Parathyroid hormone‐related peptide and the hair cycle – is it the agonists or the antagonists that cause hair growth?

While the effects of PTH rP have been studied for almost 20 years, most of these studies have focused on effects on the termination of the anagen phase, giving an incomplete picture of the overall effect of PTH rP on the hair cycle. PTH rP was determined in several experimental models to promote transition of hair follicles from anagen to catagen phase, which by itself would suggest that PTH rP blockade might prolong the anagen phase and promote hair growth. However, clinical trials with topically applied PTH rP antagonists have been disappointing, leading to a reconsideration of this model. Additional studies performed in mouse models where hair follicles are damaged (alopecia areata, chemotherapy‐induced alopecia) suggest that PTH rP has effects early in the hair cycle as well, promoting hair follicles’ entry into anagen phase and initiates the hair cycle. While the mechanism of this has yet to be elucidated, it may involve activation of the Wnt pathway. Thus, the overall effect of PTH rP is to stimulate and accelerate the hair cycle, and in the more clinically relevant models of hair loss where hair follicles have been damaged or become quiescent, it is the agonists, not the antagonists, which would be expected to promote hair growth.