C-type natriuretic peptide agent for the treatment of alopecia

Abstract

It is an object of the present invention to provide a new agent for the treatment of alopecia, the agent being not only effective and safe for, in particular, alopecia areata, androgenetic alopecia in a male, androgenetic alopecia in a female, female pattern alopecia, postpartum alopecia, seborrheic alopecia, alopecia pityroides, senile alopecia, cancer chemotherapy drug-induced alopecia, and alopecia due to radiation exposure, but also effective for a target having resistance to treatment with minoxidil or finasteride, there being no side effects such as an itching sensation, irritation, or feminization, and no contraindications, the agent suppressing dandruff or having a therapeutic effect for white hair, and the therapeutic effect for alopecia being maintained for a long period even when use of the agent is stopped. The solution means of the present invention is an agent for the treatment of alopecia containing as an active ingredient a C-type natriuretic peptide (CNP), a B-type natriuretic peptide (BNP), a derivative of these NPs, a chimeric peptide of these NPs, or a derivative of a chimeric peptide of these NPs.

Claims

1. A method of treating alopecia, the method comprising: externally applying a composition that comprises an effective amount of C-type natriuretic peptide (CNP) to a required site of skin of a subject in need of such treatment, wherein the CNP comprises an amino acid sequence selected from the group comprising the human amino acid sequence of CNP-22 and CNP-53, and wherein the alopecia is one or more selected from the group consisting of alopecia due to trichotillomania, alopecia due to thyroid disease, alopecia due to anemia, alopecia due to vitamin deficiency, telogenic alopecia, and drug-induced alopecia.

2. The method of treating alopecia according to claim 1, wherein the composition further comprises an agent for the treatment of white hair, an agent for the treatment of vellus hair formation, an agent for inhibiting seborrheic scalp or the occurrence of dandruff, or an agent for relieving itchiness.

3. The method of treating alopecia according to claim 1, wherein the required site of skin is the frontal region or the crown.

4. The method of treating alopecia according to claim 1, wherein there is coexisting seborrheic alopecia or alopecia pityroides.

5. The method of treating alopecia according to claim 1, wherein the alopecia is alopecia of a subject that has attained a steroid-dependent state or a target for which a steroid treatment agent cannot be used.

6. The method of treating alopecia according to claim 1, wherein a therapeutic effect is obtained by application for 1 week or longer.

7. The method of treating alopecia according to claim 1, wherein there is no recurrence for a period of 1 month or longer even when application is stopped.

8. The method of treating alopecia according to claim 1, wherein the dosage form is an ointment, a gel, a cream, a lotion, a liquid, a wax, a powder, a spray, a gel spray, a foam, a shampoo, a treatment, a scalp treatment, or a tonic.

9. The method of treating alopecia according to claim 1, wherein the content of the C-type natriuretic peptide (CNP) is 1 to 1000 μg/g.

10. The method of treating alopecia according to claim 1, wherein the alopecia is treated without causing an itching sensation.

11. A method of reducing hair loss or reducing hair thinning, the method comprising: externally applying a composition that comprises an effective amount of C-type natriuretic peptide (CNP), wherein the CNP comprises an amino acid sequence selected from the group comprising the human amino acid sequence of CNP-22 and CNP-53.

12. The method of reducing hair loss according to claim 11, wherein the composition is an ointment, a gel, a cream, a lotion, a liquid, a wax, a powder, a spray, a gel spray, a foam, a shampoo, a treatment, a scalp treatment, or a tonic.

13. The method of reducing hair loss or reducing hair thinning according to claim 11, wherein the composition further comprises an agent for the treatment of white hair, an agent for the treatment of vellus hair formation, an agent for inhibiting seborrheic scalp or the occurrence of dandruff, or an agent for relieving itchiness.

14. The method of reducing hair loss or reducing hair thinning according to claim 11, wherein the required site of skin is the frontal region or the crown.

15. The method of reducing hair loss or reducing hair thinning according to claim 11, wherein a therapeutic effect is obtained by application for 1 week or longer.

16. The method of reducing hair loss or reducing hair thinning according to claim 11, wherein there is no recurrence for a period of 1 month or longer even when application is stopped.

17. The method of reducing hair loss or reducing hair thinning according to claim 11, wherein the content of the C-type natriuretic peptide (CNP) is 1 to 1000 μg/g.

18. The method of reducing hair loss or reducing hair thinning according to claim 11, wherein the method does not cause an itching sensation.

Description

BRIEF DESCRIPTION OF DRAWINGS

(1) FIG. 1 A diagram comparing the amino acid sequence of human CNP peptide, the amino acid sequence of human BNP peptide, and the amino acid sequence of human ANP peptide. Each character denotes the type of amino acid as a one letter code. The line connecting C (cysteine) and C (cysteine) denotes an intramolecular disulfide bond. The amino acid sequence of human CNP peptide and the amino acid sequences of human BNP peptide and human ANP peptide have three common regions, that is, an amino acid sequence represented by ‘CFG’, an amino acid sequence represented by ‘DRI’, and an amino acid sequence represented by ‘SGLGC’, and four mutually different sequences separated by these three common sequences.

(2) FIG. 2 A diagram showing the therapeutic effects on alopecia areata from an ANP gel. The severity of the alopecia areata was evaluated in terms of the proportion of bald patch area relative to the entire head in accordance with the USA alopecia areata evaluation guidelines, and a comparison was made for each case between that before application of the ANP gel and that after the application thereof. Each point on the left-hand side denotes the severity before application and each point on the right-hand side denotes the severity after application. The point for the severity before application and the point for the severity after application from the same test subject are connected by a straight line. The ANP gel rarely exhibited a fixed effect in the treatment of alopecia areata in those cases where no symptoms of irritation occurred, but in many cases there was no change in the proportion of the bald patch area, and itchiness occurred in many cases. Furthermore, the ANP gel rather aggravated erythema, scale, itchiness, and dandruff and increased the amount of hair falling out, and its use was stopped in most cases; this tendency was particularly marked for androgenetic alopecia.

(3) FIG. 3 A diagram showing the therapeutic effects on alopecia areata from a BNP gel. The severity of alopecia areata was evaluated in terms of the proportion of bald patch area relative to the entire head in accordance with the USA alopecia areata evaluation guidelines, and a comparison was made for each case between that before application of the BNP gel and that after application thereof. Each point on the left-hand side denotes the severity before application and each point on the right-hand side denotes the severity after application. The point for the severity before application and the point for the severity after application from the same test subject are connected by a straight line. It was found that the BNP gel was effective in the treatment of alopecia areata in all cases.

(4) FIG. 4 A diagram showing the therapeutic effects on alopecia areata from a BNP ointment. The severity of alopecia areata was evaluated in terms of the proportion of bald patch area relative to the entire head in accordance with the USA alopecia areata evaluation guidelines, and a comparison was made for each case between that before application of the BNP ointment and that after application thereof. Each point on the left-hand side denotes the severity before application and each point on the right-hand side denotes the severity after application. The point for the severity before application and the point for the severity after application from the same test subject are connected by a straight line. It was found that the BNP ointment was effective in the treatment of alopecia areata in all cases.

(5) FIG. 5 A diagram showing the therapeutic effects on alopecia areata from a CNP gel. The severity of alopecia areata was evaluated in terms of the proportion of bald patch area relative to the entire head in accordance with the USA alopecia areata evaluation guidelines, and a comparison was made for each case between that before application of the CNP gel and that after application thereof. Each point on the left-hand side denotes the severity before application and each point on the right-hand side denotes the severity after application. The point for the severity before application and the point for the severity after application from the same test subject are connected by a straight line. It was found that the CNP gel was effective in the treatment of alopecia areata. In case C1, because it was the 7.sup.th day of CNP gel application the presence or absence of a therapeutic effect could not be confirmed clearly.

(6) FIG. 6 A diagram showing the therapeutic effects on alopecia areata from a CNP ointment. The severity of alopecia areata was evaluated in terms of the proportion of bald patch area relative to the entire head in accordance with the USA alopecia areata evaluation guidelines, and a comparison was made for each case between that before application of the CNP ointment and that after application thereof. Each point on the left-hand side denotes the severity before application and each point on the right-hand side denotes the severity after application. The point for the severity before application and the point for the severity after application from the same test subject are connected by a straight line. It was found that the CNP ointment exhibited clear effects in the treatment of alopecia areata except in one case, that of case C14. In case C14, insofar as the bald patch area could be evaluated there was no hair growth that covered the entire bald patch, but clear growth of terminal hair was confirmed.

(7) FIG. 7 A photographic diagram showing the therapeutic effect when an ANP gel was applied to the back of the head of alopecia areata case A2 test subject. P denotes a bald patch before application and T denotes the bald patch of the same site after 100 μg/g ANP gel was applied twice a day for 5 weeks. Clear hair growth was observed.

(8) FIG. 8-1 A photographic diagram showing the therapeutic effect when an ANP gel was applied to the right temporal region of alopecia areata case A3 test subject (case C15 test subject). The test subject faced toward the right in the photograph. P denotes a bald patch before application and T1 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 2 weeks and from the next day after that 100 μg/g ANP gel was applied twice a day for 2 weeks. Strong hair growth was observed.

(9) FIG. 8-2 A photographic diagram showing the therapeutic effect when an ANP gel was applied to the right temporal region of alopecia areata case A3 test subject (case C15 test subject). The test subject faced toward the right in the photograph. T2 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 2 weeks and from the next day after that 100 μg/g ANP gel was applied twice a day for 5 weeks. Compared with that before application and that of T1 in FIG. 8-1, stronger hair growth was observed.

(10) FIG. 9 A photographic diagram showing the therapeutic effect when an ANP gel was applied to alopecia areata case A4 test subject. P denotes a bald patch before application and T denotes the bald patch of the same site after 100 μg/g ANP gel was applied twice a day for 4 weeks. It can be seen that the bald patch was cured.

(11) FIG. 10 A photographic diagram showing the therapeutic effect when an ANP gel and a BNP gel were applied to alopecia areata case A5 test subject (case B3 test subject). The test subject faced toward the right in the photograph. P denotes a bald patch before application, T1 denotes the bald patch of the same site after 100 μg/g ANP gel was applied twice a day for 3 weeks, and T2 denotes the bald patch of the same site after application of the ANP gel was stopped at 3 weeks and from the next day after that 100 μg/g BNP gel was applied twice a day for 2 weeks. Although the ANP gel enlarged the hair loss range somewhat, marked hair growth was observed with the BNP gel.

(12) FIG. 11 A photographic diagram showing the therapeutic effect when an ANP gel was applied to the crown of alopecia areata case A6 test subject (case C3 and C4 test subject). The test subject faced upward in the photograph. P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g ANP gel was applied twice a day for 2 weeks. In the case of this test subject, there was no effect, and the hair loss range was somewhat enlarged.

(13) FIG. 12-1 A photographic diagram showing the therapeutic effect when a BNP gel was applied to the right temporal region of alopecia areata case B1 test subject (case C12 test subject). The test subject faced toward the right in the photograph. P denotes a bald patch before application and T1 denotes the bald patch of the same site after 100 μg/g BNP gel was applied twice a day for 7 days. Clear hair growth was observed.

(14) FIG. 12-2 A photographic diagram showing the therapeutic effect when a BNP gel was applied to the right temporal region of alopecia areata case B1 test subject (case C12 test subject). The test subject faced toward the right in the photograph. T2 denotes the bald patch of the same site after 100 μg/g BNP gel was applied twice a day for 23 days, and T3 denotes the bald patch of the same site after application of 100 μg/g BNP gel was stopped at 24 days and 5 months had elapsed. Hair growth was observed to such an extent that the location of the bald patch was substantially lost, and the hair growth continued after application was stopped.

(15) FIG. 13 A photographic diagram showing the therapeutic effect when a BNP gel was applied to alopecia areata case B2 test subject. P denotes a bald patch before application and T1 denotes the bald patch of the same site after 50 μg/g BNP gel was applied twice a day for 7 days. Clear hair growth was observed and there was a cure.

(16) FIG. 14 A photographic diagram showing the therapeutic effect when a BNP gel was applied to the left frontal region of alopecia areata case B4 test subject (test subject of test subject C9). The test subject faced downward in the photograph. P denotes a bald patch before application, T1 denotes the bald patch of the same site after 100 μg/g BNP gel was applied twice a day for 2 weeks, T2 denotes the bald patch of the same site after 100 μg/g BNP gel was applied twice a day for 3 weeks, and T3 denotes the bald patch of the same site after application of 100 μg/g BNP gel was stopped at 3 weeks and 3 weeks had elapsed. Marked hair growth and hair thickening were observed.

(17) FIG. 15-1 A photographic diagram showing the therapeutic effect when a BNP ointment was applied to a bald area of the crown of alopecia areata case B5 test subject. The test subject faced upward in the photograph. P denotes the bald patch before application, and T1 denotes the bald patch of the same site after 50 μg/g BNP ointment was applied twice a day for 2 weeks and from the next day after that 30 μg/g BNP ointment was applied twice a day for 1 week. Clear hair growth was observed.

(18) FIG. 15-2 A photographic diagram showing the therapeutic effect when a BNP ointment was applied to the bald area of the crown of alopecia areata case B5 test subject. The test subject faced upward in the photograph. T2 denotes the bald patch of the same site after 50 μg/g BNP ointment was applied twice a day for 2 weeks, from the next day after that 30 μg/g BNP ointment was applied twice a day for 1 week, and after that a further 50 μg/g BNP ointment was applied twice a day for 2 weeks. Compared with T1 in FIG. 15-1, further marked hair growth and hair thickening were observed.

(19) FIG. 16 A photographic diagram showing the therapeutic effect when a BNP ointment was applied to a bald area of the right temporal region of alopecia areata case B5 test subject. The test subject faced toward the right in the photograph. P denotes the bald patch before application, and T1 denotes the bald patch of the same site after 50 μg/g BNP ointment was applied twice a day for 2 weeks, from the next day after that 30 μg/g BNP ointment was applied twice a day for 1 week, and after that a further 50 μg/g BNP ointment was applied twice a day for 2 weeks. Marked hair growth that covered the entire bald patch was observed.

(20) FIG. 17 A photographic diagram showing the therapeutic effect when a CNP gel was applied to the crown of alopecia areata case C1 test subject. P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g CNP gel was applied twice a day for 1 week. Clear hair growth was observed.

(21) FIG. 18-1 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to a bald patch of the crown of alopecia areata case C2 test subject (case C11 test subject). P denotes a bald patch before application, and T1 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 1 week. Clear hair growth was observed.

(22) FIG. 18-2 A photographic diagram showing the therapeutic effect when a CNP ointment and a CNP gel were applied to the bald patch of the crown of alopecia areata case C2 test subject (case C11 test subject). T2 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 1 week and from the next day after that 100 μg/g CNP gel was applied twice a day for 1 week, and T3 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 1 week and from the next day after that 100 μg/g CNP gel was applied twice a day for 3 weeks. Clear hair growth and enlargement of the hair growth region were observed.

(23) FIG. 19-1 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to a bald patch of the frontal region of alopecia areata case C2 test subject (case C11 test subject). The test subject faced downward in the photograph. P denotes the bald patch before application, and T1 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 1 week. Clear hair growth was observed.

(24) FIG. 19-2 A photographic diagram showing the therapeutic effect when a CNP ointment and a CNP gel were applied to the bald patch of the frontal region of alopecia areata case C2 test subject (case C11 test subject). The test subject faced downward in the photograph. T2 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 1 week and from the next day after that 100 μg/g CNP gel was applied twice a day for 3 weeks. Compared with T1 in FIG. 19-1, clear hair growth and enlargement of the hair growth region were observed.

(25) FIG. 20 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a bald patch of the left temporal region of alopecia areata case C3 test subject (case A6 and C4 test subject). The test subject faced toward the left in the photograph. P denotes the bald patch before application, T1 denotes the bald patch of the same site after 100 μg/g CNP gel was applied twice a day for 2 weeks, and T2 denotes the bald patch of the same site after 100 μg/g CNP gel was applied twice a day for 3 weeks and after that application of CNP gel was stopped and 6 months had elapsed. Clear hair growth and enlargement of the hair growth region were observed.

(26) FIG. 21 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to a bald patch of the left temporal region of alopecia areata case C5 test subject (case A1 test subject). The test subject faced downward in the photograph. P denotes the bald patch before application, T1 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 3 weeks, and T2 denotes the bald patch of the same site after 100 μg/g CNP gel was applied twice a day for 3 weeks and after that application of CNP ointment was stopped and 6 months had elapsed. Clear hair growth and enlargement of the hair growth region were observed.

(27) FIG. 22 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to a bald patch of the right frontal region of alopecia areata case C6 test subject (case A7 test subject). The test subject faced toward the right in the photograph. P denotes the bald patch before application, and T denotes the bald patch of the same site after 50 μg/g CNP ointment was applied twice a day for 3 weeks. Clear growth of terminal hair was observed.

(28) FIG. 23 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to alopecia areata case C7 test subject. P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 2 weeks. Clear hair growth was observed.

(29) FIG. 24-1 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to alopecia areata case C10 test subject (case B6 test subject). P denotes a bald patch before application, and T1 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 2 weeks. Clear hair growth was observed.

(30) FIG. 24-2 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to alopecia areata case C10 test subject (case B6 test subject). T2 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 3 weeks. Compared with T1 in FIG. 24-1, clearer hair growth was observed.

(31) FIG. 25 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to a bald patch of the left temporal region of alopecia areata case C12 test subject (case B1 test subject). The test subject faced toward the left in the photograph. P denotes the bald patch before application, T1 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 3 weeks, and T2 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 5 weeks. Enlargement of the hair growth region over time and formation of terminal hair were clearly observed.

(32) FIG. 26 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to alopecia areata case C13 test subject. P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 2 weeks. Clear hair growth was observed.

(33) FIG. 27 A photographic diagram showing the therapeutic effect when an ANP gel was applied to the crown of androgenetic alopecia case A8 test subject (case B8 test subject). P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g ANP gel was applied twice a day for 2 weeks. Hair growth was not observed at all.

(34) FIG. 28-1 A photographic diagram showing the therapeutic effect when a BNP gel was applied to the crown of androgenetic alopecia case B7 test subject. P denotes a bald patch before application, and T1 denotes the bald patch of the same site after 100 μg/g BNP gel was applied twice a day for 10 days. Hair growth and formation of terminal hair were observed.

(35) FIG. 28-2 A photographic diagram showing the therapeutic effect when a BNP gel was applied to the crown of androgenetic alopecia case B7 test subject. T2 denotes the bald patch of the same site after 100 μg/g BNP gel was applied twice a day for 14 days and from the next day after that application of the BNP gel was stopped and 6 months had elapsed. Compared with T1 in FIG. 28-1, formation of terminal hair progressed, the area of thinning hair was reduced, and a substantially normal state was recovered.

(36) FIG. 29 A photographic diagram showing the therapeutic effect when a BNP gel was applied to the crown of androgenetic alopecia case B12 test subject. P denotes a bald patch before application, T1 denotes the bald patch of the same site after 50 μg/g BNP gel was applied twice a day for 3 days, and T2 denotes the bald patch of the same site after 50 μg/g BNP gel was applied twice a day for 21 days. Clear hair growth and formation of terminal hair were observed.

(37) FIG. 30-1 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to the crown and frontal region of androgenetic alopecia case C16 test subject. The test subject faced downward in the photograph. P denotes a bald patch before application, and T1 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 3 weeks. Clear hair growth and formation of terminal hair were observed.

(38) FIG. 30-2 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to the crown and frontal region of androgenetic alopecia case C16 test subject. The test subject faced downward in the photograph. T2 denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 4 weeks. Compared with that before application and that of T1 in FIG. 30-1, very marked hair growth over time and formation of terminal hair were observed.

(39) FIG. 31 A photographic diagram showing the therapeutic effect when a CNP ointment was applied to androgenetic alopecia case C17 test subject. The test subject faced downward in the photograph. P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g CNP ointment was applied twice a day for 1 week. Clear hair growth and formation of terminal hair were observed.

(40) FIG. 32 A photographic diagram showing the therapeutic effect when a CNP gel was applied to postpartum alopecia case C18 test subject. The test subject faced downward in the photograph. P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g CNP gel was applied twice a day for 1 week. Clear hair growth and formation of terminal hair were observed.

(41) FIG. 33 A photographic diagram showing the therapeutic effect when a CNP gel was applied to female pattern alopecia case C19 test subject. The test subject faced downward in the photograph. P denotes a bald patch before application, and T denotes the bald patch of the same site after 100 μg/g CNP gel was applied twice a day for 4 days. Although it was short, clear hair growth was observed.

(42) FIG. 34 A photographic diagram showing the therapeutic effect when a BNP gel was applied to a circular bald area of the crown of alopecia areata case B13 test subject (case C13 test subject). The test subject faced downward in the photograph. P denotes the bald patch before application, and T denotes the bald patch of the same site after 50 μg/g BNP gel was applied twice a day for 2 weeks. There was no hair on the scalp of the bald area within the range encircled by the dotted line in P, whereas clear hair growth was observed on the scalp of the bald area within the range encircled by the dotted line in T.

(43) FIG. 35 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a circular bald area of the left temporal region of alopecia areata case C20 test subject. The test subject faced downward and toward the left in the photograph in P2, and upward and toward the left in T2. P2 denotes a hair loss site before application, and T2 denotes the same site after 50 μg/g CNP gel was applied twice a day for 2 weeks. The areas photographed in photographs P2 and T2 were substantially identical to each other. There was almost no hair growth on the scalp of the bald area within the range encircled by the dotted line in P2, whereas a large amount of hair growth was observed on the scalp within the range encircled by the dotted line in T2.

(44) FIG. 36 A photographic diagram showing the therapeutic effect when a BNP:betamethasone:gentamicin combination was applied to a circular bald area of the crown of alopecia areata case B14 test subject. The test subject faced upward in the photograph. P denotes the bald patch before application, and T denotes the bald patch of the same site after a 50 μg/g BNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 7 days. There was no hair growth in a central part of the bald area within the range encircled by the dotted line in P, whereas a large amount of hair growth was observed in the middle of the bald area within the range encircled by the dotted line in T.

(45) FIG. 37 A photographic diagram showing the therapeutic effect when a CNP: betamethasone: gentamicin combination was applied to a circular bald area of the right crown of alopecia areata case C21 test subject. The test subject faced rearward in the photograph of P and upward and toward the left in the photograph of T. P denotes the bald patch before application, and T denotes the bald patch of the same site after a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 3 weeks and then stopped for 1 week. In P the skin of the scalp of the bald area within the range encircled by the dotted line could be seen and there was only slight growth of very fine white downy hair, whereas in T black hair grew densely on the scalp of the bald area within the range encircled by the dotted line.

(46) FIG. 38 A photographic diagram showing the therapeutic effect when a CNP:betamethasone:gentamicin combination was applied to a circular bald area of the crown of alopecia areata case C22 test subject. The test subject faced toward the left in the photograph. P denotes the bald patch before application, and T denotes the bald patch after 50 μg/g CNP gel was applied twice a day for 2 weeks and subsequently a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 2 weeks. In P there was no hair growth at all on the scalp of the bald area within the range encircled by the dotted line, whereas in T black hair grew densely on the scalp, at the upper and lower edges of the photograph, of the bald area within the range encircled by the dotted line.

(47) FIG. 39 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a circular bald area of the back of the head of alopecia areata case C23 test subject. The test subject faced rearward in the photograph. P denotes the bald patch before application, and T denotes the bald patch of the same site after 50 μg/g CNP gel was applied twice a day for 2 weeks. In P the hair growth in the bald area within the range encircled by the dotted line was scattered with fine hair, whereas in T the hair growth in the bald area within the range encircled by the dotted line was dense with thick and sturdy hair.

(48) FIG. 40 A photographic diagram showing the therapeutic effect when a BNP gel was applied to a thinning hair site of the frontal region and the crown of androgenetic alopecia case B15 test subject. The test subject faced downward in the photograph. P denotes the thinning hair site before application, and T denotes the hair loss site of the same site after 50 μg/g BNP gel was applied twice a day for 2 weeks. In P the hair growth of the hair loss site was scattered with fine hair, whereas in T the hair growth was dense with thick sturdy hair. In particular, focusing on the skin of the M-shaped site, it could be seen that the hair growth was dense.

(49) FIG. 41 A photographic diagram showing the therapeutic effect when a BNP gel was applied to a hair loss site of the crown and the frontal region of androgenetic alopecia case B16 test subject. The test subject faced downward in the photograph. P denotes the hair loss site before application, T1 denotes the hair loss site of the same site after 100 μg/g BNP gel was applied twice a day for 3 weeks, and T2 denotes the hair loss site of the same site when the application of 100 μg/g BNP gel was stopped after 3 weeks and from the next day 200 μg/g BNP gel was applied twice a day for 2 weeks. In P hair was scattered in the hair loss site within the range encircled by the dotted line, whereas in T1 hair with a feeling of volume grew densely in a central part within the range encircled by the dotted line, and in T2 the hair grew more densely and the so-called M-shaped hair loss site disappeared. In the photograph of T2, the reason why a central part within the range encircled by the dotted line, the so-called O-shaped hair loss site, was conspicuous is because the photograph was taken from a camera angle directly above the crown such that the crown, which was the remaining hair loss site, could be seen well.

(50) FIG. 42 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a hair loss site of the crown of androgenetic alopecia case C24 test subject. The test subject faced downward in the photograph. P denotes the bald patch before application, and T denotes the bald patch of the same site after 50 μg/g CNP gel was applied twice a day for 1 week. In P hair was scattered and the scalp could be seen, whereas in T hair with a feeling of volume grew and it was difficult to see the scalp.

(51) FIG. 43 A photographic diagram showing the therapeutic effect when a CNP:betamethasone:gentamicin combination was applied to a hair loss site of the frontal region of androgenetic alopecia case C25 test subject. The test subject faced forward in the photograph. P1 denotes the hair loss site before application, and T1 denotes the hair loss site of the same site after a 25 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 12 days. Compared with the photograph of P1, in the photograph of T1 the feeling of volume of the hair increased, and the scalp of the frontal region was more difficult to see.

(52) FIG. 44 A photographic diagram showing the therapeutic effect when a CNP:betamethasone:gentamicin combination was applied to a hair loss site of the frontal region of androgenetic alopecia case C25 test subject. The test subject faced toward the right in the photograph, with the right frontal region visible. P2 denotes the hair loss site before application, and T2 denotes the hair loss site of the same site after a 25 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 12 days. Compared with the photograph of P2, in the photograph of T2 the feeling of volume of the hair increased, and the scalp of the frontal region was more difficult to see.

(53) FIG. 45 A photographic diagram showing the therapeutic effect when a CNP:clobetasol combination was applied to a hair loss site of the frontal region and the crown of androgenetic alopecia case C26 test subject. The test subject faced downward in the photograph. P denotes the hair loss site before application, and T denotes the hair loss site of the same site after a 50 μg/mL CNP:250 μg/g clobetasol combination was applied twice a day for 1 week. Compared with the photograph of P, in the photograph of T the density of the hair increased, each hair thickened, and even black hairs increased.

(54) FIG. 46 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a male pattern hair loss site at the M-shaped hair line of the right frontal region of androgenetic alopecia case C27 test subject. The test subject faced toward the right in the photograph. P denotes the hair loss site before application, and T denotes the same site after 50 μg/g CNP gel was applied twice a day for 2 weeks. In P there was hardly any hair on the scalp of the hair loss site, whereas in T a large amount of hair growth was observed on the scalp of the hair loss site.

(55) FIG. 47 A photographic diagram showing the therapeutic effect when an ANP gel or a BNP gel was applied to a hair loss site of the crown of postpartum alopecia case A10 (B17) test subject. The test subject faced downward in the photograph. P denotes the hair loss site before application, T1 denotes the same site after 100 μg/g ANP gel was applied twice a day for 3 weeks, and T2 denotes the same site when application of the ANP gel was ended after 3 weeks and application was suspended for 6 months, following which 50 μg/g BNP gel was applied to the hair loss site of the crown once every 3 to 4 days for 3 weeks. In photograph (T1) after application of the ANP gel, the hair loss range enlarged, but in photograph (T2) after application of the BNP gel, thinning hair on the crown thickened to such an extent that it was not noticeable to the eye.

