remains. The good news is that these follicles have the inherent capacity to mature to their former size and thickness.

    Encouraged with the success of finasteride to reduce the amount of DHT in the scalp of patients with male pattern baldness (MPB), doctors and scientific researchers took another look at existing medications that are known to act as anti-androgens.

    There have to be stringent criteria for an anti-androgen that can be used to combat or even reverse pattern alopecia.

    The ideal anti-androgen should have the following properties:

    (1) It must have potent anti-androgen activity; (2) It should selectively prevent or successfully compete with DHT without changing testosterone levels; (3) It should be effective topically, so it can be conveniently applied with minoxidil solutions or lotions and (4), It should be easily absorbed into the skin, but should have no systemic effects where it is not applied.

    That’s a tall order. Surprisingly, there is such a medication: spironolactone. And it’s not a new medication [7.8.]. For over thirty years spironolactone has been used for its anti-androgenic effects in both males and females [14.15.]. Taken orally, it is such a potent anti-androgen that, although it is an effective anti-hypertensive drug, it is rarely used to treat men with hypertension because of its feminizing properties which can include painful gynecomastia [16.17.].

    Applied topically, however, spironolactone does not have systemic side effects [12.18.19.20.]. Clinical evaluators of topical applications of spironolactone concluded, "as far as the topical use is concerned, spironolactone seems to be highly effective with absence of systemic effects"[19]. Physicians have been treating patients for MPB for well over fifteen years and there have not been any reports of systemic side effects. In my own research, the use of topical 5% spironolactone along with Xandrox 5% solution yielded improved results as compared to the use of Xandrox 5% alone. Likewise, the combination of 5% spironolactone with Regrowth's 5% minoxidil yielded improved results as compared to the use of 5% minoxidil used with daily 1 mg doses of finasteride (with the added advantage of zero side effects).

    Among its other properties as an anti-androgen, spironolactone is a potent competitive inhibitor of DHT at its receptor sites [21]. Therefore, spironolactone effectively prevents DHT from attaching to the receptor sites on the hair follicles [22].

    As a result, the follicles no longer atrophy and can mature again to their normal size. And it does so without decreasing the circulating levels of DHT in the body. By comparison, finasteride inhibits the formation of DHT, causing troublesome side effects in many patients.

    Multiple studies in various medical centers document that spironolactone is effective when applied topically [22].

    In studying the anti-androgenic effects of topical spironolactone at the Department of Dermatology at New York University School of Medicine, researchers established that spironolactone concentrations of 0.01% to 5% produced a dose responsive decrease [23]. When both topical 5% spironolactone and topical 5% minoxidil are used daily in the treatment of MPB, the effects of the medications are synergistic. Whereas neither medication alone is particularly effective for the majority of patients, the success of the combination has been experimentally proven. Our own success rate with this formulation has been approximately 75-80%.

    Our extensive R&D have finally produced a spironolactone lotion which almost totally eliminates the inherent disagreeable smell of spironolactone. In addition to the 5% concentration of spironolactone in the lotion, there are small (1 to 3 mm) vesicular pockets of pure, unsuspended micronized spironolactone powder. This should be spread onto the scalp with one's fingertips to optimize the effects of the application.

    Do not combine medications containing spironolactone and minoxidil in the same container. The medications slowly react with each other, resulting in a compromise of their pharmacological activities. However, since it requires many hours for spironolactone and minoxidil to chemically react with each other, they can be consecutively applied to the scalp without compromising each other.

    Regrowth's 5% Spironolactone Lotion has a shelf life of more than 18 months when kept at normal room temperatures.



    Bibliography



    1. Hamilton JB: Male hormone stimulation is prerequisite and an incitant in common baldness. Am J Anat 71:451-480, 1942

    2. Rattner H: Ordinary baldness. Arch Dermatol Syph 44:201-213, 1941

    3. Rook A, Dawber R: Diseases of the Hair and Scalp. Oxford, Blackwell Scientific Publications, 1982

    4. Baden HP: Diseases of the Hair and Nails. Chicago, Year Book Medical Publishers, 1987

    5. Lattanand A, Johnson WC: Male pattern alopecia: A histopathologic and histochemical study. J Cutan Pathol 2:58-70, 1975

    6. Blauer M, Vaalasti A, Pauli SL, Ylikomi T, Joensuu T, Tuohimaa P: Location of androgen receptor in human skin. J Invest Dermatol 97:264-268, 1991

    7. Menard RH, Stripp B, Gillette JR: Spironolactone and testicular cytochrome P-450: Decreased testosterone formation in several species and changes in hepatic drug metabolism. Endocrinology 1974;94:1628-1636

    8. Menard RH, Martin HF, Stripp B, et al: Spironolactone and cytochrome P-450: Impairment of steroid hydroxylation in the adrenal cortex. Life Sci 1975;15:1639-1648

