Pattern hair loss does not generally involve the abrupt transition of shedding of terminal hair to no hair.

      Instead, Androgenetic Alopecia (AGA) manifests as a gradual and progressive miniaturization of, and decrease of, hair shaft diameter and reduced Anagen (growth) phases of hair over time. Assessing effects of treatments on hair shaft diameter are an often used and legitimate way to gauge the effectiveness of treatments in the short term. Longer term treatment efficacy evaluation typically involves the use of hair counts via various means.

      2% Nizoral Shampoo has long been a cornerstone of our treatment protocol, and rightfully so. Nizoral Shampoo, though technically approved as a treatment for dandruff, addresses several mechanisms related to AGA, and has been documented in several studies to be of significant benefit.

      The group of researchers from Belgium, who principally conducted the studies on hair loss, evaluated a relatively new anti-dandruff ingredient, Piroctone Olamine, (P.O.), and compared its effects on the AGA induced hair shaft miniaturization to both Nizoral and Head and Shoulders shampoo.

Here’s an abstract of the study:

Int J Cosmet Sci. 2002 Oct; 24(5):249-56.

Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations.

Pirard-Franchimont C, Goffin V, Henry F, Uhoda I, Braham C, Pirard GE.

      Department of Dermatopathology, University Medical Center Sart Tilman, B-4000 Lige, Belgium.

      Hair shedding and hair thinning have been reported to be affected by dandruff and seborrhoeic dermatitis. The present study was conducted in 150 men presenting with telogen effluvium related to androgenic alopecia associated with dandruff. They were randomly allocated to three groups receiving each one of the three shampoos in the market containing either 1% ketoconazole (KTZ), 1% piroctone olamine (PTO) or 1% zinc pyrithione (ZPT). Shampoos had to be used 2-3 times a week for 6 months. Hair shedding during shampoo was evaluated semiquantitatively. Hair density on the vertex was evaluated on photographs using a Dermaphot. Trichograms were used for determining the anagen hair percentage and the mean proximal hair shaft diameter using computerized image analysis. The sebum excretion rate (SER, mug cm(-2) h(-1)) was also measured using a Sebumeter((R)). The three treatments cleared pruritus and dandruff rapidly. At end point, hair density was unchanged, although hair shedding was decreased (KTZ: -17.3%, PTO: -16.5%, ZPT: -10.1%) and the anagen hair percentage was increased (KTZ: 4.9%, PTO: 7.9%, ZPT: 6.8%). The effect on the mean hair shaft diameter was contrasted between the three groups of volunteers (KTZ: 5.4%, PTO: 7.7%, ZPT: -2.2%). In conclusion, telogen effluvium was controlled by KTZ, PTO and ZPT shampoos at 1% concentration. In addition, KTZ and PTO increased the mean hair shaft thickness while discretely decreasing the sebum output at the skin surface.

      Piroctone Olamine(PTO) outperformed Nizoral (KTZ) and Head and Shoulders((ZPT) in its ability to increase hair shaft diameter in AGA. Both Nizoral and PTO also reduced sebum emission, demonstrating an anti-androgenic effect. 

      The implication of this study is that P.O. shampoo, used 2-3 times weekly will likely provide even more of a benefit to treating hormonal hair loss than Nizoral shampoo. This is exciting news given Nizoral’s proven track record.

      The problem is, at least for those who live in the U.S. and Canada, is that of this writing, there are no P.O. base shampoos commercially available in the U.S. or Canada. Fortunately there are P.O. based shampoos available in Europe and Mexico.

      The Mexican version of P.O. shampoo, which is sold under the name Follicure para Caspa; (for dandruff) is user friendly, lathers easier, and is not as drying to the hair as either 1% or 2% Nizoral Shampoo.

      You could conceivably alternate P.O. shampoo with Nizoral shampoo, if so inclined, for an added benefit, although their dual use has yet to be evaluated.