(56) FIG. 48 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a hair loss site at the parting on the frontal region of female pattern alopecia case B19 test subject. The test subject faced downward in the photograph. P denotes the hair loss site before application, and T denotes the same site after 50 μg/g BNP gel was applied twice a day for 1 week. Comparing the two, in the photograph of P the scalp had scattered hair growth, but in the photograph of T hair growth could be confirmed on the scalp.

(57) FIG. 49 A photographic diagram showing the therapeutic effect when a BNP gel was applied to a thinning hair part of the crown of female pattern alopecia case B20 test subject. The test subject faced downward in the photograph. P denotes the thinning hair part before application, and T denotes the same site after 50 μg/g BNP gel was applied twice a day for 2 weeks. After the BNP gel was applied for 2 weeks, the thinning hair became inconspicuous.

(58) FIG. 50 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a thinning hair part of the frontal region and the crown of female pattern alopecia case C28 test subject. The test subject faced downward in the photograph. P denotes the thinning hair part before application, and T denotes the same site after 50 μg/g CNP gel was applied once or twice a day for 4 weeks. After the CNP gel was applied for 4 weeks, the hair thickened to such an extent that thinning hair could hardly be seen.

(59) FIG. 51 A photographic diagram showing the therapeutic effect when a BNP gel was applied to a thinning hair part of the frontal region and the crown of case B23 test subject with coexisting senile alopecia and alopecia pityroides. The test subject faced downward in the photograph. P denotes the thinning hair part before application, and T denotes the same site when 50 μg/g BNP gel was applied for 2 weeks, application was then suspended for 1 week, and 200 μg/g BNP gel was applied once a day for 5 days. After the BNP gel was applied, pityriatic desquamation was alleviated, vellus hair turned into terminal hair and became black, and the thinning hair was greatly improved.

(60) FIG. 52 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a thinning hair part of the frontal region and the crown of alopecia pityroides case C31 test subject. The test subject faced downward in the photograph. P denotes the thinning hair part before application, and T denotes the same site after 100 μg/g CNP gel was applied twice a day for 2 weeks. After the CNP gel was applied, a considerable amount of thickly adhering scale was lost, and hair started to thicken on the crown.

(61) FIG. 53 A photographic diagram showing the therapeutic effect when a BNP gel was applied to a thinning hair part of the frontal region and the crown of alopecia pityroides case B28 test subject. The test subject faced downward in the photograph. P denotes the thinning hair part before application, and T denotes the same site after 20 μg/g BNP gel was applied for 1 week. After the BNP gel was applied, thickly accumulated scale disappeared, and fairly clear hair growth and hair thickening were observed from the frontal region to the crown.

(62) FIG. 54 A photographic diagram showing the therapeutic effect when an ANP gel or a BNP gel was applied to a thinning hair part of the frontal region and the crown of senile alopecia case A15 test subject. The test subject faced downward in the photograph. P denotes the thinning hair part before application, T1 denotes the thinning hair part after 100 μg/g ANP gel was applied twice a day for 3 weeks, and T2 denotes the same site when 50 μg/g CNP gel was applied twice a day for 4 weeks from the next day after the ANP gel had been applied for 1 week. After the CNP gel was applied, clear hair thickening was seen in the frontal region, and hair stopped falling out.

(63) FIG. 55 A photographic diagram showing the therapeutic effect when a BNP gel was applied to a bald area of the back of the head of alopecia areata case B26 test subject. The test subject faced rearward in the photograph. P denotes the bald area before application, T1 denotes the same site after 50 μg/g BNP gel was applied twice a day for 2 weeks, and T2 denotes the same site when application of the BNP gel was ended after 2 weeks and 6 weeks had elapsed after that. Marked hair growth was seen in the bald area to which the BNP gel had been applied.

(64) FIG. 56-1 A photographic diagram showing the therapeutic effect when a CNP gel was applied to a bald area of the frontal region and the crown of cancer chemotherapy drug-induced alopecia case C35 test subject. The test subject faced downward in the photograph. P denotes the hair loss site before application, and T denotes the same site after 50 μg/g concentration CNP gel was applied to an area from the frontal region to the crown twice a day for 6 weeks. The number of hairs increased in the hair loss site to which the CNP gel had been applied, considerable hair thickening was observed, and it was confirmed that the hairs had become thick and long.

(65) FIG. 56-2 A photographic diagram showing the therapeutic effect when a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied to a circular bald area occurring in the left temporal region of cancer chemotherapy drug-induced alopecia case C35 test subject. The test subject faced toward the left in the photograph. P denotes the hair loss site before application, and T denotes the same site after the 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 3 weeks. Marked terminal hair growth was confirmed for the bald area to which the CNP gel had been applied.

(66) FIG. 57 A photographic diagram showing the therapeutic effect when a BNP gel was applied to the left frontal region of alopecia areata case B4 (case C9) test subject and a CNP ointment was applied to the right frontal region. The test subject faced forward and slightly downward in the photograph. P denotes the hair loss site before application, T denotes the same site at a time when 100 μg/g BNP gel had been applied for 3 weeks and application had been suspended for 2 weeks for the left frontal region and at a time immediately after 100 μg/g CNP ointment had been applied for 3 weeks to the right frontal region, and T2 denotes the same site when application had subsequently been suspended for 1 year. The alopecia areata multilocularis was completely cured by applying the BNP gel or the CNP ointment for 3 weeks, and there was no recurrence for over 1 year.

MODES FOR CARRYING OUT THE INVENTION

(67) The present invention is an agent for the treatment or prevention of alopecia, dandruff, white hair, and seborrheic scalp, the agent containing a natriuretic peptide (NP) as an active ingredient, and the agent being for the treatment of alopecia areata, androgenetic alopecia, seborrheic alopecia, alopecia pityroides, female pattern alopecia, postpartum alopecia, senile alopecia, cancer chemotherapy drug-induced alopecia, and alopecia due to radiation exposure.

(68) The alopecia areata referred to in the present specification is not particularly limited and means alopecia that is generally clinically diagnosed as alopecia areata, in particular alopecia that occurs suddenly without a clear cause in a target having a history of, or coexisting, immune disease or a target having a genetic background of immune disease. Alopecia areata in the present specification includes alopecia that is generally clinically diagnosed as alopecia areata, but is not limited thereto, and includes all types of alopecia in a target having an overreaction or abnormality in the immune system, the cause being unclear other than there being an overreaction or immune abnormality in the immune system.

(69) The alopecia that is generally clinically diagnosed as alopecia areata is alopecia in which a coin-sized circular to patchy bald area with a clear outline suddenly occurs without any subjective symptoms, prodromal symptoms, etc., gradually increases in area if it does not spontaneously cure, and becomes intractable. With regard to the alopecia that is generally clinically diagnosed as alopecia areata, during its active stage broken hair, dead hair (black spot within hair follicle), and diseased hair that easily falls out are observed within and outside the lesion, the configuration of these hair root parts being similar to the shape of an exclamation mark being conclusive for the diagnosis.

(70) The immune disease referred to in the present specification means a disease caused by an overreaction or immune abnormality in the immune system, and includes an allergic disease and an autoimmune disease. The overreaction or immune abnormality in the immune system means an excessive immunoreaction or an abnormal immunoreaction that will damage normal cells of the target itself, and specifically includes an allergic disease and an autoimmune disease. The overreaction or immune abnormality in the immune system can be recognized as a history of, or coexisting, immune disease. The target having an overreaction or immune abnormality in the immune system referred to in the present specification has the same meaning as alopecia having a history of, or coexisting, immune disease.

(71) The target having a genetic background of an immune disease means a target for whom there is one having an overreaction or immune abnormality in the immune system among the genetically-related family. Since it is known that alopecia areata occurs with high frequency when there is one having an immune disease among the genetically-related family, alopecia of unknown cause in a target having a genetic background of immune disease can be considered to be alopecia areata.

(72) In the present specification, when there is one having a history of, or coexisting, allergic disease or autoimmune disease at least among the biological parents, biological brothers and sisters, biological grandparents, biological children, and biological grandchildren, it is determined that it is a target having a genetic background of immune disease. Furthermore, in the present specification, when there is one having a history of, or coexisting, alopecia areata at least among the biological parents, brothers and sisters, and grandparents, it is determined that it is a target having a genetic background of alopecia areata.

(73) Here, examples of the allergic disease include atopic disease, pollen allergy, food allergy, latex allergy, metal allergy, sick house syndrome, allergic granulomatous angiitis, food-dependent exercise-induced anaphylaxy, and celiac disease.

(74) The atopic disease includes bronchial asthma, atopic dermatitis, allergic rhinitis, and atopic alopecia. Atopic alopecia means a state in which alopecia is caused by exacerbation of atopic dermatitis. The target having an atopic predisposition referred to in the present specification means a target for whom at last one of themselves, biological parents, biological brothers and sisters, biological grandparents, biological children, and biological grandchildren has a history of bronchial asthma, atopic dermatitis, allergic rhinitis, or atopic alopecia.

(75) Examples of allergens causing an allergic reaction include house dust, mite, cedar, Dactylis, ragweed, and cat fur. The cedar, Dactylis, and ragweed referred to here mean cedar pollen, Dactylis pollen, and ragweed pollen respectively. A target that shows an allergic reaction toward at least one allergen among house dust, mite, cedar, Dactylis, ragweed, and cat fur in an allergen test such as any of a scratch test, an intradermal test, a patch test, and a specific IgE antibody in vitro assay is a target having a genetic background of an immune disease.

(76) Examples of the autoimmune disease include an autoimmune thyroid disease such as Hashimoto's disease, Basedow's disease, or primary hypothyroidism, vitiligo, systemic lupus erythematosus, rheumatoid arthritis, myasthenia gravis, chronic discoid lupus erythematosus, localized scleroderma, pemphigus, pemphigoid, herpes gestationis, linear IgA bullous dermatosis, acquired epidermolysis bullosa, Sutton's nevus, Guillain Barré syndrome, chronic atrophic gastritis, autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune pancreatitis, aortitis, Goodpasture's syndrome, rapidly progressive glomerulonephritis, megaloblastic anemia, autoimmune hemolytic anemia, autoimmune neutropenia, idiopathic thrombocytopenic purpura, idiopathic Addison's disease, insulin-dependent diabetes mellitus, systemic scleroderma, alopecia areata, Vogt-Koyanagi-Harada disease, autoimmune optic neuropathy, idiopathic azoospermia, habitual abortion, anti-phospholipid antibody syndrome, polymyositis, dermatomyositis, systemic dermatosclerosis, Sjogren syndrome, IgG4-related disease, polyarteritis nodosa, microscopic polyangiitis, allergic granulomatous angiitis, Wegener's granulomatosis, mixed connective tissue disease, ulcerative colitis, amyotrophic lateral sclerosis, Crohn's disease, collagen disease, relapsing polychondritis, sarcoidosis, stiff person syndrome, adult Still's disease, multiple sclerosis, immune thrombocytopenic purpura, eosinophilic pneumonia, and Behcet's disease.

(77) The autoimmune disease includes an autoimmune disease with skin symptoms. Examples of the autoimmune disease with skin symptoms include chronic discoid lupus erythematosus, localized scleroderma, pemphigus, pemphigoid, herpes gestationis, linear IgA bullous dermatosis, acquired epidermolysis bullosa, vitiligo, and Sutton's nevus. The autoimmune disease with skin symptoms tends to be accompanied by alopecia.

(78) The autoimmune disease includes an autoimmune disease that is liable to be accompanied by alopecia areata. Examples of the autoimmune disease that is particularly liable to be accompanied by alopecia areata include an autoimmune thyroid disease, vitiligo, systemic lupus erythematosus, rheumatoid arthritis, and myasthenia gravis (Non-Patent Document 8).

(79) The androgenetic alopecia referred to in the present specification means symptoms in an adult male or female in which hair on the frontal region and/or crown gradually becomes vellus hair, thinner, and shorter over a few years or longer. As also described in ‘Androgenetic alopecia Diagnosis and Treatment Guidelines 2010 edition’ (Non-Patent Document 2), regardless of the name ‘androgenetic alopecia’, it occurs in females as a pattern in which head hair over a relatively wide area of the crown becomes thin. Since androgenetic alopecia occurs as a result of hair papilla cells of the scalp of the frontal region or crown reacting with 5α dihydrotestosterone and the hair follicles miniaturizing, if in a target having a genetic background of androgenetic alopecia, hair of the frontal region and/or crown gradually becomes vellus hair, thin, and short over a few years or longer, it is androgenetic alopecia.

(80) Having a genetic background of androgenetic alopecia means having a genetic background of male hormone acting on male hormone-sensitive hair follicles to form vellus hair, and specifically means that it can be genetically diagnosed that hair papilla cells in the scalp of the frontal region or crown react with 5α dihydrotestosterone to thus cause hair follicle miniaturization or means that there is a related male in a state in which head hair of the frontal region or crown has fallen out and the scalp can be seen from 20 years old onward at least among biological parents, biological brothers and sisters, biological grandparents, biological children, and biological grandchildren.

(81) The alopecia pityroides referred to in the present specification means alopecia pityroides in terms of the normal medical meaning, and alopecia due to dandruff blocking pores to thus cause inflammation is included in alopecia pityroides.

(82) The female pattern alopecia referred to in the present specification means female pattern alopecia in terms of the normal medical meaning, and alopecia caused by the amount of the female hormone estrogen decreasing relative to the amount of androgen in the blood stream is included in female pattern alopecia.

(83) The postpartum alopecia referred to in the present specification means postpartum alopecia in terms of the normal medical meaning, and alopecia in which hair whose growth phase has been maintained by estrogen enters the resting phase all at once after childbirth and hair loss increases is included in postpartum alopecia.

(84) The target referred to in the present specification means any biological individual, preferably a vertebrate, more preferably a mammal, yet more preferably a rodent such as a mouse, a rat, a Mongolian gerbil, or a guinea pig, a cat family animal such as a cat, a puma, or a tiger, a cervid animal such as a deer or an elk, a rabbit, a dog, a mink, a sheep, a goat, a cow, a horse, a monkey, or a human, and most preferably a human.

(85) The natriuretic peptide (NP) referred to in the present invention means an A-type natriuretic peptide (ANP), a B-type natriuretic peptide (BNP), a C-type natriuretic peptide (CNP), a derivative of these NPs, a chimeric peptide of 2 or more NPs selected from these NPs, or a derivative of a chimeric peptide of the NPs, and is not particularly limited as long as it has ANP activity, BNP activity, or CNP activity. It is particularly preferably ANP, BNP, or CNP.

(86) The ANP referred to here means ANP-28 (α-ANP) formed from 28 amino acids, α-ANP[4-28] formed from the 4.sup.th to the 28.sup.th amino acids of ANP-28, α-ANP[5-28] formed from the 5.sup.th to the 28.sup.th amino acids of ANP-28, or a derivative thereof, and is not particularly limited as long as it has ANP activity. The ANP derivatives include, as long as they have ANP activity, one in which the C-terminal of ANP has been amidated, one in which the C-terminal of ANP has been methoxylated, one in which polyethylene glycol has been added to ANP, one in which a sugar chain has been added to ANP, one in which an alkyl chain has been added to ANP, and one in which a fatty acid has been added to ANP. The ANP may be β-ANP, which has a structure that is an antiparallel dimer of ANP-28, or a polymer type γ-ANP having a molecular weight of 13000 formed by cleaving a signal peptide from an ANP precursor. α-ANP and a derivative thereof are particularly preferable. The amino acid sequence of human ANP-28 is shown as the sequence with SEQ ID No: 1 in the present specification.

(87) The ANP derivative referred to here means one having preferably 1 to 5, more preferably 1 to 3, and yet more preferably 1 to 2 amino acids in the ANP-28 amino acid sequence deleted, substituted, or added and having ANP activity, or one having a sequence that is at least 85%, preferably at least 90%, and yet more preferably at least 95% homologous to the ANP-28 amino acid sequence and having ANP activity. The ANP derivative includes, as long as it has ANP activity, one in which the C-terminal of ANP has been amidated, one in which the C-terminal of ANP has been methoxylated, one in which polyethylene glycol has been added to ANP, one in which a sugar chain has been added to ANP, one in which an alkyl chain has been added to ANP, and one in which a fatty acid has been added to ANP.

(88) In the present invention, provided that it has ANP activity, any known ANP can be used. Examples thereof include 819 ANP derivates disclosed as AP1 to AP819 in U.S. Pat. Nos. 5,047,397 or 4,804,650 and 32 ANP derivatives disclosed as Compound Nos. 1 to 32 in Tables 1 to 3 of U.S. Pat. No. 5,204,328.

(89) Furthermore, the presence or absence of ANP activity may be confirmed easily by known means and, for example, it may be confirmed by testing cGMP production activity in NPR-A receptor-expressing cells.

(90) As an active ingredient of the present invention, any ANP or derivative thereof can be used, but from the viewpoint of efficacy and availability ANP-28 is preferable.

(91) The ANP of the present invention can be prepared by chemical synthesis or genetic engineering using a human ANP gene (e.g. Nature. 1984 Vol. 312 (5990): 152-155), but since ANP is already commercially available, it may be obtained from the market. Furthermore, it may be obtained for example as ANP (Human, 1-28) from the Peptide Institute, Inc.

(92) As hereinbefore described, the ANP that can be used in the present invention includes purified natural ANP, recombinant ANP produced by a known genetic engineering method, and ANP produced by a known chemical synthesis method (e.g. a solid-phase synthesis method using a peptide synthesizer). Basic methods such as a gene-recombination technique, a site-specific mutagenesis method, or a PCR technique are publicly known or well known and are described in, for example, Current Protocols In Molecular Biology; John Wiley & Sons (1998).

(93) The BNP referred to here means BNP-26, BNP-32, or BNP-45, which have 26, 32, and 45 amino acids respectively, or a derivative thereof, and is not particularly limited as long as it has BNP activity. The BNP may be a polymer type γ-BNP formed by cleaving a signal peptide from a BNP precursor and having a molecular weight of about 13000. It is particularly preferably BNP-32 or a derivative thereof. The amino acid sequence of human BNP-32 is shown as the sequence with SEQ ID No: 41 in the present specification. Furthermore, the amino acid sequence of human BNP-26 is shown as the sequence with SEQ ID No: 82 in the present specification.

(94) The BNP derivative referred to here means one having preferably 1 to 5, more preferably 1 to 3, and yet more preferably 1 or 2 amino acids in the amino acid sequence of BNP-26, BNP-32, or BNP-45 deleted, substituted, or added and having BNP activity, or one having a sequence that is at least 85%, preferably at least 90%, and more preferably at least 95% homologous to the BNP-26, BNP-32, or BNP-45 amino acid sequence and having BNP activity. The BNP derivative includes, as long as it has BNP activity, one in which the C-terminal of BNP has been amidated, one in which the C-terminal of BNP has been methoxylated, one in which polyethylene glycol has been added to BNP, one in which a sugar chain has been added to BNP, one in which an alkyl chain has been added to BNP, and one in which a fatty acid has been added to BNP.

(95) In the present invention, provided that it has BNP activity, any known BNP can be used. Examples thereof include a BNP derivative disclosed in published Japanese translation 2007-525213 of a PCT application, 29 BNP derivatives disclosed as SEQ ID No: 1 to 29 in U.S. Pat. No. 6,028,055, a BNP derivative disclosed by the Formula of Claim 1 in U.S. Pat. No. 5,114,923, BD-NP disclosed in U.S. Pat. No. 6,818,619, and a diuretic polypeptide or a natriuretic polypeptide disclosed in published Japanese translation 2010-500032 of a PCT application.

(96) Furthermore, the presence or absence of BNP activity may be confirmed easily by known means and, for example, it may be confirmed by testing cGMP production activity in NPR-A receptor-expressing cells.

(97) As an active ingredient of the present invention, any of BNP-26, BNP-32, BNP-45, and derivatives thereof can be used, but from the viewpoint of efficacy and availability BNP-32 is preferable.

(98) The BNP of the present invention can be prepared by chemical synthesis or genetic engineering using a human BNP gene (e.g. JP, A, 5-207891, published Japanese translation 2007-525957 of a PCT application, published Japanese translation 2007-525213 of a PCT application), but since BNP is already commercially available, it may be obtained from the market. Furthermore, it may be obtained for example as BNP-32 (human) from the Peptide Institute, Inc.

(99) As hereinbefore described, the BNP that can be used in the present invention includes purified natural BNP, recombinant BNP produced by a known genetic engineering method, and BNP produced by a known chemical synthesis method (e.g. a solid-phase synthesis method using a peptide synthesizer). Basic methods such as a gene-recombination technique, a site-specific mutagenesis method, or a PCR technique are publicly known or well known and are described in, for example, Current Protocols In Molecular Biology; John Wiley & Sons (1998), JP, A, 5-207891, etc.

(100) The CNP referred to here means CNP-22 having 22 amino acids, CNP-53 having 53 amino acids formed by adding 31 amino acid residues to the N-terminal of CNP-22, or a derivative thereof, and is not particularly limited as long as it has CNP activity. CNP-22 and a derivative thereof are particularly preferable.

(101) The CNP derivative referred to here means one having preferably 1 to 5, more preferably 1 to 3, and yet more preferably 1 or 2 amino acids in the CNP-22 or CNP-53 amino acid sequence deleted, substituted, or added and having CNP activity, or one having a sequence that is at least 85%, preferably at least 90%, and yet more preferably at least 95% homologous to the CNP-22 or CNP-53 amino acid sequence and having CNP activity. The CNP derivative includes, as long as it has CNP activity, one in which the C-terminal of CNP has been amidated, one in which the C-terminal of CNP has been methoxylated, one in which polyethylene glycol has been added to CNP, one in which a sugar chain has been added to CNP, one in which an alkyl chain has been added to CNP, and one in which a fatty acid has been added to CNP. The amino acid sequence of human CNP-22 is shown as the sequence with SEQ ID No: 81 in the present specification. Furthermore, the amino acid sequence of human CNP-53 is shown as the sequence with SEQ ID No: 83 in the present specification.

(102) In the present invention, provided that it has CNP activity, any known CNP can be used. Examples thereof include a CNP derivative disclosed in JP, A, 6-9688, CNP derivatives disclosed as VNP (SEQ ID No: 4) and SEQ ID No: 9 peptides in U.S. Pat. No. 558,310, and CD-NP disclosed in U.S. Pat. No. 6,818,619. Furthermore, the presence or absence of CNP activity may be confirmed easily by known means and, for example, it may be confirmed by testing the growth-inhibitory action for vascular smooth muscle cells or cGMP production activity in NPR-B receptor-expressing cells.

(103) As an active ingredient of the present invention, any of CNP-22, CNP-53, and derivatives thereof can be used, but from the viewpoint of absorbability CNP-22, which has a low molecular weight, is preferable. CNP-22 may be prepared by chemical synthesis or genetic engineering using a human CNP gene, but may be obtained for example from the Peptide Institute, Inc. as CNP-22 (human).

(104) The CNP that can be used in the present invention includes purified natural CNP, recombinant CNP produced by a known genetic engineering method, and CNP produced by a known chemical synthesis method (e.g. a solid-phase synthesis method using a peptide synthesizer). Basic methods such as a gene-recombination technique, a site-specific mutagenesis method, or a PCR technique are publicly known or well known and are described in, for example, Current Protocols In Molecular Biology; John Wiley & Sons (1998), JP, A, 5-207891, etc.

(105) The origin of a natriuretic peptide is not particularly limited as long as it has CNP activity, BNP activity, or ANP activity, but it is preferably mammal (including human)- or bird-derived NP, more preferably human-, monkey-, mouse-, rat-, or pig-derived NP, and particularly preferably human-derived NP.

(106) With regard to amino acids that can be substituted in the ANP derivatives, BNP derivatives, and CNP derivatives, it is desirable to carry out conservative amino acid substitution. Conservative amino acids are classified according to polarity or type of electric charge. For example, nonpolar uncharged type amino acids include glycine, alanine, valine, leucine, isoleucine, proline, etc., aromatic amino acids include phenylalanine, tyrosine, and tryptophan, polar uncharged type amino acids include serine, threonine, cysteine, methionine, asparagine, glutamine, etc., negatively charged amino acids include aspartic acid and glutamic acid, and positively charged amino acids include lysine, arginine, and histidine. As described above, amino acid substitution is desirably carried out such that conservative amino acids belonging to the same class are substituted for each other. However, when another nonpolar uncharged type amino acid is substituted for proline or when proline is substituted for a nonpolar uncharged type amino acid other than proline, it is necessary to note that proline does not have a sterically flexible structure. Furthermore, when another polar uncharged type amino acid is substituted for cysteine or when cysteine is substituted for a polar uncharged type amino acid other than cysteine, it is necessary to note that cysteine can form a disulfide bond with another cysteine.

(107) Moreover, when a natriuretic peptide (NP) is referred to in the present specification, a chimeric peptide of two or more natriuretic peptides (NPs) selected from ANP, BNP, and CNP is also included. That is, when an NP is referred to in the present specification, it also means

(108) a chimeric peptide of 2 or more natriuretic peptides (NPs) selected from ANP, BNP, and CNP, the chimeric peptide forming a cyclic structure via an intramolecular disulfide bond,

(109) the CNP being a peptide selected from the group consisting of CNP-22, CNP-53, a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the CNP-22 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, and a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the CNP-53 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added,

(110) the BNP being a peptide selected from the group consisting of BNP-26, BNP-32, BNP-45, a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the BNP-26 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the BNP-32 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, and a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the BNP-45 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added,

(111) the ANP being ANP-28 or a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the ANP amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, and

(112) the chimeric peptide having CNP activity, BNP activity, or ANP activity, or a derivative thereof.

(113) A preferred chimeric peptide of the natriuretic peptides (NPs) in the present invention is a chimeric peptide of CNP and BNP. That is, it is preferable to use

(114) a chimeric peptide of CNP and BNP, the chimeric peptide forming a cyclic structure via an intramolecular disulfide bond,

(115) the CNP being a peptide selected from the group consisting of CNP-22, CNP-53, a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the CNP-22 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, and a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the CNP-53 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added,

(116) the BNP being a peptide selected from the group consisting of BNP-26, BNP-32, BNP-45, a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the BNP-26 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the BNP-32 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, and a peptide containing any amino acid sequence having 5 or more contiguous amino acids from the BNP-45 amino acid sequence in which any 1 to 5 amino acids have been deleted, substituted, or added, and

(117) the chimeric peptide having CNP activity or BNP activity, or a derivative thereof.

(118) When CNP or BNP is referred to in the present specification, this means either one of CNP or BNP and also means a chimeric peptide of CNP and BNP.

(119) The origin of CNP-22 and CNP-53 is not particularly limited as long as it has CNP activity, but it is preferably mammal (including human)- or bird-derived CNP, more preferably human-, monkey-, mouse-, rat-, or pig-derived CNP, and particularly preferably human-derived CNP. Similarly, the origin of BNP-26, BNP-32, and BNP-45 is not particularly limited as long as it has BNP activity, but it is preferably mammal (including human)- or bird-derived BNP, more preferably human-, monkey-, mouse-, rat-, or pig-derived BNP, and particularly preferably human-derived BNP. Similarly, the origin of ANP-28 is not particularly limited as long as it has ANP activity, but it is preferably mammal (including human)- or bird-derived ANP, more preferably human-, monkey-, mouse-, rat-, or pig-derived ANP, and particularly preferably human-derived ANP.

(120) Furthermore, the derivative of a chimeric peptide of 2 or more NPs selected from ANP, BNP, and CNP referred to here means one having preferably 1 to 5, more preferably 1 to 3, and yet more preferably 1 or 2, amino acids in the NP chimeric peptide amino acid sequence deleted, substituted or added and having CNP activity or BNP activity.

(121) The amino acids that can be substituted in a derivative of a chimeric peptide of natriuretic peptide (NP) derivatives are the same as the amino acids that can be substituted with respect to the ANP derivative, BNP derivative, and CNP derivative.