    9. Schapiro G and Evron S. A novel use of Spironolactone:treatment of hirsutism. J Clin Endocrinol Metab. 1988;51:429-432

    10. Cumming D, Yang J, Rebar R, Yen S.: Treatment of hirsutism with Spironolactone. JAMA. 1982;247:1295-8.

    11. Boiselle A, Tremblay RR: Clinical usefulness of spironolactone in the treatment of acne and hirsutism, abstracted. Clin Res 1978;26:840A

    12. Yamamoto A, Ito M. Topical spironolactone reduces sebum secretion rates in young adults. J Dermatol, 1996 Apr,23:4,243-6

    13. Berardesca E, Gabba P, Ucci G, Borroni G, Rabbiosi G: Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris. Int J Tissue React 10:115-119, 1988

    14. Burke BM, Cunliffe WJ: Oral spironolactone therapy for female patients with acne, hirsutism or androgenetic alopecia. Br J Dermatol 112:124-125, 1985

    15. Stripp B, Taylor AA, Bartter FC, et al: Effect of spironolactone on sex hormones in man. J Clin Endocrinol Metabol 1975;41:777-781

    16. Mann NM: Gynecomastia during therapy with spironolactone. JAMA 190:160-162,1963

    17. Rose LI, Underwood RH, Newmark SR, Kisch ES, Williams GH: Pathophysiology of spironolactone-induced gynecomastia. Ann Int Med 87:398-403, 1977

    18. Corval P, Michaued A, Menard J, et al: Antiandrogenic effect of spironolactones: Mechanism of action.

    Endocrinology 1975;97:52-8

    19. Messina M, Manieri C, Musso MC, Pastorino R.: Oral and topical spironolactone therapies in skin androgenization. anminerva Med, 1990 Apr-Jun,32:2,49-55

    20. Wendt A, Hasan SH, Heinz I, Tauber U: Systemic effects of local antiandrogen therapy. Arch Dermatol Res 273:171,1982

    21. Price VH: Testosterone metabolism in the skin: A review of its function in androgenetic alopecia, acne vulgaris, and idiopathic hirsutism including recent studies with antiandrogens. Arch Dermatol 1975;111:1496-1502

    22. Stoughton RB: Penetration of drugs through the skin. Dermatologica 152 (suppl): 27-36, 1976

    23. Matias JR, Malloy V, Orentreich N: Synergistic antiandrogenic effects of topical combinations of 5 alpha reductase and androgen receptor inhibitors in the hamster sebaceous glands. J Invest Dermatol 91:429-433, 1988

    24. Takayasu S, Wakimoto H, Itami S, Sano S: Activity of testosterone 5 alpha-reductase in various tissues of human skin. J Invest Dermatol 74:187-191,1980

    25. Sawaya ME, Hoenig LS, Hsia SL: Increased androgen binding capacity in sebaceous glands in scalp of male pattern baldness. J Invest Dermatol 92:91-95, 1988, Martin HF, Stripp B, et al: SpiroH

  2. #22
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    Thanks for all of your info irishgenes. A big dilemma that I have now is that I know I'm 20 years old and completely understand that PREVENTION is the key to fighting this thing. But i still do not know how to go about preventing my early stage rhinophyma. Photodynamic therapy may not even work because it takes so many treatments to maybe get results, that's not promising. I see that I produce an abnormal amount of oil w/ painful cysts, hundreds of blackheads. I seem to have a good chance of developing advanced rhinophyma. There has to be something I can do to def put a hault to this besides accutane.
    I am very depressed about this. I just want to help my situation. Any suggestions guys?? Would a pulsed dye laser close the sebacious glands pemanently?
    **What are the ways/best way to FIBROSIS the glands shut??? Thanks.

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    I'm stupid, I didn't even see the last couple posts because I didn't go to the second page. Thankyou Dr. Nase for the info, I appreciate it. Thankyou again irishgenes. -Chris

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    Hey, ok I just read the entire passage on the Beta-Sitosterol. Do you really think this would work for my acne? And so I don't have a testosterone problem..I have a DHT problem and this will be 3000 times stronger than the saw plametto I'm currently on in order to stop sebum production and the conversion of testosterone to DHT?? I wonder if it can truly help rhinophyma too? I'm going to purchase the Beta-Sitosterol, do you think it's safe? The thing I always worry about with everything is infertility. Whenever hormones and medications are mentioned I worry about that the most for some reason.

