Acquired Localized Hypertrichosis

Years ago, when I first heard about wounding induced hair growth, I was not entirely surprised. We have read numerous examples of older men re-growing hair (after accidents and injuries) in areas of the scalp that had been bald for decades. My favorite example is of the below 78-year old man who accidentally fell into a fire, burnt his scalp, and got hair growth in return.

“Although interesting, it is difficult to see how this type of stimulation could be applied therapeutically”.

Scalp Burning Hair Regeneration
Hair growth after a burn injury.

Hair Growth After Cast Removal

My recent update on Follica made me think about the interesting phenomenon of hair growth after cast use. Many people who get arm or leg injuries have to use a plaster cast for several months. Upon removal of the cast, some people report a significant increase in the underlying body hair (i.e., hypertrichosis).

Today, I checked to see if there were any studies that discuss this unusual side effect from cast use. Lo and behold, I found some interesting ones with pretty extraordinary before and after photos. The below one is from a study from China titled: “Acquired Localized Hypertrichosis Induced by Internal Fixation and Plaster Cast Application”. The hands belong to a 15-year old boy who had to get a surgery and use a cast after a fracture.

The hair growth image in the actual study above is clearer, since I had to optimize the below image. The surprising thing is that this person has absolutely no hair at the back of the left hand. i.e., this is not just existing body hair becoming thicker. This is “new” hair growth after 6 weeks of cast use on the injured right hand. Kind of like Follica’s “de novo” hair creation concept. The new hair disappeared 4 months after the cast was removed.

Hair Growth After Cast Removal
Acquired localized hypertrichosis (ALH) after cast removal. Source: Annals of Dermatology.

Acquired Localized Hypertrichosis

It is not surprising that prolonged friction and enclosure from a plaster cast could make existing hair grow thicker. However, the creation of new hair is very unexpected. Yet another example below from Hong Kong shows hair growth on the right leg of a 28-month old child. That leg had been in a cast for 6 weeks after a fracture. Note that lack of any body hair on the left leg.

Localized Hypertrichosis
Localized hypertrichosis after cast removal. Source: Hong Kong Medical Journal.

Per the authors of the first study that I discussed above, the acquired localized hypertrichosis (ALH) results from: “chronic irritation, inflammation, friction, and occlusion” by the plaster of Paris cast.

And yet another example from Hong Kong is even more striking. This time on the left forearm (of a 16-year old boy) that had been in a splint. Note again that there is no body hair at all on the right forearm. i.e., this person does not normally have hair on any arm.

Hair Growth after Splint
Hair Growth after Splint. Source: Case Reports in Pediatrics.

If I only found examples of thicker hair growth, I would not have written this post. However, all three examples that I presented above show brand new localized hair growth.

Although this post is not exactly related to wounding, I can’t help but think of the following quote from Follica:

“Following skin disruption, cells that migrate to help healing are forced to make a decision: Should I make epidermis, or should I make a hair?

Of course none of us would ever be indecisive given such a choice.

Jason Bhardwaj and Peter Diamandis

Summary of Jason Bhardwaj’s video at the bottom of this post:

  • Follica FDA approval targeted for 2023.
  • Seems like Phase 3 trials should start shortly. They were supposed to start in 2019-2020, but got delayed.
  • 6 brief in-office treatments.
  • Cost = $3,000.
  • 75% chance of strong hair growth effect. 25% chance of modest effect.

Follica

Of all the companies that I have covered on this blog, Follica (majority owned by PureTech) is by far the most frustrating. The company was founded in 2005 and its CEO is Jason Bhardwaj. I have covered Follica regularly since this blog was incepted in August 2013.

Regular readers (and myself) expected Phase 3 clinical trials of Follica’s drug-device to have been completed at least 2-3 years ago. Yet here we are in 2022, getting a poster instead. The company’s invention (a scalp wounding device) is relatively straightforward in concept.

The purposeful scalp wounding and injury phenomenon has been proven to grow hair in numerous studies (see my post on at-home microneedling). Not entirely surprising, since even friction from long-term cast use has often grown hair in people.

Follica’s device is unlikely to require any kind of hurdles in being approved by the US FDA, as the potential for side effects seems negligible. Moreover, all signs are that the company will initially only use Minoxidil in combination with the device. Minoxidil was already approved by the FDA to treat male pattern hair loss in 1988. In fact, people are now increasingly taking off-label oral Minoxidil to treat their hair loss.

Jason Bhardwaj Presentation

Yet I keep covering Follica and giving them the benefit of doubt. Future hair cloning and hair multiplication related hair loss cures will always have the potential of major side effects. Not to mention major cost in the initial years. New medications will also be met with some trepidation when in comes to long-term side effects. In contrast, wounding related side effects will most likely be limited to minor scalp bleeding. And some scalp skin deterioration in the worst cases.

Recently, I discovered the below (see bottom of post) video presentation from Follica CEO Jason Bhardwaj. It is on Peter Diamandis’s YouTube channel. The presentation happened fairly recently and it is the first time that I have seen Mr. Bhardwaj talk. I am assuming that Mr. Diamandis arranged the conference where the below video was filmed.

Peter Diamandis Needs my Money

A funny story. In 2008, I flew across the country to attend the Singularity Summit (initiated by Ray Kurzweil) in San Jose, California. After the event was over, one of the younger guys that I befriended invited me to a mini-conference and dinner that he was organizing in a large private room in a restaurant.

Little did I know that just 20 or so people would be in that room. As soon as I entered, Mr. Peter Diamandis (at the head of the table ) approached me and shook my hand vigorously and gave me a huge smile. Within a few minutes, it became clear to me that this was a major donor meeting based on Mr. Diamandis’ intro. I was totally out of place with my lower middle class living standard.

I immediately left the restaurant after telling my organizer friend that I knew no-one in the room. Even he seemed a bit uncertain and had the deer-in-headlights look after witnessing the list of accomplished attendees. To this day, I have no idea why he invited me in the first place.

Having said that, Mr. Diamandis is known as Mr. Optimism. He is always smiling and overly optimistic about everything. You never read or hear even one pessimistic statement from him on Twitter or in his numerous YouTube video appearances.