(122) Furthermore, the derivative of the chimeric peptide of the natriuretic peptide (NP) derivatives includes, as long as it has CNP activity, BNP activity, or ANP activity, one in which the C-terminal of the chimeric peptide of the NPs has been amidated, one in which the C-terminal of the chimeric peptide of the NPs has been methoxylated, one in which polyethylene glycol has been added to the chimeric peptide of the NPs, one in which a sugar chain has been added to the chimeric peptide of the NPs, one in which an alkyl chain has been added to the chimeric peptide of the NPs, and one in which a fatty acid has been added to the chimeric peptide of the NPs.

(123) Furthermore, the amino acid sequence of human ANP peptide represented by SEQ ID No: 1, the amino acid sequence of human BNP peptide represented by SEQ ID No: 41, and the amino acid sequence of human CNP peptide represented by SEQ ID No: 81 have, as shown in FIG. 1, four mutually different sequences separated by three common sequences represented by ‘CFG’, ‘DRI’, and ‘SGLGC’ amino acid sequences respectively. Therefore, as chimeric peptides of 2 or more NPs selected from ANP, BNP, and CNP, in accordance with combinations of these four mutually different sequences, at least 78 types of chimeric peptides represented by SEQ ID No: 2 to 40 and SEQ ID No: 42 to 80 can be cited as examples. It can be expected that these chimeric peptides and derivatives thereof will have properties in common with ANP, BNP, and CNP. That is, these chimeric peptides and derivatives thereof may be used as an active ingredient of the agent for the treatment of alopecia of the present invention.

(124) As described above, in the present invention, a chimeric peptide of any known natriuretic peptides (NPs) or a derivative thereof can be used provided that it has ANP activity, BNP activity, or CNP activity. For example, it may be an aquaretic polypeptide or a natriuretic polypeptide disclosed as ABC-NP, ABC-NP1, BC-NP, etc. in published Japanese translation 2010-502231 of a PCT application, or a chimeric peptide disclosed as BD-NP (SEQ ID No: 1) or CD-NP (SEQ ID No: 2) in U.S. Pat. No. 6,818,619.

(125) The presence or absence of ANP activity, BNP activity, or CNP activity can be easily confirmed by known means, and it can be confirmed by, for example, testing cGMP production activity in NPR-A receptor-expressing cells or NPR-B expressing cells.

(126) All of ANP, BNP, CNP, derivatives of these NPs, and chimeric peptides of 2 or more NPs selected from these NPs are known and may be prepared by chemical synthesis or genetic engineering.

(127) The disease to which the agent for the treatment of alopecia of the present invention is applied is not particularly limited as long as it is so-called alopecia in which hair thins or falls out. The agent for the treatment of alopecia of the present invention may be applied to various types of alopecia.

(128) Examples of alopecia to which the agent for the treatment of alopecia of the present invention can be applied include alopecia areata, androgenetic alopecia, postpartum alopecia, female pattern alopecia, seborrheic alopecia, alopecia pityroides, and senile alopecia; from the viewpoint of the curing effect, alopecia areata, androgenetic alopecia, postpartum alopecia, and female pattern alopecia are preferable, and alopecia areata is particularly preferable.

(129) Androgenetic alopecia may be either androgenetic alopecia in a male or androgenetic alopecia in a female. In accordance with use of the agent for the treatment of alopecia of the present invention, it is possible to regenerate effectively head hair on the frontal region or the crown.

(130) With regard to alopecia areata, it may be any of standard alopecia areata monolocularis, standard alopecia areata multilocularis, alopecia totalis, alopecia universalis, and alopecia ophiasis, and the severity thereof may be any of S1 to S5 and B0 to B2.

(131) The agent for the treatment of alopecia of the present invention exhibits excellent effectiveness and safety as a drug for the treatment of intractable alopecia ophiasis, which is considered to be difficult to cure or put into remission for a long time, and is effective.

(132) The meaning of the terminology and characteristics of the symptoms of these various types of alopecia are as described in the Background Art section above.

(133) The agent for the treatment of alopecia of the present invention contains as an active ingredient an A-type natriuretic peptide (ANP), a B-type natriuretic peptide (BNP), a C-type natriuretic peptide (CNP), a derivative of these natriuretic peptides (NPs), a chimeric peptide of 2 or more NPs selected from these NPs, or a derivative of a chimeric peptide of 2 or more NPs selected from these NPs, and its route of administration and dosage form are not particularly limited.

(134) The agent for the treatment of alopecia of the present invention may, in addition to ANP, BNP, CNP, a derivative of these NPs, a chimeric peptide of 2 or more NPs selected from these NPs, or a derivative thereof, further contain as a combination a steroid drug, an antihistamine drug, a vasodilator, a male hormone activity inhibitor, a female hormone drug, an antibiotic, an antifungal agent, pentadecane, cytopurine (6-benzylaminopurine), t-flavanone, adenosine, cepharanthin, Glycyron (registered trademark), which is a complex of glycyrrhizin, methionine, and glycine, cyclosporin A, Keishikaryukotsuboreito, Hangekobokuto, biotin, Anthralin, or a tricyclic antidepressant, or may be used at the same time as these.

(135) As the steroid drug, diflorasone, betamethasone, dexamethasone, clobetasol, prednisolone, mometasone, methylprednisolone, Deprodone, difluprednate, fluocinonide, amcinonide, triamcinolone, difluprednate, or hydrocortisone is preferable, and betamethasone or clobetasol is particularly preferable.

(136) As the antihistamine drug, azelastine, oxatomide, fexofenadine, emedastine, ebastine, cetirizine, bepotastine, olopatadine, or loratadine is preferable.

(137) As the vasodilator, minoxidil or carpronium chloride is preferable. As the male hormone activity inhibitor, finasteride is preferable.

(138) As the female hormone drug, estrogen, estradiol, or progesterone is preferable.

(139) As the antibiotic, gentamicin is preferable. As the antifungal agent, amphotericin B, nystatin, ketoconazole, terbinafine, flucytosine, fluconazole, itoraconazole, griseofulvin, or micafungin is preferable.

(140) The agent for the treatment of alopecia of the present invention can be made into a preparation by generally used techniques. Examples of the preparation configuration include an external preparation.

(141) The dosage form of the agent for the treatment of alopecia of the present invention is preferably an external preparation (percutaneous absorbent) such as a gel, an ointment, or a liquid.

(142) The external preparation is not particularly limited and the present agent may be directly applied, sprayed, or put as a patch onto a required site (affected part) of the skin. The configuration of the agent for the treatment of alopecia of the present invention is preferably an external preparation such as an ointment, gel, cream, lotion, liquid, spray, gel spray, foam, patch, shampoo, treatment, scalp treatment, or tonic, it is particularly preferably an ointment, gel, cream, or liquid from the viewpoint of simplicity of application, and it is yet more preferably a gel, ointment, or liquid.

(143) These external preparations may be easily obtained in accordance with publicly or well known methods by formulating a natriuretic peptide (NP) as an active ingredient or principal agent, a pharmaceutically acceptable base, and various types of additives as necessary.

(144) The gel (suspension base) may be any of a hydrogel, an anhydrous gel, or a gel formed from a swellable gel-forming material and having a low water content. Furthermore, either a hydrogel base or a lyogel base may be used, but a transparent hydrogel having an inorganic or organic macromolecular base is preferable. In the same way as for a preparation containing an oil or a fat, the gel itself is not absorbed by the skin.

(145) A hydrogel base is free from fat, has a consistency similar to that of an ointment, and aims to increase the percutaneous absorbability of the medicinal agent, and a lyogel base is formed by suspending stearyl alcohol, etc. in propylene glycol to form a gel and has excellent percutaneous absorbability and hygroscopicity. The gel may be used as a gel spray by charging a spray container therewith.

(146) The gel of the present invention may be a gel in which a natriuretic peptide (NP) as an active ingredient is uniformly dispersed in a hydrophilic gel base containing a carboxyvinyl polymer, sodium polyacrylate, sodium polyacrylate, a (vinyl methyl ether/ethyl maleate) copolymer, polymethacrylate, propylene glycol, etc. Examples of such a gel include a gel formed by uniformly dispersing in a commercially available long-lasting water retention agent such as Lubrajel NP, Lubrajel CG, Lubrajel DV, Lubrajel MS, Lubrajel OIL, Lubrajel TW, or Lubrajel DS, which are commercial products from ISP Japan Ltd.

(147) One specific example of the ‘gel’ of the present invention is a gel preparation prepared in accordance with Example 2.

(148) The liquid of the present invention is one in which a natriuretic peptide (NP) as an active ingredient is dissolved in alcohol, propylene glycol, polyethylene glycol, water, etc. as a base, and is preferably a liquid formed from an aqueous solution in which a natriuretic peptide is dissolved in physiological saline. The aqueous solution may contain a small amount of organic base such as alcohol, propylene glycol, or polyethylene glycol in addition to physiological saline.

(149) In this case, in order to ensure the biological utilization rate and provide a more effective liquid preparation, a natriuretic peptide is used as an active ingredient, an acidic solution may be formed by combining it with one type or two or more types from the group consisting of butyric acid, lactic acid, phosphoric acid, glycine, citric acid, hydrochloric acid, propionic acid, butyric acid, benzoic acid, and salts thereof, or a polar organic solution may be formed by combining it with one type or two or more types from the group consisting of an alcohol and/or N-methyl-2-pyrrolidine, dimethylformamide, dimethylsulfoxide, and methylparaben, and the pH may be adjusted to 3.0-7.0.

(150) The ointment preparation of the present invention may be either an oleaginous base or a water-soluble base, and both may easily be obtained in accordance with a known method. An oleaginous base such as Vaseline causes little irritation, has no odor, and is excellent in terms of skin protecting action, softening action, crust removing action, granulation, and epithelization promoting action. The water-soluble base is an ointment mainly containing a Macrogol base and has a strong effect in absorbing and removing aqueous secretions.

(151) One specific example of the ‘ointment’ of the present invention is an ointment prepared in accordance with Example 2.

(152) The cream (emulsion base) may be an oil-in-water base (O/W) (vanishing cream) or a water-in-oil base (W/O) (cold cream). The oil-in-water base has a smaller amount of oil-soluble component than water-soluble component, and has the advantage that when applied the whiteness of the cream seems to disappear. It also spreads well, has a good feeling when used, even on sweaty skin, and has excellent cosmetic aspects. Furthermore, since it has excellent absorbability toward the skin, application to a chronic hypertrophic lesion is good. The water-in-oil base contains a smaller amount of water-soluble component than oil-soluble component and is also called a cold cream since when applied to and spread on the skin it exhibits a cooling action.

(153) The lotion means a liquid external preparation in which a natriuretic peptide is dissolved or uniformly dispersed in a liquid. Since an ointment or a cream sticks to the hair, a lotion is suitable for use on head hair, etc. The configuration of the lotion may be any of a suspension lotion base, an emulsion lotion, and a solution lotion base.

(154) The patch promotes absorption of a medicinal agent by making a component containing a natriuretic peptide adhere to the patch and utilizing the airtightness of the patch. Applying a patch enables scratching to be prevented.

(155) The spray is used by making a solution of a natriuretic peptide and spraying by means of gas pressure or a hand pushing operation. It is convenient when used over a wide area.

(156) The foam is a spray that is released in the form of a foam by making a solution of a natriuretic peptide and adding a surfactant. The foam is excellent in terms of adhesion to the scalp.

(157) The shampoo is a dosage form that has a natriuretic peptide mixed or dissolved in a shampoo and that can apply the medicinal agent at the same time as washing the hair. Since a shampoo is a surfactant, it has an effect in making a natriuretic peptide penetrate into the scalp. In seborrheic alopecia in particular, a shampoo is advantageous since it can also remove excessive sebum.

(158) The treatment is a dosage form that has a natriuretic peptide mixed or dissolved in a treatment used when washing hair and that can apply the medicinal agent at the same time as treatment being carried out. The treatment can supplement moisture and oil content in the scalp at the same time as application of the medicinal agent. In alopecia pityroides in particular, a treatment is advantageous since it can also moisturize and supplement the oil content in the scalp at the same time as application of the medicinal agent.

(159) The scalp treatment is a treatment agent in which a component designed to moisturize or supplement the oil content in the scalp is particularly formulated. A scalp treatment often contains various plant extract components such as rosemary extract, soapberry extract, or coconut extract.

(160) The tonic may be prepared by adding a natriuretic peptide to 50% to 70% alcohol and water as a substrate, a component having an action of keeping head hair and the scalp healthy such as hinokitiol, panthenol, or Swertia Japonica extract, and dipotassium glycyrrhizinate, which exhibits a female hormone-like action, together with a microbicidal agent, a moisturizing component such as glycerol, salicylic acid, which makes it easy to remove dandruff, menthol, which prevents itchiness and gives a refreshing feel, a fragrance, etc. A tonic is advantageous as a dosage form of an agent for the treatment of alopecia that is often accompanied by itchiness since it is a dosage form that is used after washing hair in order to prevent dandruff and head odor, maintain the cleanliness of head hair, prevent itchiness and perspiration damage, and remove unpleasant symptoms related to head hair.

(161) As described above, the agent for the treatment of alopecia of the present invention is a percutaneous external preparation formed by formulating appropriate amounts of a natriuretic peptide, various types of base, and additives as necessary. In order to exhibit efficacy as an external preparation, the way in which the natriuretic peptide as an active ingredient applied to the skin surface reaches a lesion area at an effective concentration and is maintained is important. Therefore, the dosage form and the base may be selected appropriately according to the symptoms or the patient.

(162) Furthermore, an additive may be used as appropriate according to the intended application. As the additive, those below can be used.

(163) Vaseline: may be used as a base of an ointment preparation. Its viscosity and consistency changes depending on temperature and the hardness varies between winter and summer, but it is one of the safest bases. There are yellow Vaseline and white Vaseline, which has a high degree of purification, and either may be used.

(164) Propylene glycol: may be used as a solvent for a drug, a solution adjuvant, or a base.

(165) Paraffin: may be used when the consistency of an ointment is adjusted. Since it is comparatively easy to emulsify, it may be used as an oleaginous agent in production of a cream.

(166) Beeswax (white beeswax): processed beehive wax, and may be used as a Japanese Pharmacopoeia simple ointment by formulating with a plant oil. White beeswax is formed by bleaching beeswax so as to improve color and odor.

(167) Macrogol: a mixture of polyethylene glycols having different molecular weights. It has excellent solubility and miscibility for a medicinal agent, absorbs water well, and is therefore suitable when absorbing and removing a liquid leached out from the mucous membrane or the affected lesion area.

(168) Stearyl alcohol: may be used in an emulsion lotion.

(169) Isopropanol: may be used as a solvent, a solution adjuvant, etc.

(170) Benzyl alcohol: may be used as a solution adjuvant, a preservative, etc.

(171) Parahydroxybenzoic acid esters (parabens): may be used as an antiseptic, a preservative, or a stabilizer.

(172) Gelled hydrocarbon: generally called a ‘Plastibase’ and formed by gelling (semi-solidifying) liquid paraffin using polyethylene.

(173) Citric acid and sodium citrate: may be used as a buffer or a pH adjusting agent.

(174) Squalene: used as a base and has a slightly less oily feel and less stickiness than liquid paraffin. It can be used widely in emulsion lotions as well as in creams.

(175) Lanolins: fats obtained from sheep wool, useful for improvement of skin suppleness although they have a problem with color and odor.

(176) Glycerol: may be formulated into a cream, etc. as a moisturizing agent.

(177) Polyoxyethylene hardened castor oil: may be used as an emulsifying agent, a solubilizing agent, etc.

(178) Sorbitan fatty acid ester and glycerol fatty acid ester: may be used as an emulsifying agent, etc.

(179) The agent for the treatment of alopecia of the present invention may further contain a moisturizing agent (skin softening agent), a symptom-relieving agent, etc., which are described below.

(180) Moisturizing agent (skin softening agent): a moisturizing agent provides moisture and oil to the skin. A moisturizing agent is most effective if it is used when the skin is already wet, as is the case immediately after a bath or shower. Components contained in the moisturizing agent are glycerol, mineral oil, Vaseline, etc. With regard to the form and type of the moisturizing agent, there is a lotion, a cream, an ointment, a bath oil, etc. One containing urea, lactic acid, or glycolic acid is excellent in terms of moisturizing effect.

(181) Symptom-relieving agent: many skin diseases are accompanied by itchiness. Itchiness and a slight degree of pain can be relieved by formulating a sedative, specific examples thereof including camomile, eucalyptus, camphor, menthol, zinc oxide, talc, glycerol, and Calamine. In order to suppress itchiness due to allergy, an antihistamine agent such as diphenhydramine may be added.

(182) As hereinbefore described, when producing the agent for the treatment of alopecia of the present invention, various types of base, moisturizing agent, UV absorbing agent, alcohol, chelate, pH adjusting agent, antiseptic, thickener, colorant, fragrance, filler, excipient, disintegrant, extending agent, binder, film-forming agent, solubilizing agent, suspending agent, buffer, stabilizer, preservative, surfactant, antioxidant, dispersant, emulsifying agent, solvent, solution adjuvant, etc. may be formulated in any combination. Furthermore, in addition to a natriuretic peptide, which is the main medicinal component, various types of medicinal agents such as an anti-inflammatory and analgesic agent, a microbicidal agent, a vitamin, and a skin softening agent may be appropriately formulated as necessary.

(183) When the skin external preparation composition of the present invention is used as a skin texture improvement agent, it may be used as a skin care cosmetic or a quasi-drug, and specific examples of the application form include a cream, a foam, a cosmetic lotion, a pack, a skin softener, an emulsion, a foundation, a makeup base, an essence, a soap, a liquid washing agent, a bath agent, a sunscreen cream, a sun oil, and a spray type liquid. All thereof may be produced easily by applying a publicly or well known preparation technique.

(184) As representative preparation examples of the present agent for the treatment of alopecia, production of a gel, an ointment, and a liquid is now explained.

(185) A gel may be obtained, in accordance with a publicly or well known method, by dissolving an appropriate amount of natriuretic peptide in distilled water or physiological saline to give an aqueous solution, and mixing and stirring this with a publicly or well known gel base. When the concentration of the natriuretic peptide is no greater than 1 μg/g, the effect is not sufficient, and a sufficient effect can be obtained without formulating it over 1000 μg/g. Preparation is carried out such that the final concentration of the natriuretic peptide in the gel is preferably 1 to 1000 μg/g, more preferably 10 to 500 μg/g, yet more preferably 20 to 300 μg/g, even more preferably 30 to 200 μg/g, and particularly preferably 50 to 100 μg/g.

(186) Examples of a gel base formed from a macromolecular inorganic component include hydrated or water-absorbing silicates such as aluminum silicate, for example bentonite, magnesium aluminum silicate, and colloidal silica. As a gel base formed from a macromolecular organic material, a natural, semi-synthetic, or synthetic polymer may be used. Examples of the natural and semi-synthetic polymers include polysaccharides such as cellulose, starch, tragacanth, gum arabic, xanthan gum, agar-agar, gelatin, alginic acid, a salt thereof such as sodium alginate, and a derivative thereof, a lower alkyl cellulose such as methylcellulose or ethylcellulose, and a carboxy- or hydroxy-lower-alkyl cellulose such as carboxymethylcellulose or hydroxypropylcellulose. Examples of the synthetic gel base include polyvinyl alcohol, polyvinylpyrrolidone, polyacrylic acid, and polymethacrylic acid. Furthermore, a gel base formed by carrying out uniform dispersion in a commercially available long-lasting water retention agent such as Lubrajel NP, Lubrajel CG, Lubrajel DV, Lubrajel MS, Lubrajel OIL, Lubrajel TW, or Lubrajel DS, which are commercial products from ISP Japan Ltd., may be used. With regard to these gel bases, one type thereof or a gel base mixture of two or more types thereof may be used.

(187) The ointment (Vaseline preparation) may be obtained, in accordance with a publicly or well known method, by dissolving an appropriate amount of natriuretic peptide in distilled water or physiological saline to give an aqueous solution, and mixing and stirring this with a publicly or well known Vaseline. When the concentration of the natriuretic peptide is no greater than 1 μg/g, the effect is not sufficient, and a sufficient effect can be obtained without formulating it over 1000 μg/g. Preparation is carried out so that the final concentration of the natriuretic peptide in the ointment is preferably 1 to 1000 μg/g, more preferably 10 to 500 μg/g, yet more preferably 20 to 300 μg/g, even more preferably 30 to 200 μg/g, and particularly preferably 50 to 100 μg/g.

(188) The liquid may be prepared by, for example, dissolving as a main agent 0.01 mg to 10 mg of human ANP (1-28) (Peptide Institute, Inc.), human BNP-32 (Peptide Institute, Inc.), or human CNP-22 (Peptide Institute, Inc.) in 10 mL of physiological saline, thus giving a liquid having a natriuretic peptide concentration of 1 to 1000 μg/g. Since the specific gravity of water is 1, in this case the ANP concentration, the BNP concentration, and the CNP concentration are 1 to 1000 μg/g ratio by weight. When the concentration of the natriuretic peptide is no greater than 1 μg/g, the effect is not sufficient, and a sufficient effect can be obtained without formulating it over 1000 μg/g. The concentration of the natriuretic peptide in the aqueous solution preparation is preferably 1 to 1000 μg/g, more preferably 10 to 500 μg/g, yet more preferably 20 to 300 μg/g, even more preferably 30 to 200 μg/g, and particularly preferably 50 to 100 μg/g.

(189) A percutaneous absorption adjuvant may be added as desired. Examples of the percutaneous absorption adjuvant include acetic acid, sodium acetate, limonene, menthol, salicylic acid, hyaluronic acid, oleic acid, N,N-diethyl-m-toluamide, n-butyl stearate, benzyl alcohol, isopropyl myristate, isopropyl palmitate, polypropylene glycol, crotamiton, diethyl sebacate, N-methylpyrrolidone, N-ethylpyrrolidone, and lauryl alcohol. Furthermore, an antiseptic, an antioxidant, etc. may be added as desired.

(190) The concentration of the natriuretic peptide in the present agent for the treatment of alopecia may be selected as appropriate while taking into consideration symptoms, age, dosage form, etc. The concentration of the natriuretic peptide is preferably 1 to 1000 μg/g relative to the external preparation such as a liquid, a gel, an ointment, or a lotion, more preferably 10 to 500 μg/g, yet more preferably 20 to 300 μg/g, even more preferably 30 to 200 μg/g, and particularly preferably 50 to 100 μg/g. It is preferable to use one with a concentration of 20 to 100 μg/g for a young patient or a patient with weak skin. Since the solution used in the liquid of the present invention has a specific gravity of substantially 1, when the concentration of ANP, BNP, or CNP in the liquid is expressed using units of μg/g, it has the same meaning as that when the concentration of the natriuretic peptide is expressed using units of μg/mL.

(191) Administration of the present agent for the treatment of alopecia depends on symptoms, age, agent form, etc., but it is typically twice a day and the period of administration is from 7 days to 28 days. In the case of alopecia in the chronic stage where symptoms are fixed, it is desirable to carry out administration for about 28 days, but in the acute stage administration for about 7 days is sufficient. In general, it is desirable to carry out administration for at least 14 days for an adult but administration for about 7 days is sufficient for a minor.

(192) The present invention is explained below by reference to Examples, but the present invention is in no way limited to these Examples, etc.

EXAMPLES

Example 1

(193) Diagnosis and evaluation of test subjects.

(194) First, prior to administration of a natriuretic peptide preparation, diagnosis and evaluation of test subjects were carried out. Methods for the diagnosis and evaluation of test subjects were as follows.

(195) 1. Diagnosis of Test Subject;

(196) The test subjects were patients with alopecia areata, androgenetic alopecia, postpartum alopecia, female pattern alopecia, alopecia pityroides, and senile alopecia. Diagnosis and treatment of these test subjects were carried out by the present inventors as physicians.

(197) 2. Evaluation of Symptoms;

(198) Clinical classification of alopecia was carried out in accordance with the Classification of the Japanese Dermatological Association, and evaluation of the severity of alopecia areata was carried out in accordance with the above-mentioned ‘USA Alopecia Areata Evaluation Guidelines’, the area of hair loss being classified using 6 grades of S0 to S5 and the hair loss site being classified using 3 grades of B0 to B2.

(199) 3. Test Method;

(200) In general, in order to confirm the effect of an external medicine in an individual case, a method involving separate left and right applications is desirable. The separate left and right application method is a method in which, for example, an external medicine containing an active ingredient to be tested is applied to the left-hand side of an affected site, and an external medicine not containing the active ingredient is applied to the right-hand side, thus enabling a therapeutic effect to be confirmed. With regard to the test of the preparation of the present invention, a preparatory test was carried out in accordance with the separate left and right applications method. However, taking into consideration medical ethics, the preparatory test in accordance with the separate left and right applications method was minimized, and when a preparatory test was not carried out, a therapeutic effect was evaluated by comparison between that before application and that after application.

Example 2

(201) 1. Production of Gel

(202) Preparation of a gel containing an NP as an active ingredient was carried out by weighing, as a main agent, 3 mg of any one of human ANP(1-28) (Peptide Institute, Inc.), human BNP-32 (Peptide Institute, Inc.), and human CNP-22 (Peptide Institute, Inc.), dissolving this in 3 mL of purified water to give an NP solution having a concentration of 1000 μg/mL, and mixing 1 mL of this solution with 9 g of Lubrajel NP (ISP Japan Ltd.) by uniform stirring, thus giving an ANP gel, a BNP gel, and a CNP gel having a concentration of 100 μg/g.

(203) Similarly, 500 μL of the NP solution having a concentration of 1000 μg/mL obtained above was diluted with 500 μL of physiological saline to thus adjust the concentration to 500 μg/mL, and 1 mL of this solution was mixed with 9 g of Lubrajel NP (ISP Japan Ltd.) by uniformly stirring, thus giving an ANP gel, a BNP gel, and a CNP gel having a concentration of 50 μg/g.

(204) 2. Production of Ointment (Vaseline Preparation)

(205) Preparation of an ointment (Vaseline preparation) containing an NP as an active ingredient was carried out by weighing, as a main agent, 3 mg of any one of human ANP(1-28) (Peptide Institute, Inc.), human BNP-32 (Peptide Institute, Inc.), and human CNP-22 (Peptide Institute, Inc.), dissolving this in 3 mL of physiological saline to give an NP solution having a concentration of 1000 μg/mL, and mixing 1 mL of this solution with 9 g of Japanese pharmacopoeia white Vaseline by uniform stirring at high speed, thus giving an ANP ointment, a BNP ointment, and a CNP ointment having a concentration of 100 μg/g.

(206) Similarly, 500 μL of the NP solution having a concentration of 1000 μg/mL obtained above was diluted with 500 μL of physiological saline to thus adjust the concentration to 500 μg/mL, and 1 mL of this solution was mixed with 9 g of Japanese pharmacopoeia white Vaseline by uniformly stirring at high speed, thus giving an ANP ointment, a BNP ointment, and a CNP ointment having a concentration of 50 μg/g.

(207) Similarly, 300 μL of the BNP solution having a concentration of 1000 μg/mL obtained above was diluted with 700 μL of physiological saline to thus adjust the concentration to 300 μg/mL, and 1 mL of this solution was mixed with 9 g of Japanese pharmacopoeia white Vaseline by uniformly stirring at high speed, thus giving a BNP ointment having a concentration of 30 μg/g.

(208) 3. Production of BNP:Betamethasone:Gentamicin Combination

(209) Preparation of a BNP, betamethasone, and gentamicin combination was carried out by mixing Dermosol (trademark) G lotion (Dermosol-G Lotion) manufactured by Iwaki Seiyaku Co., Ltd. with the BNP gel obtained in ‘1. Production of gel’ above at equal volumes. In the present specification, this is called a BNP:betamethasone:gentamicin combination. Since Dermosol G lotion contains betamethasone valerate at a concentration of 1200 μg/mL and gentamicin sulfate at a concentration of 1000 μg/mL, mixing the CNP gel having a concentration of 100 μg/g and Dermosol G lotion at a 1:1 ratio by volume gave a combination containing CNP at a concentration of 50 μg/g, betamethasone valerate at a concentration of 600 μg/mL, and gentamicin sulfate at a concentration of 500 μg/mL. In the present specification, this is called a 50 μg/g BNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination.