    Thanks so much Dr. Nase and Irishgenes, I am very grateful for your care and concern. -Chris

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    Beta-Sitosterol is not going to cause infertility, Chris! There's no way to know if you have too much tetosterone without doing a blood test, but usually men (and women) with acne and hair loss problems either convert too much testosterone into the bad DHT or their sebaceous glands and hair follicles just react badly to DHT. Beta-sitosterol should be much more effective at lowering DHT and thus sebum than saw palmetto, though I'm not sure if 3000X is hype or not. I went out and bought some Source Naturals Beta-Sitosterol at my local health food store a couple of days ago. It was $12 for 60 pills, and I guess I'll start off with one AM & PM. The Beta-Sitosterol is 375 mg., but it also has 187 mg. campesterol and 131 mg. stigmasterol included. The label says "Phytosterols are natural components of many vegetables and grains. Preliminary scientific evidence suggests that plant phytosterols may help to support cholesterol wellness.." That's an added benefit I hadn't known about. Says it is "natural, safe, derived entirely from plant sources", but women who are pregnant or nursing should consult a physician before taking. It's worth trying, Chris, and if it doesn't work and you get really desperate, there's always the Danazol.

    Dr. Nase, I also bought the ketoconazole shampoo, but am concerned about the spironolactone shampoo you mentioned having 50% alcohol. I wouldn't think that would be good for rosacea skin. I wonder if I could just get a spironolactone pill and grind it up, then put it in regular shampoo or the ketoconazole shampoo.

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    Thanks irishgenes, I'll look for it in my drug store and let you know what brand. Maybe I also didn't give teh saw plametto enough time, I was on it for about 3 weeks. I guess I just thought it should instantly work but maybe it takes months like zinc gluconate does?? Do you know ifit's ok to take this, being an herb, with my doxycycline. Or can I at least take it with my zinc gluconate and omega 3,6, 9 supplement, and I also have started to take acidophilus to grow good bacteria cause of the antibiotics. I seem to try to take everything apart so they don't cancel each other out, but it's too many pills to do that.

    And back to rhinophyma, I just wnated to know if you anything about using teh lumenis one for thsi and what it can potentially do. How do I help direct my laser physician in the technique for doing this? Thanks irishgenes, it's always appreciated. -Chris

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    You gave the saw palmetto long enough. I'd give up on it now and try the beta sitosterol, which is stronger. I don't know if it will be in drugstores, as I don't think it is well-known yet. If you can't find it there, it will be in health food stores. Yes, it is OK to take it with doxycycline and the other supplements you are taking. I am taking doxycycline, too, but only 25 mg. AM & PM. Taken at that level, it does not act as an antibiotic, just as an anti-inflammatory, and thus I don't have to worry about adding probiotics like acidophilus. Maybe you are taking a higher dose for some reason?

    I don't know much about IPL, so you'll have to ask others about that. I looked into getting IPL locally and could find no one who seemed knowledgeable, so I am holding off on that for now until I can find a good doctor on my side of the country.

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    Irish are you taking doxycycline??? you told us you were taking accutane last week, you cannot mix doxycycline and accutane, so you have to wait 1-2 months before you start on doxy

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    No, I took Accutane for only two days a month ago, and it was just a drop out of a 40 mg. capsule. I then remembered that mixing doxycycline with Accutane was a big no-no and quit taking the Accutane. I am still alive a month later, so no harm done. I may go back to ultra low dose Accutane someday, but right now I'm just going to try the beta sitosterol to control sebum. Reading the list of side effects for Accutane makes me nervous.

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    Quote Originally Posted by irishgenes
    Beta-Sitosterol is not going to cause infertility, Chris! There's no way to know if you have too much tetosterone without doing a blood test, but usually men (and women) with acne and hair loss problems either convert too much testosterone into the bad DHT or their sebaceous glands and hair follicles just react badly to DHT. Beta-sitosterol should be much more effective at lowering DHT and thus sebum than saw palmetto, though I'm not sure if 3000X is hype or not. I went out and bought some Source Naturals Beta-Sitosterol at my local health food store a couple of days ago. It was $12 for 60 pills, and I guess I'll start off with one AM & PM. The Beta-Sitosterol is 375 mg., but it also has 187 mg. campesterol and 131 mg. stigmasterol included. The label says "Phytosterols are natural components of many vegetables and grains. Preliminary scientific evidence suggests that plant phytosterols may help to support cholesterol wellness.." That's an added benefit I hadn't known about. Says it is "natural, safe, derived entirely from plant sources", but women who are pregnant or nursing should consult a physician before taking. It's worth trying, Chris, and if it doesn't work and you get really desperate, there's always the Danazol.

    Dr. Nase, I also bought the ketoconazole shampoo, but am concerned about the spironolactone shampoo you mentioned having 50% alcohol. I wouldn't think that would be good for rosacea skin. I wonder if I could just get a spironolactone pill and grind it up, then put it in regular shampoo or the ketoconazole shampoo.

    IrishGenes,

    This type of cosmetic alcohol will be applied directly to your scalp and most will evaporate. Some will enter the blood stream, but it should not cause an "alcohol-induced flush" or irritate the facial skin.

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