(210) 4. Production of CNP:Betamethasone:Gentamicin Combination

(211) Preparation of a CNP, betamethasone, and gentamicin combination was carried out by mixing Dermosol (trademark) G lotion (Dermosol-G Lotion) manufactured by Iwaki Seiyaku Co., Ltd. with the CNP gel obtained in ‘1. Production of gel’ above at equal volumes. In the present specification, this is called a CNP:betamethasone:gentamicin combination. Since Dermosol G lotion contains betamethasone valerate at a concentration of 1200 μg/mL and gentamicin sulfate at a concentration of 1000 μg/mL, mixing the CNP gel having a concentration of 100 μg/g and Dermosol G lotion at a 1:1 ratio by volume gave a combination containing CNP at a concentration of 50 μg/g, betamethasone valerate at a concentration of 600 μg/mL, and gentamicin sulfate at a concentration of 500 μg/mL. In the present specification, this is called a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination

(212) Similarly, mixing the CNP gel having a concentration of 50 μg/g and Dermosol G lotion at a 1:1 ratio by volume gave a combination containing CNP at a concentration of 25 μg/g, betamethasone valerate at a concentration of 600 μg/mL, and gentamicin sulfate at a concentration of 500 μg/mL. In the present specification, this is called a 25 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination.

(213) 5. Production of BNP:Clobetasol Combination

(214) A combination of BNP and clobetasol propionate was prepared by mixing Dermovate (trademark) Scalp Lotion 0.05% (Dermovate Scalp Lotion 0.05%) manufactured by GlaxoSmithKline plc and the BNP gel obtained in ‘1. Production of gel’ above at equal volumes. In the present specification, this is called a BNP:clobetasol combination. Since Dermovate Scalp Lotion 0.05% contains clobetasol propionate at a concentration of 500 μg/g, mixing the BNP gel having a concentration of 100 μg/mL and Dermovate Scalp Lotion 0.05% at a 1:1 ratio by volume gave a combination containing BNP at a concentration of 50 μg/mL and clobetasol propionate at a concentration of 250 μg/g. In the present specification, this is called a 50 μg/mL BNP:250 μg/g clobetasol combination.

(215) 6. Production of CNP:Clobetasol Combination

(216) A combination of CNP and clobetasol propionate was prepared by mixing Dermovate (trademark) Scalp Lotion 0.05% (Dermovate Scalp Lotion 0.05%) manufactured by GlaxoSmithKline plc and the CNP gel obtained in ‘1. Production of gel’ above at equal volumes. In the present specification, this is called a CNP:clobetasol combination. Since Dermovate Scalp Lotion 0.05% contains clobetasol propionate at a concentration of 500 μg/g, mixing the CNP gel having a concentration of 100 μg/mL and Dermovate Scalp Lotion 0.05% at a 1:1 ratio by volume gave a combination containing CNP at a concentration of 50 μg/mL and clobetasol propionate at a concentration of 250 μg/g. In the present specification, this is called a 50 μg/mL CNP:250 μg/g clobetasol combination.

(217) 7. Production of CNP:Carpronium Chloride Combination

(218) A combination of CNP and carpronium chloride was prepared by mixing Calpranin (trademark) solution 5% (Calpranin) manufactured by Taiyo Pharmaceutical Industry Co., Ltd. with the CNP gel obtained in ‘1. Production of gel’ above at equal volumes. In the present specification, this is called a CNP:carpronium chloride combination. Since the Calpranin solution 5% contains carpronium chloride at a concentration of 50 mg/mL, mixing the CNP gel having a concentration of 100 μg/mL and the Calpranin solution 5% at a 1:1 ratio by volume gave a combination containing CNP at a concentration of 50 μg/mL and carpronium chloride at a concentration of 50 mg/mL. In the present specification, this is called a 50 μg/mL CNP gel:50 mg/mL carpronium chloride combination.

Example 3

(219) 1. Diagnosis and Treatment of Test Subjects

(220) Prior to administration of the ANP gel, BNP gel, CNP gel, BNP ointment, and CNP ointment of the present invention, as is routine for dermatological diagnosis and treatment, the test subjects were interviewed regarding age, gender, history of disease, and family history of disease; when an allergic predisposition was suspected, a scratch test against the main allergens and an evaluation thereof were carried out. In dermatological diagnosis and treatment, since there are a relatively large number of patients who have strong immunoreactivity toward a specific allergen, or a disease such as atopic dermatitis that is suspected to be related to having an allergic predisposition, in order to assist diagnosis, an interview with respect to family history and previous history of allergic disease in addition to gender and age, and a scratch test toward the main allergens, are widely carried out as simple supplemental test methods.

(221) With regard to evaluation of the results of the scratch test, when a reactivity of 1+ or above is exhibited toward any allergen, there can be said to be a more or less allergic predisposition. In the case of patients who come to the dermatology department, many show a reactivity of 1+ or 2+ toward some allergens in the scratch test, and there are only few patients who do not show any reactivity toward any of the allergens. Since the scratch test is a simple test for estimating the presence or absence of an allergic predisposition, it cannot precisely evaluate whether or not there is allergic predisposition but, empirically, if a reactivity of 2+ is shown for a specific allergen, the relationship with an immune disease should be noted when carrying out diagnosis.

(222) Table 1 to Table 23 show the results of interviews with the test subjects and the results of the scratch test together with evaluation of the diagnostic findings and symptoms of the test subjects carried out in [Example 1] above.

(223) The therapeutic effects of the agent for the treatment of alopecia of the present invention on each alopecia are summarized in the Tables as follows.

(224) Therapeutic Effect on Alopecia Areata:

(225) ANP: Table 1, Table 2

(226) BNP: Table 3-1, Table 3-2

(227) CNP: Table 4, Table 5, Table 6, Table 7-1

(228) BNP:betamethasone:gentamicin combination: Table 7-2

(229) CNP:betamethasone:gentamicin combination: Table 7-3

(230) Therapeutic Effect on Androgenetic Alopecia:

(231) ANP: Table 8

(232) BNP: Table 9-1, Table 9-2

(233) CNP: Table 10-1, Table 10-2

(234) CNP:betamethasone:gentamicin combination: Table 10-3

(235) CNP:clobetasol combination: Table 10-4

(236) CNP:carpronium chloride combination: Table 10-5

(237) Multilayer application of CNP gel and minoxidil: Table 10-6

(238) Multilayer application of BNP gel and minoxidil: Table 10-7

(239) Therapeutic Effect on Postpartum Alopecia:

(240) ANP: Table 10-8

(241) BNP: Table 10-9

(242) CNP: Table 11-1

(243) Therapeutic Effect on Female Pattern Alopecia:

(244) BNP: Table 11-2

(245) CNP: Table 12

(246) Therapeutic Effect on Seborrheic Alopecia:

(247) ANP: Table 13

(248) BNP: Table 14

(249) Therapeutic Effect on Alopecia Pityroides:

(250) ANP: Table 15

(251) BNP: Table 16

(252) CNP: Table 17, Table 18

(253) Therapeutic Effect on Senile Alopecia:

(254) ANP: Table 19

(255) BNP: Table 20

(256) CNP: Table 21

(257) Therapeutic Effect on Cancer Chemotherapy Drug-Induced Alopecia:

(258) BNP: Table 22

(259) CNP: Table 23

(260) The ‘non-recurrence period’ referred to here means the period during which the symptoms did not recur even when treatment with the preparation of the present invention was discontinued after the symptoms had been relieved. In order to carry out evaluation objectively, photographs before and after application of the NP preparation were recorded in all cases. Photographs of some of these cases are shown in the drawings.

Example 4

(261) 2. Therapeutic Effect of ANP Gel on Alopecia Areata

(262) The therapeutic effects of the ANP gel on alopecia areata are shown in Table 1 (cases A1 to A5) and Table 2 (cases A6 and A7).

(263) TABLE-US-00001 TABLE 1 Case A1 A3 A5 (=C5) A2 (=C15) A4 (=B3) FIG. FIG. 7 FIG. 8-1 FIG. 9 FIG. 10 FIG. 8-2 Gender Female Female Female Male Male Age 33 years old 33 years old 52 years old 32 years old 16 years old When developed 13 years old 31 years old 51 years old 1 month earliar 7 years old Hair loss range S3 S3 S3 S1 S3 Treatment site Right temporal Right temporal Right temporal Left temporal Right temporal region region, back of region region, crown, region the head, crown right temporal region Hair loss site Eyebrows (B1) None (B0) None (B0) None (B0) Eyebrows, lower other than head limbs (B1) Family history None None None None None of alopecia Family history Mother: atopic None None None None of immune dermatitis disease Older sister: atopic dermatitis, allergic rhinitis Previous history Atopic None Allergic Atopic Atopic dermatitis, rhinitis dermatitis, dermatitis atopic alopecia allergic rhinitis Scratch Test House dust: 2+ House dust: 2+ House dust: 1+ House dust: 2+ House dust: 3+ Mite: 1+ Mite: 3+ Mite: — Mite: 3+ Mite: 3+ Cedar: — Cedar: 3+ Cedar: 2+ Cedar: 2− Cedar: — Dactylis: 2+ Dactylis: 2+ Dactylis: 1+ Dactylis: 2+ Dactylis: 2+ Ragweed: 2+ Ragweed: 2+ Ragweed: 1+ Ragweed: 2+ Ragweed: 1+ Effect of Not applied Not applied Not applied Not applied Not applied minoxidil Effect of No effect No effect Unknown Not applied No effect steroid drug Effect of No effect Not applied Not applied Not applied Not applied cooling therapy Antiallergic Not applied Not applied Not applied Not applied Not applied drug Effect of Not applied No effect No effect Not applied Not applied carpronium chloride Effect of Not applied No effect Not applied Not applied Not applied cepharanthin Dosage form ANP gel ANP gel ANP gel ANP gel ANP gel (changed to ANP gel after 2 weeks' application of CNP ointment) Dose 100 μg/g 100 μg/g 100 μg/g 100 μg/g 100 μg/g Number of days 21 days 5 weeks 5 weeks 4 weeks 21 days used Degree of S3.fwdarw.S3 S3.fwdarw.S3 S3.fwdarw.S2 S1.fwdarw.S0 S3.fwdarw.S3 improvement in symptoms Non-recurrence Insufficient Insufficient Treatment 2 weeks No effect period effect effect continuing
Case A1

(264) The test subject was a 33 year old female and was a patient with severe alopecia areata for which the hair loss range was S3 and which, other than the head, was accompanied by B1 hair loss of the eyebrows. There was a previous history of atopic dermatitis, and coexisting alopecia due to exacerbation of atopic dermatitis. The results of the scratch test were house dust 2+, mite 1+, Dactylis 2+, and ragweed 2+. This test subject showed erythema and pityriatic scale accompanied by itching in the scalp of the hair loss site, and there was coexisting alopecia pityroides. For this test subject, a circular bald area had appeared at the age of 13 and also in the crown at the age of 14, and it had then become alopecia totalis in half a month. Following this, the symptoms of the test subject had fluctuated, and alopecia had extended to the entire body at the age of 15. External and orally administered steroid had not given any therapeutic effect at all with this test subject. This test subject had continued to receive stimulation therapy with liquid nitrogen, but there had been hardly any therapeutic effect. This test subject was the same test subject as that of case C5.

(265) When 100 μg/g ANP gel was applied to the entire bald area on the right temporal region of this test subject twice a day for 3 weeks, growth of vellus hair was observed, but erythema and pityriatic desquamation of the scalp were not relieved and there was itching.

(266) Case A2

(267) The test subject was a 33 year old female and was a patient with severe alopecia areata having a hair loss range of S3. The results of the scratch test were house dust 2+, mite 3+, cedar 3+, Dactylis 2+, and ragweed 2+. This test subject had been affected by alopecia areata 2 years earlier and had two bald patches, which had cured spontaneously. This time, after stress in the workplace had continued for about 1 month half a year earlier, a bald area had appeared on the right temporal region, the back of the head, and the crown. This test subject had for 6 months been subjected to external steroid treatment, application of carpronium chloride, and orally administered cepharanthin, but there had been no change at all.

(268) When 100 μg/g ANP gel was applied to the bald area on the right temporal region, the back of the head, and the crown of this test subject twice a day, hair growth was clearly confirmed in 1 week, and growth of short black hair was observed over a wider area in 2 weeks, but in terms of subjective symptoms felt by the test subject there was still a large amount of hair falling out. The rate of growth of hair after the ANP gel was applied to this test subject was slow, and there was no formation of terminal hair. A photograph of the bald area before application and a photograph of the bald area after 100 μg/g ANP gel was applied twice a day for 5 weeks are shown in FIG. 7. In the case of this test subject, although vellus hair growth was observed, formation of terminal hair was not seen, and the hair did not become long.

(269) Case A3

(270) The test subject was a 52 year old female and was a patient with severe alopecia areata having a hair loss range of S3. There was a previous history of allergic rhinitis. The results of the scratch test were house dust 1+, cedar 2+, Dactylis 1+, and ragweed 1+. A bald patch had appeared on the frontal region of this test subject about 1 year earlier when doing continuous night shifts, following this there had been a tendency for enlargement, and multiple bald areas had appeared over the entire scalp. Application of carpronium chloride to the bald patch had continued for 8 months, but the hair loss range had only enlarged and there had been no therapeutic effect. This test subject was a case in which there were no inflammatory symptoms such as erythema, crust, or scale on the scalp of the hair loss area. This test subject was the same test subject as the test subject of case C15.

(271) When 100 μg/g CNP ointment was applied to the entire bald area of the right temporal region of this test subject twice a day, hair growth was confirmed in 1 week, further marked hair growth was observed in 2 weeks, and enlargement of the bald area stopped completely. Application of the CNP ointment was stopped after 14 days, from the next day after that 100 μg/g ANP gel was applied twice a day with the expectation of further effects, and the therapeutic effect of the CNP ointment continued as it was; currently, with 5 weeks elapsed after the treatment with CNP ointment started, although application of the ANP gel is continuing, thickening of terminal hair and enlargement of the hair growth area can be seen (Ref. FIG. 8-1 and FIG. 8-2). This test subject could not be subjected to continuing treatment thereafter, and the bald area remained.

(272) Case A4

(273) The test subject was a 32 year old male and was a patient with alopecia areata having a hair loss range of S1. There was a previous history of atopic dermatitis and allergic rhinitis. The results of the scratch test were house dust 2+, mite 3+, cedar 2+, Dactylis 2+, and ragweed 2+. A bald area, triggered by mental stress, had appeared in the left temporal region of this test subject 1 month earlier, and following this bald areas had been observed in the crown and the right temporal region. This was accompanied by itching.

(274) When 100 μg/g ANP gel was applied to the entire bald area of this test subject twice a day, hair growth was confirmed in 1 week on all of the left temporal region, the crown, and the right temporal region. Following this, there was a cure 4 weeks after starting application. Currently, with 2 weeks elapsed after application of the ANP gel was stopped after 4 weeks, there is no recurrence of the bald patch (Ref. FIG. 9). However, application of the ANP gel to this test subject did not grow hair at the hair line on the back of the head.

(275) Case A5

(276) The test subject was a 16 year old male and was a patient with alopecia ophiasis type alopecia areata having a hair loss range of S3, which was said to be intractable. This test subject was also affected by atopic dermatitis. The results of the scratch test were house dust 3+, mite 3+, Dactylis 2+, and ragweed 1+. This test subject had been subjected to surgical removal of the adenoids and palatine tonsils at the age of 6, alopecia areata had occurred from the age of 7, and hair loss was also observed in the eyebrows and lower limbs in addition to the head. This test subject had not been cured by internal or external use of a steroid. Invasive erythema and scale accompanied by itching were observed on the scalp of the hair loss site of this test subject. This test subject was the same test subject as the test subject of case B3.

(277) When 100 μg/g ANP gel was applied to the entire bald area of the right temporal region of this test subject twice a day for 3 weeks, the erythema seemed to be relieved slightly, but short terminal hair remaining around the hair loss area fell out and the hair loss range was somewhat enlarged (Ref. T1 of FIG. 10).

(278) TABLE-US-00002 TABLE 2 Case A6 A7 (=C3, C4) (=C6) FIG. FIG. 11 Gender Female Female Age 50 years old 22 years old When developed 40 years old >1.5 years earlier Hair loss range S2 S3 Treatment site Crown Frontal region, temporal region ophiasic loss area Hair loss site other None (B0) Eyebrows (B1) than head Family history of Mother: alopecia None alopecia areata Family history of Child: allergic Grandfather: atopic immune disease rhinitis, chronic dermatitis urticaria Mother, older brother, older sister: allergic rhinitis Previous history Atopic dermatitis, Atopic dermatitis, allergic rhinitis allergic rhinitis Scratch Test House dust: 1+ House dust: 2+ Mite: 1+ Mite: 3+ Cedar: — Ceder: — Dactylis: 2+ Dactylis: 1+ Ragweed: 1+ Ragweed: — Effect of minoxidil Not applied Not applied Effect of steroid No effect No effect drug Effect of cooling Not applied Not applied therapy Antiallergic drug No effect No effect Effect of carpronium No effect Not applied chloride Effect of Not applied Not applied cepharanthin Dosage form ANP gel ANP gel Dose 100 μg/g 50 μg/g Number of days used 14 days 3 days Degree of S2.fwdarw.S2 S3.fwdarw.S3 improvement in symptoms Non-recurrence No effect No effect period
Case A6

(279) The test subject was a 50 year old female and was a patient with severe alopecia areata multilocularis having a hair loss range of S2. There was a previous history of atopic dermatitis and allergic rhinitis. The mother of the subject had a history of alopecia areata, and a child was affected by allergic rhinitis and chronic urticaria. The results of the scratch test were house dust 1+, mite 1+, Dactylis 2+, and ragweed 1+. Erythema and pityriatic scale accompanied by itching were observed on the scalp of the hair loss site of this test subject, and there was coexisting alopecia pityroides. This test subject had been affected by alopecia areata multilocularis 10 years earlier, and there had been repeated partial remission and recurrence of alopecia areata. When this test subject became busy at work, the symptoms of alopecia tended to deteriorate. There had been no effect from the external use of steroid and carpronium chloride and an orally administered antiallergy drug for 6 months. This test subject was the same test subject as the test subject of case C3 and case C4.

(280) 100 μg/g ANP gel was applied to the multiple bald areas on the crown of this test subject for 2 weeks, but there was no effect, rough scale increased, erythema appeared, itchiness occurred, the amount of hair falling out increased, and the hair loss range enlarged somewhat (Ref. FIG. 11).

(281) Case A7

(282) The test subject was a 22 year old female and was a patient with severe alopecia ophiasis type alopecia areata having a hair loss range of S3, which was said to be intractable. This test subject had a previous history of atopic dermatitis and allergic rhinitis. A grandfather of this test subject was affected by atopic dermatitis, and the father, the mother, and the brother were affected by allergic rhinitis. The results of the scratch test were house dust 2+, mite 3+, and Dactylis 1+. This test subject had been affected by a bald area more than one and half years earlier, and a band-shaped bald area in a state in which hair did not grow at all was observed with a clear border along the outside edge of the part where hair was growing. Erythema, scale, crust, and inflammatory symptoms that seemed to be due to atopic alopecia were observed on the hair loss site of this test subject, and were accompanied by itching. This test subject had hair loss on the eyebrows in addition to the head. The skin of this test subject was in an erythrodermic state, which seemed to be due to steroid rebound, and redness and infiltration were observed on the skin of the entire body including the scalp. There had been no therapeutic effect at all on this test subject from treatment with a steroid and an antiallergy drug. This test subject was the same test subject as the test subject of case C6.

(283) 50 μg/g ANP gel was applied to the entire bald area of this test subject twice a day for 3 days, but there was no improvement in redness or itching, redness appeared on the scalp somewhat, and there was no sign of hair growth.

(284) 3. Therapeutic Effect of BNP Gel on Alopecia Areata

(285) The therapeutic effects of BNP gel are shown in Table 3-1 (cases B1 to B4 and B13) and Table 3-2 (case B26).

(286) TABLE-US-00003 TABLE 3-1 Case B1 B4 B13 (=C12) B2 B3 (C9) (C13) FIG. FIG. 12-1 FIG. 13 FIG. 10 FIG. 14 FIG. 34 FIG. 12-2 FIG. 57 Gender Female Male Male Female Male Age 63 years old 13 years old 16 years old 24 years old 39 years old When developed 62 years old 1 month earlier 7 years old As a junior high 2 months earlier (1.5 years school student earlier) Hair loss S2 S1 S3 S2 S1 range Treatment site Right temporal Crown Right temporal Left frontal Right temporal region region region, right region, back of frontal region the head Hair loss site None (B0) None (B0) Eyebrows, lower None (B0) None (B0) other than limbs (B1) head Family history None None None None None of alopecia Family history None None None Mother: None of immune bronchial asthma disease Previous Allergic None Atopic Allergic None history rhinitis, atopic dermatitis rhinitis dermatitis Scratch Test House dust: 2+ Not tested House dust: 3+ House dust: 2+ House dust: 1+ Mite: 1+ Mite: 3+ Mite: 2+ Mite: 1+ Cedar: — Cedar: — Cedar: 2+ Cedar: 1+ Dactylis: 2+ Dactylis: 2+ Dactylis: 1+ Dactylis: — Ragweed: 1+ Ragweed: 1+ Ragweed: 1+ Ragweed 1+ Effect of Not applied Not applied Not applied Not applied Not applied minoxidil Effect of No effect Not applied No effect No effect Not applied steroid drug Effect of Not applied Not applied Not applied Not applied Not applied cooling therapy Antiallergic Not applied Not applied Not applied No effect Not applied drug Effect of No effect Not applied Not applied No effect No effect carpronium chloride Effect of Not applied Not applied Not applied Not applied Not applied cepharanthin Dosage form BNP gel BNP gel BNP gel BNP gel(left BNP gel frontal region) Dose 100 μg/g 50 μg/g 100 μg/g 100 μg/g 50 μg/g Number of days 24 days 7 days 14 days 21 days 14 days used Degree of S2.fwdarw.S0 S1.fwdarw.S0 (Note) S2.fwdarw.S0 S1.fwdarw.S0 improvement in symptoms Non-recurrence 8 months 9 months 4 months 1 year 1 year period Note: applied only to right temporal region and not to entire region, degree of improvement could not be evaluated by proportion (S) of bald patch area occupying entire head area.
Case B1

(287) The test subject was a 63 year old female and was a patient with severe alopecia areata multilocularis having a hair loss range of S2. This test subject had a history of allergic rhinitis, and there was coexisting atopic dermatitis. The results of the scratch test were house dust 2+, mite 1+, Dactylis 2+, and ragweed 1+. The alopecia areata of this test subject had continued for over one and a half years. This test subject had previously received application of a steroid and carpronium chloride to the bald area continuously for 10 months, but there had been no effect, and no hair growth had been observed. This test subject was the same test subject as the test subject of case C12.

(288) When 100 μg/g BNP gel was applied to the entire bald area of the right temporal region of this test subject twice a day morning and evening, clear hair growth was observed in 2 weeks. After the application of BNP gel was stopped after 24 days, there was no recurrence of hair loss at the application site even after 8 months had elapsed (Ref. FIG. 12-1 and FIG. 12-2).

(289) Case B2

(290) The test subject was a 13 year old male with alopecia areata monolocularis having a hair loss range of S1. This test subject was not subjected to a scratch test.

(291) When 50 μg/g BNP gel was applied to the entire bald area of this test subject twice a day for 1 week, hair growth was clearly confirmed and there was a cure. After application of the BNP gel was stopped after 7 days, there was no recurrence even after 9 months had elapsed (Ref. FIG. 13).

(292) Case B3

(293) The test subject was a 16 year old male and was a patient with ophiasis type alopecia areata having a hair loss range of S3, which was said to be intractable. There was coexisting atopic dermatitis. The results of the scratch test were house dust 3+, mite 3+, Dactylis 2+, and ragweed 1+. This test subject had been subjected to surgical removal of the adenoids and palatine tonsils at the age of 6, alopecia areata had occurred from the age of 7, and hair loss was also observed in the eyebrows and lower limbs in addition to the head. This test subject had not been cured by internal or external use of a steroid. Invasive erythema and scale accompanied by itching were observed on the scalp of the hair loss site of this test subject. This test subject was the same test subject as the test subject of case A5.

(294) When 100 μg/g ANP gel was applied to the bald area of the right temporal region of this test subject twice a day for 3 weeks, erythema seemed to be relieved slightly, but short terminal hair remaining around the hair loss area fell out and the hair loss range enlarged somewhat. When 100 μg/g BNP gel was then applied to the hair loss area of the right temporal region twice a day from 2 days after the ANP gel was stopped, marked hair growth was observed in 2 weeks (Ref. T2 of FIG. 10). There was no hair growth at all in the left temporal region, to which the BNP was not applied. After application of the BNP gel was stopped after 14 days, there was no recurrence for 4 months, but a new bald area occurred in another place at the time of a school entrance examination when 4 months had elapsed.

(295) This test subject did not come to the clinic thereafter, and the progress thereafter is not known.

(296) Case B4

(297) The test subject was a 24 year old female and was a patient with severe alopecia areata multilocularis having a hair loss range of S2. There was a history of allergic rhinitis. The mother was affected by bronchial asthma. The results of the scratch test were house dust 2+, mite 2+, cedar 2+, Dactylis 1+, and ragweed 1+. There had been repeated partial remission and recurrence of the alopecia areata of this test subject since junior high school. A slight degree of itching sensation had started to appear on and around the frontal region half a year earlier, and following this the multiple bald areas enlarged. Even when a steroid or carpronium chloride had been applied to the hair loss site of this test subject for 3 months or an antiallergy drug had been orally administered to the test subject, hair growth had not been observed, and the susceptibility to hair loss could not be improved. This test subject was the same test subject as the test subject of case C9.

(298) In accordance with the separate left and right application method, 100 μg/g BNP gel was applied to the left frontal region of this test subject, and only Lubrajel NP (ISP Japan Ltd.), which is a gel base, was applied to the right frontal region twice a day; hair growth was observed after 1 week only on the site of the left frontal region to which the BNP gel was applied, and after 2 weeks hair growth became more marked on the site of the left frontal region to which the BNP gel had been applied. On the other hand, no hair growth was observed on the right frontal region to which only the gel base had been applied. Therefore, it was determined that the hair growth was due to the hair growth effect of the BNP gel. Application of 100 μg/g BNP gel to the left frontal region was continued, application of 100 μg/g CNP ointment to the right frontal region was started, hair growth was also observed on the right frontal region after 1 week, and marked hair growth and hair thickening were observed on the entire hair loss site of the right frontal region after 3 weeks. Before starting the treatment two handfuls of hair had fallen out each time it was shampooed, but the amount of hair falling out decreased dramatically, and only 5 to 6 hairs fell out per shampooing. External application was stopped after the BNP gel had been applied to the left frontal region for 3 weeks and the CNP ointment to the right frontal region for 3 weeks, but following that hair continued to grow on the left frontal region and the right frontal region, the alopecia was substantially cured by the second week after application was stopped, and subsequently there was a complete cure. For this test subject, there has been no recurrence up to the present, that is, after a further 1 year has elapsed (FIG. 14 and FIG. 57).

(299) Case B13

(300) The test subject was a 39 year old male and is the same test subject as the test subject of case C13 described later. When 100 μg/g CNP ointment was applied twice a day to a circular bald area of the temporal region and the back of the head of this test subject, hair grew after 1 week's application, and it spontaneously cured after the application was stopped at 1 week. However, a new circular bald area occurred on the crown after 10 months had elapsed since application of the CNP ointment had stopped.

(301) When 50 μg/g BNP gel was applied twice a day to the circular bald area of the crown of this test subject, growth of black terminal hair was observed on the entire bald area of the crown after 2 weeks' application (FIG. 34).

(302) Progress was examined after application of the BNP gel was stopped at 2 weeks, but since hair growth was not observed in a central area, a 50 μg/g BNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied once a day for 2 weeks starting 3 weeks after the BNP gel was stopped, and black terminal hair grew at a higher hair growth rate.

(303) 4. Therapeutic Effect of BNP Ointment on Alopecia Areata

(304) The therapeutic effects of BNP ointment are shown in Table 3-2 (test subjects B5 and B6).

(305) TABLE-US-00004 TABLE 3-2 Case B6 B26 B5 (C10) (C7) FIG. FIG. 15-1 FIG. 55 FIG. 15-2 FIG. 16 Gender Female Female Female Age 50 years old 33 years old 38 ears old When developed 4 months earlier 5 months earlier 1 month earlier Hair loss range S3 S1 S1 Treatment site Crown, Temporal region Left temporal region, Back of the head crown, back of the head Hair loss site other None (B0) None (B0) None (B0) than head Family history of None None Relative: alopecia alopecia areata Family history of None Child: atopic dermatitis Child: atopic dermatitis immune disease Previous history Allergic rhinitis, atopic None None dermatitis Scratch Test House dust: 3+ House dust: 2+ Not tested Mite: 3+ Mite: 2+ Cedar: 3+ Cedar: — Dactylis: 2+ Dactylis: 2+ Ragweed: 2+ Ragweed: 2+ Effect of minoxidil Not applied Not applied Not applied Effect of steroid drug No effect No effect No effect Effect of cooling Not applied Not applied Not applied therapy Antiallergic drug Not applied No effect No effect Effect of carpronium No effect No effect No effect chloride Effect of cepharanthin Not applied Not applied Not applied Dosage form BNP ointment BNP ointment BNP gel Dose 30 μg/g 100 μg/g 50 μg/g 50 μg/g Number of days used 35 days 7 days 14 days Degree of improvement S3.fwdarw.S0 S1.fwdarw.S0 S1.fwdarw.S0 in symptoms Non-recurrence period Immediately after end of 1 month 3 weeks treatment
Case B5

(306) The test subject was a 50 year old female and was a patient with severe alopecia areata multilocularis having a hair loss range of S3. There was a history of allergic rhinitis, and there was coexisting atopic dermatitis. The results of the scratch test were house dust 3+, mite 3+, cedar 3+, Dactylis 2+, and ragweed 2+. Alopecia areata of this test subject had developed 4 months earlier due to stress caused by relationships in the workplace, and 2 months after the onset multilocularis started. Steroid lotion and carpronium chloride had been applied to the hair loss site of this test subject continuously for 10 months, but no hair growth had been observed, susceptibility to hair loss had not been suppressed, and there had been no therapeutic effects.

(307) When 50 μg/g BNP ointment was applied to the entire bald area of the crown and temporal region of this test subject twice a day morning and evening, hair completely stopped falling out after starting the application. When application of the BNP ointment to the entire hair loss site was continued for 2 weeks, hair growth could be clearly confirmed. Application of 50 μg/g BNP ointment twice a day was ended after 2 weeks, and when from the next day after that 30 μg/g BNP ointment was applied twice a day for 1 week, and from the next day after that 50 μg/g BNP ointment was applied twice a day for 2 weeks, hair thickening continued to progress. The hair growth had a characteristic pattern, hair started to grow in double rings and recovered so as to give complete coverage in 20 days (Ref. FIG. 15-1, FIG. 15-2, and FIG. 16). However, since this test subject was affected by the Great East Japan Earthquake on 11 Mar. 2011, treatment with the BNP ointment was stopped. According to this test subject, the hair grew to some extent, but it stopped growing after application of the BNP ointment was stopped.

(308) Case B6

(309) The test subject was a 33 year old female and was a patient with alopecia areata having a hair loss range of S1. A child of this test subject was affected by atopic dermatitis. The mother of this test subject had alopecia areata and a history of allergic rhinitis. The results of the scratch test were house dust 2+, mite 2+, Dactylis 2+, and ragweed 2+, which were those of a case with an atopic predisposition. This test subject had developed a circular bald area 5 months earlier, treatments involving external use of a steroid, application of carpronium chloride, and an orally administered antiallergy drug had been continued for 7 weeks, but not only had hair continued to fall out but the hair loss range had also enlarged and multilocularis was seen; orally administered steroid had been given in combination, but there had been no therapeutic effect. This test subject showed bald areas on the left temporal region, the crown, and the back of the head, with a hair loss range of S1. This test subject was the same test subject as the test subject of case C10.

(310) Among the bald areas of this test subject, when 100 μg/g BNP ointment was applied to the left temporal region and the crown twice a day, growth of mainly white hair was observed on the 7.sup.th day after the application of BNP ointment was started. On the other hand, hair growth was not observed on the bald area of the back of the head, to which the BNP ointment had not been applied. However, since there was still a large amount of hair falling out, application of the BNP ointment was stopped after 7 days, and 100 μg/g CNP ointment was applied twice a day to all the bald areas of the left temporal region, the crown, and the back of the head from the 8.sup.th day. As a result, hair stopped falling out, marked hair growth was confirmed on all the bald areas including the back of the head after 3 weeks, and there was a cure.

(311) Case B26

(312) The test subject was a 38 year old female and was a patient with alopecia areata monolocularis having a hair loss range of S1. A child of this test subject was affected by atopic dermatitis. A cousin, a niece, an aunt, and a child of this test subject were affected by alopecia areata multilocularis. This test subject was not subjected to a scratch test.

(313) When 100 μg/g CNP ointment was applied twice a day for 2 weeks to the entire circular bald area of the crown of this test subject, clear hair growth was observed (Ref. FIG. 23). There was no recurrence of the bald area in the site that had been cured by the CNP ointment even when 1 year had elapsed since application of the CNP ointment was stopped after 2 weeks.

(314) However, one year after the circular bald area on the crown had been cured by the CNP ointment a new circular bald area appeared, this time on the back of the head.

(315) When 50 μg/g BNP gel was applied twice a day for 2 weeks, hair grew markedly and became terminal hair, and there was almost a cure (FIG. 55). Application of the BNP gel was stopped after 2 weeks, and there was a complete cure and no recurrence even when 6 weeks had subsequently elapsed (FIG. 55).

(316) This test subject was the same test subject as the test subject of case C7.

(317) 5. Therapeutic Effect of CNP Gel on Alopecia Areata

(318) The therapeutic effects of CNP gel on alopecia areata are shown in Table 4 (test subjects C1, C3, C20, and C23).

(319) TABLE-US-00005 TABLE 4 Case C2 C3 C1 (=C11) (=A6, C4) C20 FIG. FIG. 17 FIG. 18-1 FIG. 20 FIG. 35 FIG. 18-2 FIG. 19-1 FIG. 19-2 Gender Female Female Female Male Age 32 years old 47 years old 50 years old 32 years old When developed Half year earlier 1 month earlier 40 years old About 30 years old Hair loss range S2 S1 S2 Frontal region Treatment site Crown Crown, frontal Left temporal Hairline of the region, left region frontal region temporal region became thin. Circular bald area seen in left temporal region. Hair loss site None (B0) None (B0) None (B0) None other than head Family history of None None Mother: alopecia None alopecia areata Family history of None Child: allergic Child: allergic None immune disease rhinitis rhinitis, chronic urticaria Previous history None Glaucoma Atopic dermatitis, Not tested allergic rhinitis Scratch Test House dust: 2+ House dust: 3+ House dust: 1+ Not applied Mite: 3+ Mite: 3+ Mite: 1+ Cedar: 2+ Cedar: 2+ Cedar: — Dactylis: 3+ Dactylis: 2+ Dactylis: 2+ Ragweed: 2+ Ragweed: 2+ Ragweed: 1+ Effect of Not applied Not applied Not applied Not applied minoxidil Effect of steroid Not applied Unable to use No effect Not applied drug Effect of cooling Not applied Not applied Not applied Not applied therapy Antiallergic drug Not applied Not applied No effect Not applied Effect of No effect Not applied No effect Not applied carpronium chloride Effect of Not applied Not applied Not applied Not applied cepharanthin Dosage form CNP gel CNP ointment CNP gel CNP gel Dose 100 μg/g 100 μg/g 100 μg/g 50 μg/ml Number of days 7 days 28 days 21 days 14 days used Degree of S2.fwdarw.S2 S1.fwdarw.S0 S2.fwdarw.S0 S1.fwdarw.S0 improvement in symptoms Non-recurrence Unknown 3 weeks 8 months 5 weeks period
Case C1

(320) The test subject was a 32 year old female and was a patient with a serious case of alopecia areata multilocularis having a hair loss range of S3. There was a history of allergic rhinitis. The results of the scratch test were house dust 2+, mite 3+, cedar 2+, Dactylis 3+, and ragweed 2+. With regard to the alopecia areata of this test subject, alopecia had developed half a year earlier, it had enlarged, and there were multiple occurrences, and a tendency for hair to be lost over the entire scalp had been seen 5 months after onset. For this test subject, a change of workplace had triggered the onset of alopecia areata. This test subject had not shown any therapeutic effect from the application of carpronium chloride.

(321) When 100 μg/g CNP gel was applied twice a day to the entire bald area of the crown of this test subject, marked hair growth was observed after 1 week (Ref. FIG. 17).

(322) Case C2

(323) The test subject was a 47 year old female and was a patient with alopecia areata having a hair loss range of S1. This test subject had a previous history of glaucoma. A child of this test subject was affected by atopic dermatitis and allergic rhinitis. The results of the scratch test were house dust 3+, mite 3+, cedar 2+, Dactylis 2+, and ragweed 2+. A bald patch had appeared on the crown of this test subject 1 month earlier, and following this bald areas had been observed on the frontal region and left temporal region. Since this test subject had a history of glaucoma, this was a case in which use of a steroid should be avoided. This test subject had been affected by thyroid cancer 7 years earlier and had received surgical removal. This test subject was the same test subject as the test subject of case C11.

(324) When 100 μg/g CNP ointment was applied to the crown and the frontal region of this test subject twice a day, hair growth was confirmed after 1 week of application (Ref. FIG. 18-1, FIG. 19-1, and FIG. 19-2). From the following day, that is, the 8.sup.th day, the dosage form was changed on request from the test subject, 100 μg/g CNP gel continued to be applied twice a day for a further 1 week, further marked hair growth was observed, and the amount of hair falling out decreased (Ref. FIG. 18-1, FIG. 18-2, FIG. 19-1, and FIG. 19-2). However, in the left temporal region of this test subject, to which external CNP ointment had not been applied, there was no hair growth. Since an effect had been confirmed, from the 8.sup.th day after application of the CNP ointment to the crown and the frontal region was started, application of 100 μg/g CNP gel to the left temporal region twice a day was started, and 2 weeks after the start of application marked hair growth was confirmed for the left temporal region in the same way as for the crown and the frontal region. There was no recurrence even when 3 weeks had elapsed after application of the CNP gel was stopped after 28 days.

(325) Case C3

(326) The test subject was a 50 year old female and was a patient with a serious case of alopecia areata multilocularis having a hair loss range of S2. This test subject had a previous history of atopic dermatitis and allergic rhinitis. The mother of this test subject had a history of alopecia areata, and a child was affected by allergic rhinitis and chronic urticaria. The results of the scratch test were house dust 1+, mite 1+, Dactylis 2+, and ragweed 1+. This test subject showed erythema and pityriatic scale accompanied by itching on the scalp of the hair loss site, and there was coexisting alopecia pityroides. This test subject had been affected by alopecia areata multilocularis 10 years earlier, and there had been repeated partial remission and recurrence. When work became busy, in the case of this test subject the alopecia areata tended to deteriorate. There had been no effect from external use of a steroid, external use of carpronium chloride, and an orally administered antiallergy drug for 6 months. This test subject was the same test subject as the test subject of case A6 and case C4.

(327) When 100 μg/g CNP gel was applied to the entire bald area of the left temporal region of this test subject twice a day, the amount of hair falling out decreased from the next day, hair growth was clearly confirmed after 2 weeks, and application was stopped after 3 weeks' application, but recovery progressed well after the application was stopped, and there was no recurrence on the application site after 8 months had elapsed since stopping the application (Ref. FIG. 20). There was no subsequent recurrence for this test subject even when a further 1 year had elapsed.

(328) Case C20

(329) The test subject was a 32 year old male with androgenetic alopecia. For this test subject, at the age of 30 the hair line of the M-shaped part in the frontal region had rapidly become thin and retreated. Alopecia areata monolocularis had also developed in the left temporal region 6 weeks before visiting the clinic. This test subject had no family history of alopecia patient. This test subject had so-called M-shaped androgenetic alopecia that was classified as type III on the Hamilton-Norwood scale. This test subject was the same test subject as the test subject of case C27.

(330) When 50 μg/g CNP gel was applied twice a day to the androgenetic alopecia area of the frontal region and the circular bald area of the left temporal region of this test subject, growth of black terminal hair was observed 2 weeks later both in the M-shaped hair line area (FIG. 46) and the circular bald area (FIG. 35).

(331) Furthermore, when 50 μg/mL CNP gel:50 mg/mL carpronium chloride combination was applied twice a day for 1 week to the androgenetic alopecia area of the frontal region and the circular bald area of the left temporal region of this test subject, the same degree of hair growth effect as that from the application of 50 μg/g CNP gel was maintained.

(332) Subsequently, when the 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied for 1 week after the application of 50 μg/g CNP gel was suspended for 3 weeks, further marked hair growth was observed, and following this even though application was stopped hair growth continued and there was a cure.

(333) 6. Therapeutic Effect of CNP Ointment on Alopecia Areata

(334) The therapeutic effects of CNP ointment on alopecia areata are shown in Table 4 (case C2), Table 5 (test subjects C4 to C7), Table 6 (test subjects C8 to C12), and Table 7-1 (test subjects C13 to C15, and C36).

(335) TABLE-US-00006 TABLE 5 Case C4 C5 C6 (=A6, C3) (=A1) (=A7) C7 FIG. FIG. 21 FIG. 22 FIG. 23 Gender Female Female Female Female Age 50 years old 33 years old 22 years old 38 years old When developed 40 years old 13 years old >1.5 years earlier About 1 year earlier Hair loss range S2 S3 S3 S1 Treatment site Right frontal Left temporal Frontal region, Crown region region temporal region Hair loss site None (B0) Eyebrows (B1) Eyebrows (B1) None (B0) other than head Family history of Mother: alopecia None None Relative: alopecia alopecia areata areata Family history of Child: allergic Mother: atopic Grandfather: atopic Child: atopic immune disease rhinitis, chronic dermatitis dermatitis dermatitis, urticaria Older sister: Mother, older alopecia areata atopic dermatitis, brother, older multilocularis allergic rhinitis sister: allergic rhinitis Previous history Atopic dermatitis, Atopic dermatitis Atopic dermatitis, None allergic rhinitis allergic rhinitis Scratch Test House dust: 1+ House dust: 2+ House dust: 2+ Not tested Mite: 1+ Mite: 1+ Mite: 3+ Cedar: — Cedar: — Cedar: — Dactylis: 2+ Dactylis: 2+ Dactylis: 1+ Ragweed: 1+ Ragweed: 2+ Ragweed: — Effect of Not applied Not applied Not applied Not applied minoxidil Effect of steroid No effect No effect No effect No effect drug Effect of cooling Not applied No effect Not applied Not applied therapy Artiallergic drug No effect No effect No effect No effect Effect of No effect Not applied Not applied No effect carpronium chloride Effect of Not applied Not applied Not applied Not applied cepharanthin Dosage form CNP ointment CNP ointment CNP ointment CNP ointment Dose 100 μg/g 100 μg/g 50 μg/g 100 μg/g Number of days 14 days 21 days 28 days 14 days used Degree of S2.fwdarw.S1 S3.fwdarw.S1 S3.fwdarw.S0 S1.fwdarw.S0 improvement in symptoms Non-recurrence Treatment At least 5 months 9 months 1 year period continuing
Case C4

(336) The test subject was a 50 year old female and was a patient with severe alopecia areata multilocularis having a hair loss range of S2. This test subject had a previous history of atopic dermatitis and allergic rhinitis. The mother of this test subject had a history of alopecia areata, and a child was affected by allergic rhinitis and chronic urticaria. The results of the scratch test were house dust 1+, mite 1+, Dactylis 2+, and ragweed 1+. Erythema and pityriatic scale accompanied by itching were observed on the scalp of the hair loss site of this test subject, and there was coexisting alopecia pityroides. This test subject had been affected by alopecia areata multilocularis 10 years earlier, and there had been repeated partial remission and recurrence. When work became busy, in the case of this test subject the alopecia areata tended to deteriorate. There had been no effect from external use of a steroid, external use of carpronium chloride, and an orally administered antiallergy drug for 6 months. This test subject was the same test subject as the test subject of case A6 and case C3.

(337) When 100 μg/g CNP gel was applied to the entire bald area of the left temporal region of this test subject twice a day, the amount of hair falling out decreased from the next day, hair growth was clearly confirmed after 2 weeks, and application was stopped after 3 weeks' application, but recovery progressed well after the application was stopped, and there was no recurrence on the application site after 8 months had elapsed since stopping the application (Ref. FIG. 20).

(338) However, half a year after stopping the application a new bald area appeared, this time on the right frontal region; 100 μg/g CNP ointment was applied twice a day, hair growth was clearly observed in 2 weeks, and erythema and scale of the scalp disappeared. The application to the bald area of the right frontal region was stopped after 2 weeks, but the hair continued to recover even after the application was stopped, and there was a complete cure. There was no recurrence in the bald area of the right frontal region even when over 1 year had elapsed since the application was stopped.

(339) 100 μg/g ANP gel was applied for 2 weeks to new multiple bald areas on the crown, which appeared around the same time as the bald area on the right frontal region, but there was no effect, rough scale increased, there was itching, and the hair loss range enlarged somewhat.

(340) Case C5

(341) The test subject was a 33 year old female and was a patient with severe alopecia areata for which the hair loss range was S3 and which, other than the head, was accompanied by B1 hair loss of the eyebrows. There was a previous history of atopic dermatitis, and coexisting alopecia due to exacerbation of atopic dermatitis. The results of the scratch test were house dust 2+, mite 1+, Dactylis 2+, and ragweed 2+. This test subject showed erythema and pityriatic scale accompanied by itching in the scalp of the hair loss site, and there was coexisting alopecia pityroides. For this test subject, a circular bald area had appeared at the age of 13 and also in the crown at the age of 14, and it had then become alopecia totalis in half a month. Following this, the symptoms of the test subject had fluctuated, and alopecia had extended to the entire body at the age of 15. External and orally administered steroid had not given any therapeutic effect at all with this test subject. This test subject had continued to receive stimulation therapy with liquid nitrogen, but there had been hardly any therapeutic effect. This test subject was the same test subject as that of case A1.

(342) When 100 μg/g ANP gel was applied to the bald area on the left temporal region twice a day for 3 weeks, growth of vellus hair was observed, but erythema and pityriatic desquamation of the scalp were not relieved and there was itching. Therefore, 100 μg/g CNP ointment was applied to the entire bald area of the left temporal region twice a day for 1 week starting 2 weeks after stopping the ANP gel, erythema, pityriatic desquamation, and the itching sensation of the scalp disappeared, hair restoration and hair growth were promoted, and terminal hair covered the scalp. Following this, the CNP ointment was applied for another week, and as a result the terminal hair grew and there was almost a cure. 7 months have elapsed since application of the CNP ointment was stopped after 21 days, but there has been no recurrence of the alopecia (Ref. FIG. 21). This test subject had been subjected to orally administered steroid, liquid nitrogen cooling therapy, etc. since her teens, and this was the first time that there had been such hair growth.

(343) Case C6

(344) The test subject was a 22 year old female and was a patient with severe ophiasis type alopecia areata having a hair loss range of S3, which was said to be intractable. This test subject had a previous history of atopic dermatitis and allergic rhinitis. A grandfather of this test subject was affected by atopic dermatitis, and the father, the mother, and the brother were affected by allergic rhinitis. The results of the scratch test were house dust 2+, mite 3+, and Dactylis 1+. This test subject had been affected by a bald area more than one and half years earlier, and a band-shaped bald area in a state in which hair did not grow at all was observed with a clear border along the outside edge of the part where hair was growing. Erythema, scale, crust, and inflammatory symptoms that seemed to be due to atopic alopecia were observed on the hair loss site of this test subject, and were accompanied by itching. This test subject had hair loss on the eyebrows in addition to the head. This test subject was a case of coexisting atopic dermatitis and allergic rhinitis. The skin of this test subject was in an erythrodermic state, which seemed to be due to steroid rebound, and redness and infiltration were observed on the skin of the entire body including the scalp. There had been no therapeutic effect at all on this test subject from treatment with a steroid and an antiallergy drug. This test subject was the same test subject as the test subject of case A7.

(345) Although 50 μg/g ANP gel was applied twice a day for 3 days to the entire bald area of this test subject, there was no improvement in either redness or itching, and there was no sign of hair growth.

(346) When it was changed to application of 50 μg/g CNP ointment twice a day to the entire bald area of the frontal region and the temporal region of this test subject, erythema was relieved on the second day, and the itching sensation disappeared. Marked growth of terminal hair was observed after 3 weeks' application, and once terminal hair grew, the hair thickened while vellus hair became dark and grew even without external application, terminal hair also grew, and there was a cure (Ref. FIG. 22). The hair continued to grow even after application of the CNP ointment was stopped after 4 weeks and there was a complete cure. There was no recurrence for this test subject even after 9 months had elapsed, and the alopecia areata ophiasis was completely cured without any marking.

(347) Case C7

(348) The test subject was a 38 year old female and was a patient with alopecia areata monolocularis having a hair loss range of S1. A child of this test subject was affected by atopic dermatitis. A cousin, a niece, an aunt, and a child of this test subject were affected by alopecia areata multilocularis. This test subject was not subjected to a scratch test.

(349) When 100 μg/g CNP ointment was applied to the entire circular bald area of the crown of this test subject twice a day for 2 weeks, clear hair growth was observed (Ref. FIG. 23). After application of the CNP ointment was stopped after 2 weeks, even after 1 year had elapsed there was no recurrence in the site that had been cured by the CNP ointment.

(350) However, 1 year after the circular bald area of the crown was cured by the CNP ointment, a new circular bald area appeared, this time on the back of the head.

(351) When 50 μg/g BNP gel was applied twice a day for 2 weeks, there was a marked hair growth and terminal hair formed, and the bald area was almost cured.

(352) This test subject was the same test subject as the test subject of case B26.

(353) TABLE-US-00007 TABLE 6 Case C10 C11 C12 C8 C9 (=B4) (=B6) (=C2) (=B1) FIG. FIG. 24-1 FIG. 18 FIG. 25 FIG. 24-2 Gender Female Female Female Female Female Age 32 years old 24 years old 33 years old 47 years old 63 years old When developed 1.5 years As a junior high 5 months 1 month 64 years old earlier school student earlier earlier (1.5 years earlier) Hair loss range S1 S2 S1 S1 S2 Treatment site Right temporal Right frontal Left temporal Crown, frontal Left temporal region region region, crown, region region back of the head Hair loss site None (B0) None (B0) None (B0) None (B0) None (B0) other than head Family history of None None None None None alopecia Family history of Child: allergic Mother: bronchial Child: atopic Child: None? immune disease rhinitis asthma dermatitis allergic rhinitis Previous history Allergic Allergic rhinitis None Glaucoma Allergic rhinitis rhinitis, atopic dermatitis Scratch Test House dust: — House dust: 2+ House dust: 2+ House dust: 3+ House dust: 2+ Mite: 1+ Mite: 2+ Mite: 2+ Mite: 3+ Mite: 1+ Cedar: 2+ Cedar: 2+ Cedar: — Cedar: 2+ Cedar: — Dactylis: 2+ Dactylis: 1+ Dactylis: 2+ Dactylis: 2+ Dactylis: 2+ Ragweed: 2+ Ragweed: 1+ Ragweed: 2+ Ragweed: 2+ Ragweed: 1+ Effect of Not applied Not applied Not applied Not applied Not applied minoxidil Effect of steroid No effect No effect No effect Unable to use No effect drug Effect of cooling Not applied Not applied Not applied Not applied Not applied therapy Antiallergic drug No effect No effect No effect Not applied Not applied Effect of No effect No effect No effect Not applied No effect carpronium chloride Effect of Not applied Not applied Not applied Not applied Not applied cepharanthin Dosage form CNP ointment CNP ointment CNP ointment CNP ointment CNP ointment (right frontal region) Dose 100 μg/g 100 μg/g 100 μg/g 100 μg/g 100 μg/g Number of days 7 days 21 days 21 days 28 days 20 days used Degree of S1.fwdarw.S0 S2.fwdarw.S0 S1.fwdarw.S0 S1.fwdarw.S0 S2.fwdarw.S0 improvement in symptoms Non-recurrence 1 month 1 year 1 month 3 weeks 11 months period
Case C8

(354) The test subject was a 32 year old female and was a patient with alopecia areata multilocularis having a hair loss range of S1. The results of the scratch test were house dust −, mite 1+, cedar 2+, Dactylis 2+, and ragweed 2+. This test subject had been affected by alopecia multilocularis one and a half years earlier, and had received treatment involving external use of a steroid, application of carpronium chloride, and an orally administered antiallergy drug for one and a half years, but a satisfactory effect could not be obtained. A slight degree of erythema was observed on a hair loss area of this test subject, and was accompanied by an itching sensation. In the case of this test subject, multiple bald areas were observed on the right temporal region and the left temporal region.

(355) When 100 μg/g CNP ointment was applied to the entire bald area of this test subject twice a day, erythema and the itching sensation disappeared after 3 days' application, the amount of hair falling out decreased after 10 days' application, and clear hair growth was observed. There was no recurrence even when 1 month had elapsed after application of the CNP ointment was stopped after 7 days.

(356) Case C9

(357) The test subject was a 24 year old female and was a patient with severe alopecia areata multilocularis having a hair loss range of S2. There was a history of allergic rhinitis. The mother was affected by bronchial asthma. The results of the scratch test were house dust 2+, mite 2+, cedar 2+, Dactylis 1+, and ragweed 1+. There had been repeated partial remission and recurrence of the alopecia areata of this test subject since junior high school. A slight degree of itching sensation had started to appear on and around the frontal region half a year earlier, and following this multiple bald areas enlarged. Even when a steroid or carpronium chloride had been applied to the hair loss site of this test subject for 3 months or an antiallergy drug had been orally administered to the test subject, hair growth had not been observed, and the susceptibility to hair loss could not be improved. This test subject was the same test subject as the test subject of case B4.

(358) In accordance with the separate left and right application method, 100 μg/g BNP gel was applied to the left frontal region of this test subject, and only Lubrajel NP (ISP Japan Ltd.), which is a gel base, was applied to the right frontal region twice a day; hair growth was observed after 1 week only on the site of the left-hand side to which the BNP gel had been applied, and after 2 weeks hair growth became more marked on the site of the left-hand side to which the BNP gel had been applied. On the other hand, no hair growth was observed on the right-hand side to which only the gel base had been applied. Therefore, it was determined that the hair growth was due to the hair growth effect of the BNP gel.

(359) Application of 100 μg/g BNP gel to the left frontal region was continued, and application of 100 μg/g CNP ointment to the right frontal region was started, hair growth was observed after 1 week, and marked hair growth and hair thickening were observed on the entire hair loss site after 3 weeks. Before starting the treatment two handfuls of hair had fallen out each time it was shampooed, but the amount of hair falling out decreased dramatically, and only 5 to 6 hairs fell out per shampooing. External application was stopped after the BNP gel had been applied to the left frontal region for 3 weeks and the CNP ointment to the right frontal region for 3 weeks, but following this hair continued to grow, the alopecia was substantially cured by the second week after application was stopped, and there has been no recurrence up to the present, that is, after 1 year has elapsed.

(360) Case C10

(361) The test subject was a 33 year old female and was a patient with alopecia areata having a hair loss range of S1. A child of this test subject was affected by atopic dermatitis. The mother of this test subject had alopecia areata and a history of allergic rhinitis. The results of the scratch test were house dust 2+, mite 2+, Dactylis 2+, and ragweed 2+, which were those of a case with an atopic predisposition. This test subject had developed a circular bald area 5 months earlier, treatments involving the external use of a steroid, application of carpronium chloride, and an orally administered antiallergy drug had been continued for 7 weeks, but not only had hair continued to fall out but the hair loss range had also enlarged and multilocularis was seen; orally administered steroid had been given in combination, but there had been no therapeutic effect. This test subject showed bald areas on the left temporal region, the crown, and the back of the head, with a hair loss range of S1. This test subject was the same test subject as the test subject of case B6.

(362) Among the bald areas of this test subject, when 100 μg/g BNP ointment was applied to the left temporal region and the crown twice a day, growth of mainly white hair was observed on the 7.sup.th day after application of the BNP ointment was started. On the other hand, hair growth was not observed on the bald area of the back of the head, to which the BNP ointment had not been applied. However, since there was still a large amount of hair falling out, application of the BNP ointment was stopped after 7 days, and 100 μg/g CNP ointment was applied twice a day to all the bald areas of the left temporal region, the crown, and the back of the head from the 8.sup.th day. As a result, hair stopped falling out, and marked hair growth was observed on all of the left temporal region, the crown, and the back of the head on the 3rd week after application of the CNP ointment was started (Ref. FIG. 24-1 and FIG. 24-2). The test subject was surprised with the rate of hair growth compared with conventional therapy. There was no recurrence in this test subject even when 1 month had elapsed after application of the CNP ointment was stopped after 21 days.

(363) Case C11

(364) The test subject was a 47 year old female and was a patient with alopecia areata having a hair loss range of S1. This test subject had a previous history of glaucoma. A child of this test subject was affected by atopic dermatitis and allergic rhinitis. The results of the scratch test were house dust 3+, mite 3+, cedar 2+, Dactylis 2+, and ragweed 2+. A bald patch had appeared on the crown of this test subject 1 month earlier, and following this bald areas had been observed on the frontal region and left temporal region. Since this test subject had a history of glaucoma, this was a case in which use of a steroid should be avoided. This test subject had been affected by thyroid cancer 7 years earlier and had received surgical removal. This test subject was the same test subject as the test subject of case C2.

(365) When 100 μg/g CNP ointment was applied to the crown and the frontal region of this test subject twice a day, hair growth was confirmed after 1 week of application (Ref. FIG. 18-1, FIG. 18-2, FIG. 19-1 and FIG. 19-2).

(366) TABLE-US-00008 TABLE 7-1 Case C13 C14 C15 (=A3) C36 C23 FIG. FIG. 26 FIG. 8 FIG. 39 Gender Male Female Female Male Female Age 38 years old 35 years old 52 years old 57 years old 26 years old When developed 2 months 3 months 51 years old 55 years old 26 years old earlier earlier Hair loss range S1 S2 S3 S2 S1 Treatment site Temporal Back of the Whole of scalp Temporal region, Back of the head region, back of head back of the head, the head frontal region Hair loss site None (B0) None (B0) None (B0) Eyebrows (B1) None other than head Family history of None None None None None alopecia Family history of None Mother: None None None immune disease allergic rhinitis Previous history None Allergic Allergic Atopic dermatitis None rhinitis rhinitis Scratch Test House dust: 1+ House dust: 2+ House dust: 1+ House dust: 1+ Not tested Mite: 1+ Mite: 2+ Mite: — Mite: 3+ Cedar: 1+ Cedar: 2+ Cedar: 2+ Cedar: 2+ Dactylis: — Dactylis: 2+ Dactylis: 1+ Dactylis: 1+ Ragweed: 1+ Ragweed: 1+ Ragweed: 1+ Ragweed: 1+ Effect of Not applied Not applied Not applied Not applied Not applied minoxidil Effect of steroid Not applied Hair loss range Unknown No effect from Small amount of drug enlarged external hair growth, but application and bald area oral enlarged administration Effect of cooling Not applied Not applied Not applied No effect Not applied therapy Antiallergic drug Not applied Not applied Not applied No effect Not applied Effect of No effect Not applied No effect No effect Not applied carpronium chloride Effect of Not applied Not applied Not applied Not applied Not applied cepharanthin Dosage form CNP ointment CNP ointment CNP ointment CNP ointment CNP gel Dose 100 μg/g 50 μg/g 100 μg/g 100 μg/g 50 μg/g Number of days 28 days 28 days 2 weeks 6 weeks 2 weeks used Degree of S1.fwdarw.S0 S1.fwdarw.S1 S3.fwdarw.S2 S2.fwdarw.S0 S1.fwdarw.S0 improvement in Bald area symptoms remained at 1 position at hairline Non-recurrence 12 months Treatment Treatment 9 months 2 months period suspended continuing
Case C12

(367) The test subject was a 63 year old female and was a patient with severe alopecia areata multilocularis having a hair loss range of S2. There was a history of allergic rhinitis, and there was coexisting atopic dermatitis. The results of the scratch test were house dust 2+, mite 1+, Dactylis 2+, and ragweed 1+. The alopecia areata of this test subject had continued for over one and a half years. This test subject had received application of a steroid and carpronium chloride to the bald area continuously for 10 months, but there had been no effect, and no hair growth had been observed. This test subject was the same test subject as the test subject of case B1.

(368) When 100 μg/g BNP gel was applied to the entire bald area of the right temporal region of this test subject twice a day morning and evening, clear hair growth was observed in 2 weeks. There was no recurrence of hair loss on the application site even when 8 months had elapsed after the application of BNP gel was stopped after 24 days.

(369) However, new multiple bald areas appeared on the left temporal region; 100 μg/g CNP ointment was applied twice a day morning and evening, growth of vellus hair was observed after 1 week of application, and clear growth of terminal hair was observed 3 weeks after the application was started. 50 μg/g CNP ointment was applied twice a day morning and evening for 20 days, the hair thickened so as to cover the entire hair loss area, and there was a cure without subsequent application (Ref. FIG. 25). There was no recurrence even when 1 month had elapsed.

(370) Case C13

(371) The test subject was a 38 year old male and was a patient with alopecia areata multilocularis having a hair loss range of S1. A bald patch had appeared on the temporal region 2 months earlier, and following this a bald area had been observed on the back of the head. There was no previous history or family history of immune disease. The results of the scratch test of this test subject were house dust 2+, mite 2+, cedar 2+, Dactylis 2+, and ragweed 1+. This test subject had received orally administered cepharanthin, but there had been no therapeutic effect.

(372) When 100 μg/g CNP ointment was applied to the entire alopecia of the temporal region and the back of the head of this test subject twice a day, growth of white hair was confirmed on the entire bald patch after 1 week's application, and black hair growth was observed on the peripheral area (Ref. FIG. 26). This test subject was in a state in which mainly white hair had grown and thickened. With regard to this test subject, the hair continued to thicken even when application of the CNP ointment was stopped after 1 week, and there was a spontaneous cure. With regard to this test subject, there was no recurrence on the temporal region or the back of the head even when 1 year had elapsed after application of the CNP ointment was stopped.

(373) However, a circular bald area appeared, this time on the crown, 10 months after application of the CNP ointment was stopped, and when 50 μg/g BNP gel was applied twice a day for 2 weeks, growth of black terminal hair was observed. However, extensive hair growth was not observed even when 50 μg/g BNP gel was applied for 3 weeks; when a 50 μg/g BCNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied once a day for 2 weeks, hair growth was observed earlier than had been the case with use of a single agent, the rate of hair lengthening increased, and terminal hair grew extensively.

(374) Case C14

(375) The test subject was a 35 year old female and was a patient with alopecia areata having a hair loss range of S1. This test subject had a history of allergic rhinitis, the mother of this test subject was also affected by allergic rhinitis, and this test subject was a case with an atopic predisposition. The results of the scratch test of this test subject were house dust 2+, mite 2+, cedar 2+, Dactylis 2+, and ragweed 1+. A bald patch had appeared on the back of the head of this test subject 3 months earlier, it subsequently showed a tendency to enlarge, and the entire back of the head had become thin, accompanied by itching. In the case of this test subject, application of a steroid drug had caused itchiness, and the hair loss range had enlarged somewhat.

(376) When 100 μg/g CNP ointment was applied to the entire bald patch of the back of the head of this test subject twice a day, growth of white hair and vellus hair was observed after 1 week of application, and growth of black terminal hair was clearly observed after 3 weeks. However, although growth of vellus hair was observed in part of the bald area at the hair growth line of the left back of the head, it did not recover so as to cover the entire bald patch.

(377) Case C15

(378) The test subject was a 52 year old female and was a patient with severe alopecia areata having a hair loss range of S3. There was a previous history of allergic rhinitis. The results of the scratch test were house dust 1+, cedar 2+, Dactylis 1+, and ragweed 1+. A bald patch had appeared on the frontal region of this test subject about 1 year earlier when doing continuous night shifts, following this there had been a tendency for enlargement, and multiple bald areas had appeared over the entire scalp. Application of carpronium chloride to the bald patch had been continued for 8 months, but the hair loss range had only enlarged and there had been no therapeutic effect. This was a case in which there were no inflammatory symptoms such as erythema, crust, or scale on the scalp of the hair loss area of the test subject. This test subject was the same test subject as the test subject of case A3.

(379) When 100 μg/g CNP ointment was applied to the entire bald area of the right temporal region of this test subject twice a day, hair growth was confirmed in 1 week, further marked hair growth was observed in 2 weeks, and enlargement of the bald area was completely stopped. Application of the CNP ointment was stopped after 14 days, from the next day after that 100 μg/g ANP gel was applied twice a day with the expectation of further effects, and the therapeutic effect of the CNP ointment continued as it was; after 5 weeks had elapsed, although application of the ANP gel was continuing, thickening of terminal hair and enlargement of the hair growth area were seen. However, since this test subject lived far away from the clinic of the present inventor, she could not visit frequently, and the treatment was suspended. Because of this, the bald area of this test subject remained, and is currently not cured.

(380) Case C36

(381) The test subject was a 57 year old male and was a patient with a serious case of alopecia areata having a hair loss range of S2 with coexisting eyebrow hair loss. This test subject had a previous history of atopic dermatitis. The results of the scratch test were house dust 1+, mite 3+, cedar 2+, Dactylis 1+, and ragweed 1+. With regard to this test subject, multiple bald patches had developed about 5 years earlier due to stress at work. This test subject had received liquid nitrogen therapy, but the hair loss range had only spread, and there had been no therapeutic effect at all. Subsequently, this test subject had been subjected to oral administration and external application of steroid and external application of carpronium chloride for 3 years, but there had not been any effect.

(382) When 100 μg/g CNP ointment was applied twice a day to the entire bald area of the right temporal region of this test subject, hair growth mainly of white hair was observed after 3 weeks. Although application of the CNP ointment was stopped after 6 weeks, the therapeutic effect of the CNP ointment continued thereafter, the hair continued to grow, and there was a cure. 9 months later, there was no recurrence in this test subject.

(383) Case C23

(384) The test subject was a 26 year old female and was a patient with alopecia areata monolocularis having a hair loss range of S1. This test subject had no previous history of alopecia, and none of the family of this test subject was a patient with alopecia areata. This test subject had developed alopecia areata monolocularis on the back of the head, had visited another clinic, and had received application of Rinderon (trademark)-V ointment (Shionogi & Co., Ltd.), which contains 1.2 mg/g betamethasone valerate, for 6 weeks; there had been a little hair growth, but the size of the bald area had increased.

(385) Application of the betamethasone valerate ointment was stopped, and after being suspended for 4 weeks, when 50 μg/g CNP gel was applied twice a day for 2 weeks to a circular bald area of the back of the head of this test subject, marked growth of black terminal hair was observed, and vellus hair became thick and long (FIG. 39).

(386) 7. Therapeutic Effect of BNP:Betamethasone:Gentamicin Combination on Alopecia Areata

(387) The therapeutic effects of a BNP:betamethasone:gentamicin combination on alopecia areata are shown in Table 7-2 (case B14).

(388) TABLE-US-00009 TABLE 7-2 Case B14 FIG. FIG. 36 Gender Female Age 31 years old When developed 31 years old Hair loss range S1 Treatment site Crown Hair loss site other than None head Family history of alopecia None Family history of immune None disease Previous history Affected by alopecia areata multilocularis 10 years earlier. Scratch Test House dust: — Mite: 1+ Cedar: 1+ Dactylis: 1+ Ragweed: 2+ Effect of minoxidil Not applied Effect of steroid drug Not applied Effect of cooling therapy Not applied Antiallergic drug Not applied Effect of carpronium Not applied chloride Effect of cepharanthin Not applied Dosage form BNP:betamethasone:gentamicin combination Dose BNP: 50 μg/g betamethasone: 600 μg/ml gentamicin: 500 μg/ml Number of days used 7 days Degree of improvement in S1.fwdarw.S0 symptoms Non-recurrence period 6 weeks
Case B14

(389) The test subject was a 31 year old female and was a patient with alopecia areata monolocularis having a hair loss range of S1. This test subject had no family members with alopecia areata. The results of the scratch test of this test subject were house dust-, mite 1+, cedar 1+, Dactylis 1+, and ragweed 2+. She had been affected by alopecia areata multilocularis 10 years earlier. This time, alopecia areata monolocularis developed on the crown when work became busy.

(390) When 50 μg/g BNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied to a bald area of the crown of this test subject for 1 week, marked hair growth was confirmed (FIG. 36).

(391) 8. Therapeutic Effect of CNP:Betamethasone:Gentamicin Combination on Alopecia Areata

(392) The therapeutic effects of a CNP:betamethasone:gentamicin combination on alopecia areata are shown in Table 7-3 (cases C21 and C22).

(393) TABLE-US-00010 TABLE 7-3 Case C21 C22 FIG. FIG. 37 FIG. 38 Gender Male Female Age 51 years old 33 years old When developed 51 years old 33 years old Hair loss range S1 S1 Treatment site Crown Crown Hair loss site other None None than head Family history of None None alopecia Family history of None None immune disease Previous history None Affected by alopecia areata when at primary school and junior high school. Scratch Test Not tested House dust: 2+ Mite: 1+ Cedar: 3+ Dactylis: 2+ Ragweed: 2+ Effect of minoxidil Not applied Not applied Effect of steroid No effect No effect drug Effect of cooling Not applied Not applied therapy Antiallergic drug Not applied Not applied Effect of carpronium No effect No effect chloride Effect of Not applied Not applied cepharanthin Dosage form CNP:betamethasone:gentamicin CNP:betamethasone:gentamicin combination combination Dose CNP: 50 μg/g CNP: 50 μg/g betamethasone: 600 μg/ml betamethasone: 600 μg/ml gentamicin: 500 μg/ml gentamicin: 500 μg/ml Number of days used 21 days 14 days Degree of S1.fwdarw.S0 S1.fwdarw.S0 improvement in symptoms Non-recurrence 2 weeks 7 weeks period
Case C21

(394) The test subject was a 51 year old male and was a patient with alopecia areata monolocularis having a hair loss range of S1. This test subject had not been affected by alopecia areata in the past, and none of the family of this test subject was a patient with alopecia areata. This test subject had developed a single circular bald area on the right crown about 2 months before visiting the clinic.

(395) ‘Dermosol-G Lotion’ (Iwaki Seiyaku Co., Ltd.), which contains 1200 μg/mL betamethasone valerate and 1000 μg/mL gentamicin sulfate and ‘Calpranin solution 5%’ (Taiyo Pharmaceutical Industry Co., Ltd.), which contains 50 mg/mL carpronium chloride, were applied to the circular bald area of the right crown of this test subject twice a day for 2 months, but only vellus hair grew, and there was no further hair growth.

(396) The application of Dermosol-G lotion and Calpranin solution 5% was stopped after 2 months, and when from 3 weeks after that a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day to the circular bald area of the right crown of this test subject, hair growth was observed after 2 weeks' application, and marked hair growth was observed after 3 weeks' application. Although application of the CNP:betamethasone:gentamicin combination was stopped after 3 weeks, the hair continued to grow even when 1 week had elapsed thereafter, and the skin was hidden (FIG. 37).

(397) Case C22

(398) The test subject was a 33 year old female and visited the clinic when a single circular bald area appeared on the crown. This test subject was a patient with alopecia areata monolocularis having a hair loss range of S1. None of the family of this test subject was a patient with alopecia areata. The results of the scratch test of this test subject were house dust 2+, mite 1+, cedar 3+, Dactylis 2+, and ragweed 2+. This test subject had been affected by alopecia areata when she was in primary school and junior high school.

(399) When 50 μg/g CNP gel was applied twice a day for 2 weeks to the circular bald area of the crown of this test subject, the amount of hair falling out decreased, the hair became thick, and growth of black terminal hair was observed.

(400) When application of the CNP gel was stopped after 2 weeks, and from 1 week thereafter a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 2 weeks to the circular bald area of the same site, the amount of hair falling out continued to decrease and thick terminal hair continued to grow (FIG. 38).

(401) 9. Therapeutic Effect of ANP Gel on Androgenetic Alopecia

(402) The therapeutic effects of ANP gel on androgenetic alopecia are shown in Table 8 (cases A8 and A9).

(403) TABLE-US-00011 TABLE 8 Case A8 (=B8) A9 (=B11) FIG. FIG. 27 Gender Male Male Age 45 years old 75 years old When developed From 44 years old About 40 years old to 50 years old Treatment site Crown Crown Hair loss state Hair thinning confined to crown, Erythema accompanied by itching erythema accompanied by itching and seborrheic scale seen on scalp and seborrheic scale seen on scalp at hair loss site. at hair loss site. Family history of androgenetic Father: androgenetic alopecia Father: androgenetic alopecia alopecia Family history of immune None None disease Previous history Atopic dermatitis, allergic Allergic rhinitis rhinitis Scratch Test House dust: 2+ House dust: 2+ Mite: 3+ Mite: 2+ Cedar: — Cedar: 3+ Dactylis: 1+ Dactylis: 2+ Ragweed: 1+ Ragweed: 2+ Effect of minoxidil Not applied No effect Effect of finasteride Not applied Not applied Effect of glycyrrhetinic acid Not applied No effect Effect of steroid drug No effect No effect Effect of carpronium chloride Not applied Not applied Effect of cepharanthin Not applied Not applied Dosage form ANP gel ANP gel Dose 100 μg/g 100 μg/g Number of days used 2 weeks 4 days Degree of improvement in Erythema aggravated and became No improvement in erythema and symptoms seborrheic, itching occurred, hair seborrheic scale, no improvement loss range enlarged, no in hair thinning. improvement in seborrheic scale. Non-recurrence period No improvement No improvement
Case A8

(404) The test subject was a 45 year old male and had suffered from thinning hair confined to the crown since about the age of 44. This test subject had coexisting seborrheic alopecia with erythema accompanied by itching and seborrheic scale on the scalp of the hair loss site. It was classified as type II vertex on the Hamilton-Norwood scale. The father of this test subject had androgenetic alopecia confined to the crown. The scratch test of this test subject was house dust 2+, mite 3+, Dactylis 1+, and ragweed 1+. This test subject was the same test subject as the test subject of case B8.

(405) When 100 μg/g ANP gel was applied twice a day morning and evening for 2 weeks to the entire hair loss site of the crown of this test subject, the erythema was only slightly improved, hair growth was not observed at all, and in addition itching occurred, erythema appeared, and the hair loss range enlarged. The seborrheic scalp was not markedly improved (Ref. FIG. 27).

(406) Case A9

(407) The test subject was a 75 year old male, and hair on the crown had become thin at around 40 to 50 years old. This test subject showed erythema accompanied by itching and seborrheic scale on the scalp of a hair loss site, and had androgenetic alopecia with coexisting seborrheic alopecia. This was classified as type VI on the Hamilton-Norwood scale. The father of this test subject had androgenetic alopecia. The results of the scratch test of this test subject were house dust 2+, mite 2+, cedar 3+, Dactylis 2+, and ragweed 2+, and there was a history of allergic rhinitis. Minoxidil had been applied to this test subject for one year, but there had been no effect. This test subject had also being using glycyrrhetinic acid for 2 years, but said that there had been no effect. This test subject was the same test subject as the test subject of case B11.

(408) 100 μg/g ANP gel was applied to the hair loss site of the crown of this test subject twice a day morning and evening for 4 days, but improvement in the erythema and seborrheic scale was not observed, and no effect in improving the alopecia was observed.

(409) 10. Therapeutic Effect of BNP Gel on Androgenetic Alopecia

(410) The therapeutic effects of BNP gel on androgenetic alopecia are shown in Table 9-1 (cases B7 to B10) and Table 9-2 (cases B11 to B16).

(411) TABLE-US-00012 TABLE 9-1 Case B7 B8 (=A8) B9 B10 FIG. FIG. 28-1 FIG. 28-2 Gender Male Male Male Male Age 39 years old 45 years old 42 years old 65 years old When developed From 38 years old From 44 years old From 40 years old 30s to 40s Treatment site Crown Crown Crown Right frontal region (right M- shaped part) Hair loss state Tingling of crown, Hair thinning Hair thinning Hairline in erythema and scale confined to crown, confined to crown, frontal region and appeared, hair erythema slight degree of forehead corners thinning on crown. accompanied by erythema and scale retreated and itching and seen on scalp at there was hair seborrheic scale hair loss site. thinning, wide seen on scalp at range of crown was hair loss site. in hair thinning state. Family history of Paternal Father: Father, maternal Father: androgenetic grandfather: androgenetic grandfather: androgenetic alopecia androgenetic alopecia androgenetic alopecia alopecia alopecia Family history of Mother: atopic None None None immune disease dermatitis Previous history Atopic dermatitis Atopic dermatitis, Atopic dermatitis Atopic dermatitis allergic rhinitis Scratch Test House dust: 3+ House dust: 2+ Not tested House dust: 2+ Mite: 3+ Mite: 3+ Mite: 2+ Cedar: 1+ Cedar: — Cedar: 1+ Dactylis: 2+ Dactylis: 1+ Dactylis: 1+ Ragweed: 1+ Ragweed: 1+ Ragweed: 1+ Effect of minoxidil Not applied Not applied No effect Not applied Effect of Not applied Not applied Not applied Not applied finasteride Effect of Not applied Not applied Not applied Not applied glycyrrhetinic acid Effect of steroid Not applied? No effect Not applied Not applied drug Effect of Not applied Not applied Not applied Not applied carpronium chloride Effect of Not applied Not applied Not applied Not applied cepharanthin Dosage form BNP gel BNP gel BNP gel BNP gel Dose 100 μg/g 50 μg/g 50 μg/g Started with 50 μg/g, increased to 100 μg/g Number of days used 10 days 3 weeks 3 weeks 50 μg/g for 3 weeks, then 100 μg/g for 3 weeks Degree of Terminal hair Erythema, Hair falling out Only for right- improvement in grew, hair was seborrheic scale, decreased, vellus hand side to which symptoms restored, and hair and itching of hair hair became dark, BNP gel had been extension loss site markedly and growth of applied, vellus promoted. improved, hair terminal hair hair became Dandruff falling out observed. terminal hair and disappeared, hair decreased. grew in length thinning range Terminal hair grew, compared with decreased, almost hair was restored, before normal state and hair thinning application. recovered. clearly improved. Non-recurrence 8 months Treatment Treatment suspended Treatment period continuing continuing
Case B7

(412) The test subject was a 39 year old male; the crown had become irritated at the age of 38, erythema and scale had appeared, the hair of the crown had become thin, and androgenetic alopecia had developed. This was classified as type II vertex on the Hamilton-Norwood scale. The paternal grandfather of this test subject had androgenetic alopecia. The results of the scratch test of this test subject were house dust 3+, mite 3+, cedar 1+, Dactylis 2+, and ragweed 1+.

(413) When 100 μg/g BNP gel was applied to the hair loss site of the crown of this test subject twice a day morning and evening, the irritation started to disappear after about 1 week, the amount of hair falling out decreased, after 10 days' application the terminal hair became dark, the area of thinning hair decreased, and there was recovery to a substantially normal state. There was no recurrence even when 8 months had elapsed after application of the BNP gel was stopped after 10 days (Ref. FIG. 28-1 and FIG. 28-2).

(414) Case B8

(415) The test subject was a 45 year old male and had suffered from thinning hair confined to the crown from about 44 years old. This test subject showed erythema accompanied by itching and seborrheic scale on the scalp at the hair loss site, and had androgenetic alopecia with coexisting seborrheic alopecia. This was classified as type II vertex on the Hamilton-Norwood scale. The father of this test subject had androgenetic alopecia confined to the crown. The results of the scratch test of this test subject were house dust 2+, mite 3+, Dactylis 1+, and ragweed 1+. This test subject was the same test subject as the test subject of case A8.

(416) When 100 μg/g ANP gel was applied to the entire hair loss site of the crown of this test subject twice a day morning and evening for 2 weeks, although the erythema seemed to be slightly improved, the amount of hair falling out remained large, the seborrheic scalp was not improved, and the hair loss range enlarged somewhat. Furthermore, itching occurred about 1 hour after application of the ANP gel, and strong itching appeared on the 2.sup.nd day.

(417) When 50 μg/g BNP gel was applied twice a day morning and evening to the entire hair loss site of the crown of this test subject, erythema, seborrheic scale, and itching on the hair loss site were markedly improved on the 1.sup.st week after application of the BNP gel was started, the amount of hair falling out decreased to an unnoticeable level, the hair clearly thickened objectively, and the thinning hair was improved.

(418) When external application of the BNP gel was stopped, with regard to this test subject, the effect continued for 2 months after the external application was stopped, and a good state in which the amount of hair falling out was small and there was no itching continued. Furthermore, with regard to this test subject, about 3 months after the external application of the BNP gel was stopped, the volume of hair on the crown decreased, the thinning hair became conspicuous, the amount of hair falling out increased, and itchiness occurred.

(419) When, this time, 50 μg/g CNP gel was applied twice a day, this test subject noticed that blood circulation improved, the amount of hair falling out started to decrease on about the 5.sup.th day, and the itching disappeared. With regard to this test subject, the hair started to thicken in about the 3.sup.rd week after application of the CNP gel was started, and the hair thickened to a substantially normal state after 7 weeks of application. However, for this test subject, if application of the CNP gel was stopped for 2 to 3 months, the amount of hair falling out increased and thinning hair occurred on the crown; the treatment is being continued at the present time.

(420) Case B9

(421) The test subject was a 42 year old male and had suffered from thinning hair confined to the crown from about 40 years old. This test subject had a slight degree of erythema and scale on the scalp of the hair loss site. This was classified as type V on the Hamilton-Norwood scale. The father and the maternal grandfather of this test subject had androgenetic alopecia. This test subject was not subjected to a scratch test.

(422) When 50 μg/g BNP gel was applied twice a day morning and evening to the entire thinning hair site of the crown of this test subject, by the 1.sup.st week after application was started, the amount of hair falling out decreased, vellus hair darkened, and growth of terminal hair was observed, compared with the state before application in which there was only vellus hair. The hair became darker after 3 weeks, and hair thickening could be confirmed objectively.

(423) Case B10

(424) The test subject was a 65 year old male and the hair had thinned when the hair line of the frontal region and the corners of the forehead retreated during his 30s to 40s. The father also had androgenetic alopecia. This was classified as type VI on the Hamilton-Norwood scale. The results of the scratch test of this test subject were house dust 2+, mite 2+, cedar 1+, Dactylis 1+, and ragweed 1+, and there was a history of atopic dermatitis and allergic conjunctivitis.

(425) Since the thinning hair had left-and-right symmetry, in order to evaluate the effects, 50 μg/g BNP gel was applied twice a day morning and evening to the right front temporal region, that is, the so-called M-shaped part, and only a gel base was applied to the left-hand side. By the 2.sup.nd week thickening of vellus hair was observed only on the right-hand side, to which the BNP had been applied, compared with that before application; the concentration of the BNP gel was changed to 100 μg/g, it was applied to the right front temporal region for 2 weeks, and vellus hair in the M-shaped part clearly became terminal hair and thick and long compared with that when 50 μg/g BNP gel was applied.

(426) Case B11

(427) The test subject was a 75 year old male and hair on the crown had thinned from around 40 years old to 50 years old. This test subject had androgenetic alopecia with coexisting seborrheic alopecia, in which there was erythema accompanied by itching and seborrheic scale on the scalp of the hair loss site. This was classified as type VI on the Hamilton-Norwood scale. The father of this test subject had androgenetic alopecia. The results of the scratch test of this test subject were house dust 2+, mite 3+, Dactylis 1+, and ragweed 1+. There had been no effect on this test subject when minoxidil had been applied for 1 year. This test subject had been also using glycyrrhetinic acid for 2 years, but said that there had been no effect. This test subject was the same test subject as the test subject of case A9.

(428) When 100 μg/g ANP gel was applied to the hair loss site of the crown of this test subject twice a day morning and evening for 4 days, there was no improvement in the erythema or the seborrheic scale.

(429) When 50 μg/g BNP gel was applied to the hair loss site of the crown of this test subject twice a day morning and evening, on the 3.sup.rd day after application was started erythema, seborrheic scale, and itching on the hair loss site were markedly improved and the amount of hair falling out become unnoticeable. The hair quality was improved after 2 weeks, the hair became black and thick and darkened, and there was hair thickening. When the BNP gel was also applied to the M-shaped part of this test subject twice a day for 20 days, terminal hair grew, and it was confirmed that growth of hair in the M-shaped part was also promoted. This test subject is still being treated with the BNP gel at present.

(430) Case B12

(431) The test subject was a 62 year old male who had developed thinning hair on the crown at around 50 years old, and had pityriatic scale and erythema accompanied by itching on the scalp of the hair loss site. This test subject had androgenetic alopecia with coexisting alopecia pityroides. This was classified as type III vertex on the Hamilton-Norwood scale. The father and a younger brother of this test subject had androgenetic alopecia. The results of the scratch test of this test subject were house dust 2+, mite 3+, cedar 2+, Dactylis 1+, and ragweed 2+, and there was atopic dermatitis and bronchial asthma. The brother had a history of atopic dermatitis and a child had a history of allergic rhinitis.

(432) When 50 μg/g BNP gel was applied to the entire hair loss site of the crown of this test subject twice a day morning and evening for 3 weeks, the amount of hair falling out decreased markedly on the 3.sup.rd day after application of the BNP gel started, and the erythema and seborrheic scale were improved. In the 3.sup.rd week the hair became dark, there was hair thickening, and the thinning hair was improved objectively (Ref. FIG. 29).

(433) When application of the BNP gel was stopped after 3 weeks, and from the following day 50 μg/g ANP gel was applied twice a day, this test subject exhibited seborrheic scale, erythema, and itching, the application was stopped after 1 week.

(434) When from the following day 50 μg/g BNP gel was applied again twice a day, it was as if the seborrheic scale, erythema, and itching due to the ANP gel had never happened, the amount of hair falling out decreased, the itching and the seborrheic scale were also improved, the hair became thick, dark, and long, and there was hair thickening. Since this test subject had coexisting atopic dermatitis, the body was itchy, but there was no itchiness on the scalp. With regard to this test subject, even when application of the BNP gel was stopped after 2 weeks, the amount of hair falling out remained low for 2 months, and only 1 or 2 hairs became attached to a towel when washing the hair. However, when 2 months had elapsed after application of the BNP gel was stopped after 2 weeks, the amount of hair falling out started to increase again; when this time 50 μg/g CNP gel was applied twice a day, the amount of hair falling out decreased markedly, the erythema and seborrheic scale were also improved, and the itchiness disappeared. By the 3.sup.rd week after application of the CNP gel was started, the hair had become thick, dark, and long, and there was hair thickening.

(435) TABLE-US-00013 TABLE 9-2 Case B11 (=A9) B12 B15 B16 FIG. FIG. 29 FIG. 40 FIG. 41 Gender Male Male Male Male Age 75 years old 62 years old 44 years old 46 years old When developed 40s 50s Late 30s Late 30s Treatment site Crown, frontal Crown Frontal region Crown, frontal region region (M-shaped part) Hair loss Hair on crown Hair on crown Hairline retreated in Hair in frontal state thinned, and thinned, and M shape. region thinned, and erythema accompanied erythema accompanied hair on crown thinned by itching and by itching and after 40 years old. seborrheic scale pityriatic seen on scalp at desquamation seen on hair loss site. scalp at hair loss site. Family history Father: androgenetic Father, younger Father had Maternal grandfather of alopecia brother: androgenetic alopecia and father had androgenetic androgenetic androgenetic alopecia alopecia alopecia Family history None Younger brother: None None of immune atopic dermatitis disease Child: allergic rhinitis Previous Allergic rhinitis Atopic dermatitis, None None history bronchial asthma Scratch Test House dust: 2+ House dust: 2+ Not tested Not tested Mite: 2+ Mite: 3+ Cedar: 3+ Cedar: 2+ Dactylis: 2+ Dactylis: 1+ Ragweed: 2+ Ragweed: 2+ Effect of No effect Not applied Not applied Not applied minoxidil Effect of Not applied Not applied Not applied Not applied finasteride Effect of No effect Not applied Not applied Not applied glycyrrhetinic acid Effect of No effect No effect Not applied Not applied steroid drug Effect of Not applied Not applied Not applied Not applied carpronium chloride Effect of Not applied Not applied Not applied Not applied cepharanthin Dosage form BNP gel BNP gel BNP gel BNP gel Dose 50 μg/g 50 μg/g 100 μg/g 100 μg/g 200 μg/g Number of days 3 weeks 20 days 3 weeks 3 weeks + 2 weeks used Degree of Erythema, seborrheic Erythema, pityriatic Hair falling out Hair loss area of improvement in scale, and itching desquamation, and decreased, and hair crown decreased. symptoms of hair loss site itching of hair loss thickened. Hairs Hairs became thick, markedly improved, site markedly became thick and terminal hair grew hair falling out improved, hair long, and black and restored, and decreased, and hair falling out terminal hair grew in feeling of volume quality improved. decreased markedly, hair thinning part of increased. Hair in Hairs became thick, and hair became dark M-shaped part. frontal region became black, and dense. and thickened. thick and hair Terminal hair grew thickening observed. in M-shaped part and became dark. Non-recurrence Treatment continuing Treatment continuing Treatment continuing Treatment continuing period
Case B15

(436) The test subject was a 44 year old male who had developed M-shaped androgenetic alopecia in his late 30s. This was classified as type III on the Hamilton-Norwood scale and this was a so-called M-shaped hair loss case. The father of this test subject had androgenetic alopecia.

(437) When 100 μg/g BNP gel was applied to the frontal region of this test subject twice a day for 2 weeks, growth of black terminal hair was observed on the M-shaped thinning hair part after 5 days, and it became more marked in the 2.sup.nd week (FIG. 40).

(438) When application of the BNP gel was stopped after 2 weeks, and from the 5.sup.th day after that a 50 μg/g BNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 1 week, the amount of hair falling out further decreased, the number of hairs lost during washing decreased to 1 to 2 hairs, and the hair became thicker. Due to this test subject being busy, the application was stopped, and even when 3 weeks had elapsed, the thickened hair state was certainly maintained compared with that before application.

(439) Case B16

(440) The test subject was a 46 year old male; thinning hair had occurred in the frontal region from the late 30s, and thinning hair occurred also on the crown after the age of 40. This test subject was classified as type V on the Hamilton-Norwood scale, and both the father and the maternal grandfather had androgenetic alopecia.

(441) When 100 μg/g BNP gel was applied to the frontal region and the crown of this test subject twice a day for 3 weeks, marked growth of black terminal hair was observed on the crown, the feeling of volume of the hair increased, and the hair loss range on the crown decreased. The hair loss range of the crown at this point was 4 cm×3.4 cm (FIG. 41).

(442) When the application of 100 μg/g BNP gel was stopped after 3 weeks and from the following day 200 μg/g BNP gel was applied twice a day for 2 weeks, the hair further thickened and restored, and the hair loss range decreased to 2.5 cm×2.4 cm. Furthermore, hair on the frontal region, for which clear improvement could not be observed by application of 100 μg/g BNP gel, became thick and dark with 2 weeks' application of 200 μg/g BNP gel, and the number of terminal hairs increased (FIG. 41).

(443) 11. Therapeutic Effect of CNP Ointment on Androgenetic Alopecia

(444) The therapeutic effects of CNP ointment on androgenetic alopecia are shown in Table 10 (cases C16 and C17).

(445) TABLE-US-00014 TABLE 10-1 Case C16 C17 FIG. FIG. 30-1 FIG. 31 FIG. 30-2 Gender Male Male Age 56 years old 59 years old When developed Late 30s 50s Treatment site Crown, frontal region Crown, frontal region Hair loss state Hair thinning with vellus hair Hair thinning from crown to seen from crown to frontal frontal region. Scalp at hair region. loss site had erythema, scale, abrasion scars, and strong itching sensation. Family history of androgenetic Father, paternal grandfather: Father, grandfather: androgenetic alopecia androgenetic alopecia alopecia Family history of immune None None disease Previous history Atopic dermatitis Diabetes Scratch Test House dust: — House dust: 2+ Mite: 1+ Mite: 3+ Cedar: — Cedar: — Dactylis: — Dactylis: 2+ Ragweed: — Ragweed: 2+ Effect of minoxidil No effect Not applied Effect of finasteride Not applied Not applied Effect of glycyrrhetinic acid Not applied Not applied Effect of steroid drug Not applied No effect Effect of carpronium chloride Not applied Not applied Effect of cepharanthin Not applied Not applied Dosage form CNP ointment CNP ointment Dose 100 μg/g 50 μg/g Number of days used 28 days 14 days Degree of improvement in Hair falling out decreased, Itching subsided, erythema and symptoms vellus hair turned into terminal abrasion scars on scalp hair, thick and dark. disappeared, and short hair grew in frontal region and crown. Non-recurrence period Treatment continuing Treatment continuing
Case C16

(446) The test subject was a 56 year old male with androgenetic alopecia in which the hair from the crown to the frontal region had become thin and vellus since his 40s. This test subject was classified as type Va on the Hamilton-Norwood scale and was a case in which there was both the so-called M-shaped and 0-shaped hair loss sites. 1% minoxidil had previously been applied to this test subject for many years, but there had been no effect, and because recently there had been redness with itchiness, its use had been stopped. In the case of this test subject, the hair had become thin without inflammatory symptoms such as erythema or scale on the scalp of the hair loss site. The father and the paternal grandfather of this test subject had androgenetic alopecia. The results of the scratch test of this test subject were house dust −, mite 1+, cedar −, Dactylis −, and ragweed −.

(447) When 100 μg/g CNP ointment was applied to the entire hair loss site of the crown and the frontal region of this test subject twice a day morning and evening, the amount of hair falling out decreased after 2 weeks of application, apparent improvement effects were observed, vellus hair became dark, and vellus hair clearly grew and became dark after 4 weeks of application (Ref. FIGS. 30-1 and 30-2). With regard to this test subject, when treatment with the CNP ointment was stopped after it had continued for 8 weeks, the therapeutic effect on hair loss was gradually lost after 3 months has elapsed subsequent to stopping application.

(448) When 50 μg/g BNP gel was applied to the entire hair loss site of the crown and the frontal region of this test subject once a day for 1 month, fine hair became dark and thick, and the amount of hair falling out decreased.

(449) After 2 months had elapsed since the application of 50 μg/g BNP gel was started, it was changed to application of 200 μg/g BNP gel once a day, and when the application had continued for 1 week, hair started to rise and the rate of hair lengthening increased compared with the case with 50 μg/g BNP gel. The hair of this test subject had become white 5 years earlier if it was not dyed, but black hair thickened and lengthened in almost all of the frontal region, which was an area to which the BNP gel had been applied.

(450) Case C17

(451) The test subject was a 59 year old male with androgenetic alopecia in which the hair had become thin from the crown to the frontal region. This test subject was classified as type VII on the Hamilton-Norwood scale, and was a case in which there were both M-shaped and O-shaped hair loss sites. In the case of this test subject, there were erythema, scale, and abrasion scars on the scalp at the hair loss site, and the itching sensation was strong. The father and a grandfather of this test subject had androgenetic alopecia. The results of the scratch test of this test subject were house dust 2+, mite 3+, cedar −, Dactylis 2+, and ragweed 2+. This test subject had previously been prescribed a steroid and had continued with its external use for 7 months, but the itching sensation recurred after only about 1 hour, the inflammation did not calm down, and there was no improvement.

(452) When 50 μg/g CNP ointment was applied to the entire hair loss site of this test subject twice a day for 1 week, the itching calmed down, erythema and abrasion scars on the scalp disappeared, and accompanying this there was growth of short hair on the crown and the frontal region (Ref. FIG. 31). This test subject is currently still being treated with the CNP ointment, and the application of CNP ointment had continued for 14 days at the time of filing of this patent application.

(453) 12. Therapeutic Effect of CNP Gel on Androgenetic Alopecia

(454) The therapeutic effects of CNP gel on androgenetic alopecia are shown in Table 10-2 (cases C24 and C37 to C39).

(455) TABLE-US-00015 TABLE 10-2 Case C24 (=C40) C37 C38 C39 FIG. FIG. 42 Gender Male Male Male Male Age 48 years old 43 years old 33 years old 34 years old When developed 5 year earlier 40s 30s Late 20's Treatment site Crown Frontal region, Frontal region Frontal region crown Hair loss state Hairline in frontal Thinning hair in Thinning hair on Thinning hair on region retreated in front temporal crown, and hair crown, and hair M shape and became region and crown. loss in front loss in front vellus hair, and temporal region. temporal region. thinning hair on crown. Family history of None None Father and maternal Father: androgenetic grandfather: androgenetic alopecia androgenetic alopecia alopecia Family history of Older brother: Unknown Unknown Unknown immune disease atopic dermatitis and allergic rhinitis Previous history Allergic rhinitis Unknown Unknown Unknown and allergic conjunctivitis Scratch Test House dust: 2+ Not tested Not tested Not tested Mite: 3+ Cedar: 2+ Dactylis: 2+ Ragweed: 2+ Effect of Not applied Not applied Not applied Not applied minoxidil Effect of Not applied Not applied Not applied Not applied finasteride Effect of Not applied Not applied Not applied Not applied glycyrrhetinic acid Effect of steroid Not applied Not applied Not applied Not applied drug Effect of Not applied Not applied Not applied Not applied carpronium chloride Effect of Not applied Not applied Not applied Not applied cepharanthin Dosage form CNP gel CNP gel CNP gel CNP gel Dose 50 μg/g 100 μg/g 50 μg/g 50 μg/g Number of days 1 week 2 weeks 2 weeks 3 weeks used Degree of Hair falling out Hair falling out Hair thickening Hair thickening improvement in decreased, hair decreased, hair seen on crown, and seen on crown, and symptoms became thick, and quality became vellus hair became hair became thick the number of hairs thick, and hair thick and dark. In and dark. In M- increased. thinning on crown M-shaped hair shaped part, hair improved. thinning part, grew and hair was vellus hair became restored at slow thick and long, and pace. hair falling out decreased. Non-recurrence Treatment Treatment Treatment Treatment period continuing continuing continuing continuing
Case C24

(456) The test subject was a 48 year old male and had androgenetic alopecia. With regard to this test subject, 5 years earlier, the hair line in the frontal region had retreated in an M-shape and had become vellus hair, and the hair on the crown had become thin. This was classified as type III vertex on the Hamilton-Norwood scale. None of the family of this test subject had thinning hair.

(457) When 50 μg/g CNP gel was applied twice a day to the crown of this test subject for 1 week, the amount of hair falling out decreased, the hair became thick, and the number of hairs increased (FIG. 42).

(458) When application of the CNP gel was stopped after 1 week and a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was then applied twice a day for 1 week, the amount of hair falling out further decreased, and the hair became thicker. Furthermore, hair growth was observed also in the M-shaped part 2 weeks after application of the CNP:betamethasone:gentamicin combination was started.

(459) After the application was suspended for 3 weeks, when a 5% minoxidil solution was applied and 100 μg/g CNP gel was then applied as a multilayer application, there were no symptoms of irritation, the hair gradually became thick and there was restoration of terminal hair both in the M-shaped part and the crown after 1 week following starting the multilayer application.

(460) Case C37

(461) The test subject was a 43 year old male and had androgenetic alopecia in which thinning hair had appeared on the front temporal region and the crown from his 40s. This test subject was classified as type V on the Hamilton-Norwood scale, and was a case having both so-called M-shaped and 0-shaped hair loss sites.

(462) When 100 μg/g CNP gel was applied to the frontal region and the crown of this test subject twice a day for 2 weeks, the amount of hair falling out decreased, the number of hairs falling became about 10 when washing the hair, the quality of the hair changed from being fine to being thick, the hair became long, the thinning hair on the crown was improved, and it became difficult to see through to the skin.

(463) Case C38

(464) The test subject was a 33 year old male whose hair quality had become curly and fine in his late 20s, and androgenetic alopecia had developed in his 30s. This was classified as type III vertex on the Hamilton-Norwood scale, and there was so-called M-shaped alopecia in which the hair on the crown became thin and the front temporal region had hair loss. The father and the maternal grandfather of this test subject had androgenetic alopecia.

(465) When 50 μg/g CNP gel was applied to the frontal region of this test subject twice a day for 1 week, the amount of hair falling out decreased, and hair did not become attached to a pillow. Hair thickening on the crown of this test subject was confirmed by the 2.sup.nd week, and vellus hair became thick and dark. This test subject said that when he entered a freezer at work, he subjectively did not feel cold air penetrating the scalp. With regard to this test subject, vellus hair in the M-shaped thinning hair part also became thick and long. With regard to this test subject, when application was subsequently continued, the number of terminal hairs on the crown increased considerably and the hair became longer after 2 months had elapsed, there was hair thickening, and thinning hair became inconspicuous. Even in the M-shaped thinning hair part, although the hair was finer than that on the crown, terminal hair rather than vellus hair increased, became longer, and the number of long hairs increased.

(466) Subsequently, when a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 2 weeks, the hair further thickened on the crown and the hair on the M-shaped part became longer and thicker, but there was accompanying folliculitis, which was thought to be a side effect of a steroid.

(467) Case C39

(468) The test subject was a 34 year old male whose hair had become thin in his late 20's and who had androgenetic alopecia. This was classified as type V on the Hamilton-Norwood scale, and there was thinning hair on the crown and so-called M-shaped alopecia in which there was hair loss on the front temporal region. The father of this test subject had androgenetic alopecia. A 1% minoxidil solution had been applied to this test subject for 1 year, but there had been no effect. Furthermore, biotin and a Chinese medicine had been orally administered to this test subject, but there had been no effect.

(469) When 50 μg/g CNP gel was applied to the frontal region of this test subject twice a day for 3 weeks, hair thickening was observed on the crown, and the hair became thick and dark. On the M-shaped part also hair growth and hair restoration were observed at a slow pace.

(470) 13. Therapeutic Effect of CNP:Betamethasone:Gentamicin Combination on Androgenetic Alopecia

(471) The therapeutic effects of CNP:betamethasone:gentamicin combination on androgenetic alopecia are shown in Table 10-3 (case C25).

(472) TABLE-US-00016 TABLE 10-3 Case C25 FIG. FIG. 43, FIG. 44 Gender Male Age 75 years old When developed 5 years earlier Treatment site Frontal region and crown Hair loss state Hairline in frontal region retreated in M-shape and became vellus hair, and thinning hair on crown. From half a year earlier there had been coexisting alopecia pityroides accompanied by scale, erythema, and itching. Family history of androgenetic alopecia None Family history of immune disease Unknown Previous history Unknown Scratch Test Unknown Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug No effect Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form CNP:betamethasone:gentamicin combination Dose 25 μg/g CNP 600 μg/ml betamethasone 500 μg/ml gentamicin Number of days used 12 days Degree of improvement in symptoms Hair falling out decreased, scale and erythema improved, and marked hair thickening in both crown and M-shaped part. Hair became thick and long. Non-recurrence period Unknown
Case C25

(473) The test subject was a 75 year old male who had androgenetic alopecia. With regard to this test subject, the hair line in the frontal region had retreated in an M-shape and the crown had started to become thin from 5 years earlier. This test subject had scale and erythema with accompanying itching, and had coexisting alopecia pityroides. This test subject was a case having both the so-called M-shaped and 0-shaped hair loss sites, and was classified as type VI on the Hamilton-Norwood scale.

(474) When a 25 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied to the frontal region and the crown of this test subject twice a day for 12 days, there was almost no hair falling out, and the scale and erythema disappeared completely. Application of the CNP:betamethasone:gentamicin combination was stopped after 12 days, and when observation was made 18 days after application had been stopped, the hair quality had improved for both the hair line of the frontal region and the crown, the hair had become thick and long, and there was marked hair thickening (FIG. 43 and FIG. 44).

(475) 14. Therapeutic Effect of CNP:Clobetasol Combination on Androgenetic Alopecia

(476) The therapeutic effects of CNP:clobetasol combination on androgenetic alopecia are shown in Table 10-4 (case C26).

(477) TABLE-US-00017 TABLE 10-4 Case C26 FIG. FIG. 45 Gender Male Age 61 years old When developed Unknown Treatment site Frontal region and crown Hair loss state Hair thinning was conspicuous in frontal region and crown. Family history of androgenetic alopecia Father, paternal grandfather, and maternal grandfather had androgenetic alopecia. Family history of immune disease Unknown Previous history Bronchial asthma Scratch Test — Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug No effect Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form CNP:clobetasol combination Dose 50 μg/g CNP 250 μg/g clobetasol Number of days used 7 days Degree of improvement in symptoms Marked growth of black terminal hair, itching sensation disappeared, and dandruff stopped. Non-recurrence period Treatment continuing
Case C26

(478) The test subject was a 61 year old male who had androgenetic alopecia. This test subject was a case in which the frontal region and the crown had thinning hair mixed with white hair and there was coexisting alopecia pityroides accompanied by itching and scale. The father, the paternal grandfather, and the maternal grandfather of this test subject had androgenetic alopecia. This test subject was affected by bronchial asthma. The test results of the scratch test of this test subject were as given, and this test subject was a case having both the so-called M-shaped and O-shaped hair loss sites, and was classified as type IVa on the Hamilton-Norwood scale. ‘Dermovate Scalp Lotion 0.05%’ (GlaxoSmithKline plc), which contains 0.05% of clobetasol propionate and ‘Fulmeta Lotion’ (Shionogi & Co., Ltd.), which contains 0.1% of mometasone furancarboxylate had been applied to the frontal region and the crown of this test subject for 9 months, but there had been no effect at all, and the hair had become somewhat thin.

(479) When a 50 μg/mL CNP:250 μg/g clobetasol combination was applied to the frontal region and the crown of this test subject twice a day for 1 week, marked growth of black terminal hair was observed, the itching sensation disappeared, and dandruff disappeared (FIG. 45).

(480) When the application of 50 μg/mL CNP:250 μg/g clobetasol combination was stopped after 1 week, and from the following day a 50 μg/mL BNP:250 μg/g clobetasol combination was applied twice a day, growth of black terminal hair became more marked after 1 week, the amount of hair falling out decreased markedly after 2 weeks, and black terminal hair lengthened at a very high rate.

(481) 15. Therapeutic Effect of CNP:Carpronium Chloride Combination on Androgenetic Alopecia

(482) The therapeutic effects of CNP:carpronium chloride combination on androgenetic alopecia are shown in Table 10-5 (case C27).

(483) TABLE-US-00018 TABLE 10-5 Case C27 FIG. FIG. 46 Gender Male Age 32 years old When developed About 30 years old Treatment site Frontal region, left temporal region Hair loss state Hair loss in M-shaped part of frontal region, and circular bald area in left temporal region. Family history of androgenetic alopecia None Family history of immune disease None Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not applied Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form CNP:carpronium chloride combination Dose 50 μg/g Number of days used 14 days Degree of improvement in symptoms Larger number of black terminal hairs grew than when single agent was applied. Non-recurrence period Treatment continuing
Case C27

(484) The test subject was a 32 year old male who had androgenetic alopecia. With regard to this test subject, hair of the M-shaped hair line in the frontal region suddenly thinned at the age of 30 and retreated. Alopecia areata monolocularis had also developed in the left temporal region 6 weeks before visiting the clinic. None of the family of this test subject had alopecia. This test subject was classified as type III on the Hamilton-Norwood scale, and had so-called M-shaped androgenetic alopecia.

(485) When 50 μg/g CNP gel was applied twice a day to an androgenetic alopecia area of the frontal region and a circular bald area of the left temporal region of this test subject, growth of black terminal hair was observed after 2 weeks both in the M-shaped hair line area and the circular bald area (FIG. 46).

(486) When application of the CNP gel was stopped after 2 weeks and from the following day a CNP:carpronium chloride combination was applied twice a day, a larger amount of black terminal hair than with the single agent grew after 1 week.

(487) 16. Therapeutic Effect of Multilayer Application of CNP Gel and Minoxidil on Androgenetic Alopecia

(488) The therapeutic effects of multilayer application of CNP gel and minoxidil on androgenetic alopecia are shown in Table 10-6 (case C40).

(489) TABLE-US-00019 TABLE 10-6 Case C40 (=C24) Figure Gender Male Age 48 years old When developed 5 years earlier Treatment site Frontal region, crown Hair loss state Hairline in frontal region retreated in M-shape and became vellus hair, thinning hair on crown. Family history of androgenetic alopecia None Family history of immune disease Older brother: atopic dermatitis and allergic rhinitis Previous history Allergic rhinitis and allergic conjunctivitis Scratch Test House dust: 2+ Mite: 3+ Cedar: 2+ Dactylis: 2+ Ragweed: 2+ Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not applied Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form Multilayer application of CNP gel and minoxidil Dose 100 μg/g CNP gel 1% minoxidil Number of days used 1 week Degree of improvement in symptoms Restoration of terminal hair seen in M-shaped part and crown. Non-recurrence period Treatment continuing
Case C40

(490) Case C40 was the same test subject as C24 and was an androgenetic alopecia case. Details of this case are as described for case C24.

(491) When 5% minoxidil solution was applied to this test subject and after that 100 μg/g CNP gel was applied by multilayer application, there were no symptoms of irritation, and restoration of black terminal hair was observed, although it was gradual, on the M-shaped part and the crown from 1 week after starting the multilayer application.

(492) 17. Therapeutic Effect of Multilayer Application of BNP Gel and Minoxidil on Androgenetic Alopecia

(493) The therapeutic effects of multilayer application of BNP gel and minoxidil on androgenetic alopecia are shown in Table 10-7 (case B29).

(494) TABLE-US-00020 TABLE 10-7 Case B29 Figure Gender Male Age 52 years old When developed About 23 years old Treatment site Crown Hair loss state Frontal region and crown had thinning hair. Family history of androgenetic alopecia None Family history of immune disease None Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not applied Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form Multilayer application of BNP gel and minoxidil Dose 100 μg/g BNP gel 5% minoxidil Number of days used 1 week Degree of improvement in symptoms No symptoms of irritation, hair became supple, and hair thinning on crown improved. Non-recurrence period Treatment continuing
Case B29

(495) The test subject was a 52 year old male and had androgenetic alopecia that was classified as type IV on the Hamilton-Norwood scale. This test subject had shown thinning hair in the frontal region at around 23 years old, and the crown currently had thinning hair. This test subject had no family members with alopecia. Oral administration of Hangekobokuto had not shown any effect on this test subject.

(496) When 100 μg/g BNP gel was applied twice a day to the androgenetic alopecia area of the crown of this test subject, the amount of hair falling out decreased dramatically 2 weeks later, the hair on the crown became thick and dark, and growth of black terminal hair was observed. However, after that, when application of the BNP gel was suspended for 3 weeks, the hair became less robust and less resilient.

(497) When multilayer application of 5% minoxidil solution and then 100 μg/g BNP gel was carried out for 1 week, there were no symptoms of irritation, the hair became robust, and the thinning hair on the crown was improved.

(498) Case C32

(499) Case C32 was a case of coexisting androgenetic alopecia and seborrheic alopecia, and was the same as cases A9, B11, and B22.

(500) When 100 μg/g BNP gel was applied to thinning hair sites of the crown and the M-shaped part of this test subject twice a day morning and evening, erythema, seborrheic scale, and itching of the hair loss sites markedly improved on the 3.sup.rd day after application was started, and the amount of hair falling out become unnoticeable. With regard to this test subject, the hair quality was improved after 2 weeks, the hair became thick and dark, and there was hair thickening. With regard to this test subject, on the 2.sup.nd week of application, in the M-shaped part also, vellus hair became thick, dark, and although it was slow the hair became long.

(501) In order to examine an external preparation that could further reduce the thinning hair range of the crown of this test subject, after 5% minoxidil solution was applied to the crown and the M-shaped part, 100 μg/g BNP gel was applied by multilayer application; the hair on the crown became black and dark compared with application of a single BNP agent when 1 week had elapsed after the multilayer application had started, and there was hair thickening. This test subject is still having multilayer application treatment with 5% minoxidil and 100 μg/g BNP gel at the present.

(502) 18. Therapeutic Effect of ANP Gel on Postpartum Alopecia

(503) The therapeutic effects of ANP gel on postpartum alopecia are shown in Table 10-8 (case A10).

(504) TABLE-US-00021 TABLE 10-8 Case A10 FIG. FIG. 47 Gender Female Age 45 years old When developed 44 years old Treatment site Crown Hair loss state Thinning hair on crown was conspicuous. Hair loss site other than head None Family history of alopecia Unknown Family history of immune disease Unknown Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not applied Effect of cooling therapy Not applied Antiallergic drug No effect Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form ANP gel Dose 100 μg/g Number of days used 21 days Degree of improvement in symptoms Hair falling out did not decrease, but hair loss range of crown enlarged. Non-recurrence period Treatment continuing
Case A10

(505) This test subject was a 45 year old female and had developed thinning hair on the crown after childbirth.

(506) When 100 μg/g ANP gel was applied to the crown of this test subject twice a day for 3 weeks, the amount of hair falling out did not decrease, but the hair loss range on the crown enlarged somewhat.

(507) When application of the ANP gel was stopped after 3 weeks and suspended for 6 months, and then 50 μg/g BNP gel was applied to the hair loss site of the crown once every 3 to 4 days for 3 weeks, the thinning hair on the crown thickened to a level such that it was visually unnoticeable (FIG. 47).

(508) 19. Therapeutic Effect of BNP Gel on Postpartum Alopecia

(509) The therapeutic effects of BNP gel on postpartum alopecia are shown in Table 10-9 (case B17).

(510) TABLE-US-00022 TABLE 10-9 Case B17 FIG. FIG. 47 Gender Female Age 45 years old When developed 44 years old Treatment site Crown Hair loss state Thinning hair on crown was conspicuous. Hair loss site other than head None Family history of alopecia Unknown Family history of immune disease Unknown Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not applied Effect of cooling therapy Not applied Antiallergic drug No effect Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form BNP gel Dose 50 μg/g Number of days used 21 days Degree of improvement in symptoms Hair grew on crown, thinning hair improved to a level such that it was unnoticeable Non-recurrence period 2 months
Case B17

(511) Case B17 was the same test subject as case A10.

(512) When, 6 months after application of the ANP gel was stopped, 50 μg/g BNP gel was applied to the crown 3 to 4 times a day for 3 weeks, the terminal hair thickened, the amount of hair falling out decreased, and the thinning hair recovered to the extent that it was unnoticeable (FIG. 47).

(513) 20. Therapeutic Effect of CNP Gel on Postpartum Alopecia

(514) The therapeutic effects of CNP gel on postpartum alopecia are shown in Table 11-1 (case C18).

(515) TABLE-US-00023 TABLE 11-1 Case C18 FIG. FIG. 32 Gender Female Age 27 years old When developed 27 years old Treatment site Crown Hair loss state Thinning hair from crown to frontal region was conspicuous. Hair loss site other than head None Family history of alopecia Mother: androgenetic alopecia in female with thinning on crown Family history of immune disease Mother: allergic rhinitis Previous history Atopic dermatitis Scratch Test House dust: 3+ Mite: 2+ Cedar: 2+ Dactylis: 2+ Ragweed: 2+ Effect of minoxidil Not applied Effect of steroid drug No effect Effect of cooling therapy Not applied Antiallergic drug Not applied Effect of carpronium chloride No effect Effect of cepharanthin Not applied Dosage form CNP gel Dose 100 μg/g Number of days used 7 days Degree of improvement in symptoms Hair parting was wide and conspicuous, but short sturdy terminal hair grew, and bald area along hair parting improved. Non-recurrence period 6 months
Case C18

(516) The test subject was a 27 year old female and was a patient with postpartum alopecia. This was a case with a history of atopic dermatitis and with an atopic predisposition. The mother of this test subject was affected by allergic rhinitis, and the mother of this test subject also had female pattern alopecia with a thin crown. The results of the scratch test were house dust 3+, mite 3+, cedar 2+, Dactylis 2+, and ragweed 2+. This test subject had rapidly lost hair due to childbirth 7 months earlier. Thinning hair on the crown and the frontal region was conspicuous for this test subject. This test subject had received application of a steroid and carpronium chloride for 5 months, but there was still a large amount of hair falling out, and thinning hair on the crown had not improved.

(517) When 100 μg/g CNP gel was applied to the entire crown of this test subject twice a day, the amount of hair falling out decreased dramatically after 7 days of application, it improved such that only 5 to 6 hairs fell out per day, and the seborrheic scalp was also improved (Ref. FIG. 32). A large amount of short terminal hair grew from the frontal region to the crown, the thinning hair of the crown became inconspicuous objectively, and a substantially normal state was recovered. However, the amount of hair falling out increased around the summer when half a year had elapsed since application of the CNP gel was stopped after 7 days, and the crown showed thinning hair.

(518) When this time 100 μg/g BNP gel was applied twice a day to the entire crown, the amount of hair falling out decreased dramatically after 7 days' application, and a large amount of short terminal hair grew. Application of the BNP gel was stopped after 7 days, but there was no recurrence for half a year thereafter.

(519) 21. Therapeutic Effect of BNP Gel on Female Pattern Alopecia

(520) The therapeutic effects of BNP gel on female pattern alopecia are shown in Table 11-2 (cases B18 to B20 and B27).

(521) TABLE-US-00024 TABLE 11-2 Case B18 B19 B20 B27 FIG. None FIG. 48 FIG. 49 Gender Female Female Female Female Age 46 years old 59 years old 50 years old 66 years old When developed 46 years old 59 years old About 47 years old 65 years old Treatment site Crown Frontal region Crown Crown, frontal region, left M- shaped part Hair loss state Diffuse hair loss Thinning hair in Hair thinning on Thinning hair in on and around the hair parting in crown and its wide range from mid line. frontal region was periphery, large crown to frontal conspicuous. amount of hair region and left M- falling out. shaped part, the skin showed through. Seborrheic scale was conspicuous. The amount of hair falling out was very large. Hair loss site None None None None other than head Family history of Father, None Mother had female 65 years old alopecia grandfather, and pattern alopecia and older brother had father had androgenetic androgenetic alopecia alopecia Family history of Grandfather, Older None None None immune disease brother: asthma Previous history Atopic dermatitis None None None bronchial asthma allergic rhinitis Scratch Test House dust: 2+ Not tested Not tested Not tested Mite: 2+ Cedar: — Dactylis: — Ragweed: — Effect of Not tested Not tested Not tested Not tested minoxidil Effect of steroid Not applied Not applied No effect No effect drug Effect of cooling Not applied Not applied Not applied Not applied therapy Antiallergic drug Not applied Not applied Not applied No effect Effect of Not applied Not applied Not applied Not applied carpronium chloride Effect of Not applied Not applied Not applied Not applied cepharanthin Dosage form BNP gel BNP gel BNP gel BNP gel Dose 50 μg/g 100 μg/g 50 μg/g 50 μg/g Number of days 28 days 14 days 14 days 21 days used Degree of After BNP gel was Hair thinning in Hair falling out By 10.sup.th day after improvement in applied for 2 frontal region decreased to one application twice a symptoms weeks, marked hair improved, and slight third, and hair day for 5 days, growth and degree of erythema thinning became black terminal hair restoration was disappeared. inconspicuous. grew on hairline and observed, and hair crown, seborrheic thickened so that scale on scalp was no skin could be markedly improved, seen. The number and hair falling out of hairs falling decreased. out during shampooing decreased to about 10. Non-recurrence >4 months 1 month 1 month 2 weeks period
Case B18

(522) The test subject was a 56 year old female and was a patient with female pattern alopecia. This test subject had a large amount of broken hair and hair falling out, and diffuse hair loss was observed centered on the mid line. The father, a grandfather, and an older brother of this test subject had androgenetic alopecia.

(523) When 50 μg/g BNP gel was applied to the crown of this test subject, marked hair growth and hair restoration were observed about 2 weeks after the application was started, and during application the amount of hair falling out and sticking to the hands when shampooing decreased to about 10 hairs. With regard to this test subject, the hair thickened to an extent such that eventually the skin could not be seen. There was no subsequent external application for 4 months, the terminal hair remained, and a state with a small amount of hair falling out could be maintained.

(524) Case B19

(525) The test subject was a 59 year old female and was a patient with female pattern alopecia. This test subject had developed conspicuous thinning hair at the hair parting in the frontal region in her 50s.

(526) When 100 μg/g BNP gel was applied twice a day for 2 weeks, the thinning hair thickened and became inconspicuous to a degree that could be said to be normal, and the application was therefore stopped.

(527) However, half a year later, thinning hair at the hair parting in the frontal region became conspicuous again, and when this time 50 μg/g CNP gel was applied twice a day for 1 week, the thinning hair thickened to an extent such that it was unnoticeable (FIG. 48).

(528) When a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was further applied twice a day, during the 1.sup.st week a state in which the amount of hair falling out was unchanged was maintained and there was no itching, but during the 2.sup.nd week a slight degree of erythema occurred and it became possible to see through to the scalp slightly. The application of 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was therefore stopped after 10 days, and when from the following day it was changed to 100 μg/g CNP gel, the hair thickened again with application twice a day for 1 week.

(529) However, when the application of 100 μg/g CNP gel was stopped after 1 week and 100 μg/g ANP gel was applied twice a day for 1 week, a slight degree of erythema appeared, it was possible to see through to the scalp, and the hair became thinner than it had been before application.

(530) Case B20

(531) The test subject was a 50 year old female and was a patient with female pattern alopecia. The hair of this test subject had thinned from the crown to the frontal region a few years earlier, and the hair parting had enlarged. The mother of this test subject had female pattern alopecia, and the father had androgenetic alopecia.

(532) When ‘Dermosol-G Lotion’ (Iwaki Seiyaku Co., Ltd.), which contains 1200 μg/mL of betamethasone valerate and 1000 μg/mL of gentamicin sulfate, was applied to the crown of this test subject continuously for 8 weeks, the thinning hair was not improved at all.

(533) When 50 μg/g BNP gel was applied to the crown of this test subject twice a day for 1 week, the amount of hair falling out decreased to one third after 1 week, and the thinning hair became inconspicuous after 2 weeks (FIG. 49). After application of the BNP gel was stopped after 2 weeks, a state in which the amount of hair falling out was small was maintained for about 1 month, but the amount of hair falling out increased again after about 1 month.

(534) When 50 μg/g CNP gel was applied twice a day for 2 weeks, in the same way as for the BNP gel the amount of hair falling out decreased to about one third, and the thinning hair became inconspicuous after 2 weeks.

(535) Moreover, when application of the CNP gel was stopped after 2 weeks and 2 weeks after that a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 2 weeks, the state in which the amount of hair falling out decreased was maintained. Even when 2 weeks had elapsed after application of the 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was stopped after 2 weeks, a state in which the thinning hair was inconspicuous and it could be said to be normal was maintained.

(536) Case B27

(537) The test subject was a 66 year old female whose hair had thinned at about 65 years old. This was female pattern alopecia having coexisting seborrheic alopecia with conspicuous seborrheic scale on the scalp. This test subject had thinning hair from the crown to the frontal region and the left-hand side M-shaped part with the skin being quite visible. With regard to this test subject, the amount of hair falling out was very large, and the hair fell out immediately simply by touching it. The father and an older brother of this test subject had androgenetic alopecia.

(538) When 50 μg/g BNP gel was applied to the crown of this test subject twice a day, hair growth and hair restoration were observed about 4 to 5 days after the application was started, and the seborrheic scale on the scalp was markedly improved. The amount of hair falling out for this test subject, for whom a large amount had fallen out simply by touching it before the application, decreased. With regard to this test subject, the thinning hair became inconspicuous to a degree such that the skin could not be seen 21 days after application of 50 μg/g BNP gel had been started.

(539) 22. Therapeutic Effect of CNP Gel on Female Pattern Alopecia

(540) The therapeutic effects of CNP gel on female pattern alopecia are shown in Table 12 (cases C19, C28, and C29).

(541) TABLE-US-00025 TABLE 12 Case C19 C28 C29 FIG. FIG. 33 FIG. 50 — Gender Female Female Female Age 46 years old 62 years old 60 years old When developed About 46 years old 62 years old 59 years old Treatment site Crown Frontal region and crown Frontal region Hair loss state Diffuse hair thinning was Hair thinning occurred Hair thinning occurred on conspicuous from crown to from frontal region to hairline of frontal frontal region. crown. Large amount of region, accompanied by dandruff on scalp, there scale. was erythema, large amount of hair falling out. Hair loss site other None None None than head Family history of Grandfather, older Father had androgenetic Unknown alopecia brother: androgenetic alopecia at around 35 alopecia years old Family history of Mother: allergic rhinitis Unknown Unknown immune disease Previous history Atopic dermatitis Unknown Unknown Scratch Test Not tested Not tested Unknown Effect of minoxidil Not tested Not tested Unknown Effect of steroid No effect Not applied Not applied drug Effect of cooling Not applied Not applied Not applied therapy Antiallergic drug Not applied Not applied Not applied Effect of carpronium No effect Not applied Not applied chloride Effect of Not applied Not applied Not applied cepharanthin Dosage form CNP gel CNP gel CNP gel Dose 100 μg/g 50 μg/g 50 μg/g Number of days used 4 weeks 28 days 14 days Degree of Thinning hair part After 2 weeks' Hair thinning at hairline improvement in recovered to almost application, hair falling of frontal region symptoms normal state, and hair out decreased, and hair improved to normal state. falling out decreased. thickened from frontal Scale also disappeared. region to crown. 1 month after starting application, hair thinning improved to unnoticeable level. Non-recurrence 1 month 3 months 6 weeks period
Case C19

(542) The test subject was a 56 year old female and was a patient with female pattern alopecia. There was a history of atopic dermatitis, the mother of this test subject was affected by allergic rhinitis, and this was a case with an atopic predisposition. The father of this test subject had androgenetic alopecia, and the mother of this test subject had female pattern alopecia. The results of the scratch test were house dust 2+, mite 2+, cedar 1+, Dactylis 1+, and ragweed 1+. The hair on the crown of this test subject had become thin 10 years earlier. This test subject had been externally applying a steroid and carpronium chloride, but there had been no effect.

(543) When 100 μg/g CNP gel was applied to the crown and the thinning hair part on the crown of this test subject twice a day, the amount of hair falling out decreased after 4 days of application, new terminal hair grew on the frontal region and the crown, and the hair parting on the scalp did not widen (ref. FIG. 33). However, when application of the CNP gel was stopped after 2 weeks, about 2 weeks after the application was stopped a slight degree of erythema and scale reappeared on the scalp of the frontal region and the crown, and there was thinning hair.

(544) When this time 50 μg/g BNP gel was applied twice a day for 3 weeks, vellus hair became thick, hair growth was observed, and the thinning hair improved. However, when application of the BNP gel was stopped after 3 weeks, about 1 month after the application was stopped a slight degree of erythema and scale on the scalp of the frontal region and the crown reappeared, and there was thinning hair.

(545) When 50 μg/g BNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 1 week, vellus hair became thick, and the thinning hair improved.

(546) Case C28

(547) The test subject was a 62 year old female and was a patient with female pattern alopecia. This test subject had developed a dry rough scalp around the April following the Great East Japan Earthquake of 11 Mar. 2011, and had thinning hair from the frontal region to the crown. The father of this test subject had hair loss on the entire head due to androgenetic alopecia at about 35 years old.

(548) When 50 μg/g CNP gel was applied to the frontal region and the crown of this test subject once to twice a day for 2 weeks, the amount of hair falling out decreased, and marked hair thickening was observed from the frontal region to the crown. When application of the CNP gel was continued for a further 2 weeks, the hair thickened so that thinning hair could hardly be seen (FIG. 50).

(549) 1 month after the application was stopped, thinning hair became slightly conspicuous again, but when a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day for 2 weeks the thickened hair state was maintained.

(550) Case C29

(551) The test subject was a 60 year old female and was a patient with female pattern alopecia. With regard to this test subject, scale and itching had appeared 1 year earlier, and hair at the hair line in the frontal region had become thin.

(552) When 50 μg/g CNP gel was applied to the frontal region of this test subject twice a day for 2 weeks, the hair thickened to such a degree that there was no widening of the hair parting and it was not possible to see through to the scalp. Even after 6 weeks had elapsed since application of the CNP gel was stopped, the effects were maintained, and it was not possible to see through to the scalp.

(553) 23. Therapeutic Effect of ANP Gel on Seborrheic Alopecia

(554) The therapeutic effects of ANP gel on seborrheic alopecia are shown in Table 13 (cases A11 and A12).

(555) TABLE-US-00026 TABLE 13 Case A11 A12 (=A8, B8) (=A9, B11) FIG. FIG. 27 Gender Male Male Age 45 years old 75 years old When developed From 44 years old About 40s to 50s Treatment site Crown Crown Hair loss state Thinning hair occurred only on Erythema accompanied by itching and crown, and erythema accompanied seborrheic scale were seen on scalp by itching and seborrheic scale at hair loss site. were seen on scalp at hair loss site. Family history of androgenetic Father: androgenetic alopecia Father: androgenetic alopecia alopecia Family history of immune None None disease Previous history Atopic dermatitis, allergic Allergic rhinitis rhinitis Scratch Test House dust: 2+ House dust: 2+ Mite: 3+ Mite: 2+ Cedar: — Cedar: 3+ Dactylis: 1+ Dactylis: 2+ Ragweed: 1+ Ragweed: 2+ Effect of minoxidil Not applied No effect Effect of finasteride Not applied Not applied Effect of glycyrrhetinic acid Not applied No effect Effect of steroid drug No effect No effect Effect of cooling therapy Not applied Not applied Antiallergic drug Not applied Not applied Effect of carpronium chloride Not applied Not applied Effect of cepharanthin Not applied Not applied Dosage form ANP gel ANP gel Dose 100 μg/g 100 μg/g Number of days used 2 weeks 4 days Degree of improvement in Intense itchiness occurred, No improvement in erythema and symptoms seborrheic scale aggravated, and seborrheic scale. hair thinning range enlarged. Non-recurrence period No improvement No improvement
Case A11

(556) Case A11 was a case with coexisting androgenetic alopecia and seborrheic alopecia and is the same case as cases A8 and B8. Details of this case are as described for cases A8 and B8; when 100 μg/g ANP gel was applied to the entire hair loss site of the crown twice a day morning and evening, intense itching appeared on the 2.sup.nd day, the amount of hair falling out increased, the hair loss range enlarged, seborrheic scalp was aggravated, erythema appeared, and no hair growth was observed.

(557) Case A12

(558) Case A12 was a case with coexisting androgenetic alopecia and seborrheic alopecia and is the same case as cases A9 and B11. Details of this case are as described for cases A9 and B11; when 100 μg/g ANP gel was applied to the hair loss site of the crown twice a day morning and evening for 4 days, there was no improvement in erythema and seborrheic scale, and there was no improvement effect for alopecia either.

(559) 24. Therapeutic Effect of BNP Gel on Seborrheic Alopecia

(560) The therapeutic effects of BNP gel on seborrheic alopecia are shown in Table 14 (cases B21 and B22).

(561) TABLE-US-00027 TABLE 14 Case B21 B22 (=A8, B8) (=A9, B11) FIG. Gender Male Male Age 45 years old 75 years old When developed From 44 years old 40s Treatment site Crown Crown Hair loss state Hair thinning occurred only on Hair thinning occurred on crown, crown, and erythema accompanied and erythema accompanied by itching by itching and seborrheic scale and seborrheic scale were seen on were seen on scalp at hair loss scalp at hair loss site. site. Family history of androgenetic Father: androgenetic alopecia Father: androgenetic alopecia alopecia Family history of immune None None disease Previous history Atopic dermatitis, allergic Allergic rhinitis rhinitis Scratch Test House dust: 2+ House dust: 2+ Mite: 3+ Mite: 2+ Cedar: — Cedar: 3+ Dactylis: 1+ Dactylis: 2+ Ragweed: 1+ Ragweed: 2+ Effect of minoxidil Not applied No effect Effect of finasteride Not applied Not applied Effect of glycyrrhetinic acid Not applied No effect Effect of steroid drug No effect No effect Effect of cooling therapy Not applied Not applied Antiallergic drug No effect No effect Effect of carpronium chloride No effect Not applied Effect of cepharanthin Not applied Not applied Dosage form BNP gel BNP gel Dose 50 μg/g 100 μg/g Number of days used 5 weeks 3 weeks Degree of improvement in Erythema, seborrheic scale, and Erythema, seborrheic scale, and symptoms itching at hair loss site itching at hair loss site markedly markedly improved and hair improved, hair falling out thinning improved. decreased, and hair quality improved and became dark. Non-recurrence period Treatment continuing Treatment continuing
Case B21

(562) Case B21 was a case with coexisting androgenetic alopecia and seborrheic alopecia and is the same case as cases A8 and B8. Details of this case are as described for cases A8 and B8.

(563) When 50 μg/g BNP gel was applied to the entire hair loss site of the crown of this test subject twice a day morning and evening, on the 1.sup.st week after application of the BNP gel was started erythema, seborrheic scale, and itching on the hair loss site markedly improved, the amount of hair falling out decreased to an unnoticeable level, hair became thick on the crown objectively, the number of terminal hairs increased, and the thinning hair improved.

(564) When application of the BNP gel to this test subject was stopped after 3 weeks, the feeling of volume on the crown decreased after 2 months, and itching started.

(565) When multilayer application to the crown was carried out with 5% minoxidil solution and then with 100 μg/g BNP gel, there were no symptoms of irritation as there had been when the ANP gel was applied, when 1 week had elapsed after the multilayer application was started the amount of hair falling out decreased, the itchiness disappeared, and hair growth effects were observed. This test subject is still continuing to receive multilayer application with 5% minoxidil solution and 100 μg/g BNP gel at the present.

(566) Case B22

(567) Case B22 was a case with coexisting androgenetic alopecia and seborrheic alopecia and is the same as cases A9 and B11. Details of this case are as described for cases A9 and B11.

(568) When 100 μg/g BNP gel was applied to thinning hair sites of the crown and the M-shaped part of this test subject twice a day morning and evening, on the 3.sup.rd day after the application was started erythema, seborrheic scale, and itching in the hair loss sites markedly improved, and the amount of hair falling out become unnoticeable. With regard to this test subject, 2 weeks after, the hair quality improved, the hair became thick and dark, and there was hair thickening. With regard to this test subject, even in the M-shaped part, in the 2.sup.nd week of application vellus hair became thick and dark, and the hair became long, albeit slowly.

(569) In order to examine an external preparation that could further reduce the thinning hair range of the crown of this test subject, after a 5% minoxidil solution was applied to the crown and the M-shaped part, 100 μg/g BNP gel was applied by multilayer application, compared with application of a single BNP agent, the hair on the crown became black and dark when 1 week had elapsed since the multilayer application had started, and there was hair thickening. This test subject is still having multilayer application treatment with 5% minoxidil and 100 μg/g BNP gel at the present.

(570) 25. Therapeutic Effect of ANP Gel on Alopecia Pityroides

(571) The therapeutic effects of ANP gel on alopecia pityroides are shown in Table 15 (case A13).

(572) TABLE-US-00028 TABLE 15 Case A13 A14 (=A6, C3, C4) (=A1, C5) FIG. FIG. 21 Gender Female Female Age 50 years old 33 years old When developed 40 years old 13 years old Hair loss range S2 S3 Treatment site Crown Right temporal region Hair loss site other than head None (B0) Eyebrows (B1) Family history of alopecia Mother: alopecia areata None Family history of immune Child: allergic rhinitis, Mother: atopic dermatitis disease chronic urticaria Older sister: atopic dermatitis, allergic rhinitis Previous history Atopic dermatitis, allergic Atopic dermatitis rhinitis Scratch Test House dust: 1+ House dust: 2+ Mite: 1+ Mite: 1+ Cedar: — Cedar: — Dactylis: 2+ Dactylis: 2+ Ragweed: 1+ Ragweed: 2+ Effect of minoxidil Not applied Not applied Effect of finasteride Contraindicated Contraindicated Effect of glycyrrhetinic acid Not applied Not applied Effect of steroid drug No effect No effect Effect of cooling therapy Not applied No effect Antiallergic drug No effect No effect Effect of carpronium chloride No effect Not applied Effect of cepharanthin Not applied Not applied Dosage form ANP gel ANP ointment Dose 100 μg/g 100 μg/g Number of days used 14 days 21 days Degree of improvement in S2.fwdarw.S2 S3.fwdarw.S3 symptoms Non-recurrence period — —
Case A13

(573) Case A13 was a case with coexisting alopecia areata and alopecia pityroides and is the same case as cases A6, C3, C4, and C30. CNP ointment was applied to the crown. Details of this case are as described for cases A6, C3, and C4; there was no effect from application of 100 μg/g ANP gel for 2 weeks, dry rough scale increased, there was itching, and the hair loss range enlarged somewhat.

(574) 26. Therapeutic Effect of ANP Ointment on Alopecia Pityroides

(575) The therapeutic effects of ANP ointment on alopecia pityroides are shown in Table 15 (case A14).

(576) Case A14

(577) Case A14 was a case with coexisting alopecia areata and alopecia pityroides and is the same case as cases A1 and C5. It should be noted that CNP ointment was applied after a 2 week period of drug suspension. Details of this case are as described for cases A1 and C5; when 100 μg/g ANP gel was applied twice a day for 3 weeks, there was growth of vellus hair, but erythema and pityriatic desquamation on the scalp were not alleviated, and there was itching.

(578) 27. Therapeutic Effect of BNP Gel on Alopecia Pityroides

(579) The therapeutic effects of BNP gel on alopecia pityroides are shown in Table 16 (cases B23 and B28).

(580) TABLE-US-00029 TABLE 16 Case B23 B28 FIG. FIG. 51 FIG. 53 Gender Male Male Age 81 years old 59 years old When developed About 78 years old 57 years old Treatment site Frontal region and crown Frontal region and crown Hair loss state Hair thinning was conspicuous Frontal region and crown all over Hair loss site other than head None None (B0) Family history of alopecia None None Family history of immune None None disease Previous history None None Scratch Test Not tested Negative Effect of minoxidil Not applied No effect Effect of finasteride Not applied Not applied Effect of glycyrrhetinic acid Not applied Not applied Effect of steroid drug Not applied Not applied Effect of cooling therapy Not applied Not applied Antiallergic drug Not applied Not applied Effect of carpronium chloride Not applied Not applied Effect of cepharanthin Not applied Not applied Dosage form BNP gel BNP gel Dose 50 μg/g, 200 μg/g 20 μg/g Number of days used 14 days + 5 days 7 days Degree of improvement in Pityriatic scale improved, Dandruff, scale, and itching symptoms vellus hair turned into terminal disappeared, and hair falling out hair and became thick and black, decreased. Hair growth and hair and thinning hair improved. thickening were observed. Non-recurrence period — Treatment continuing
Case B23

(581) The test subject was a 81 year old male who had developed thinning hair from the frontal region to the crown 3 years earlier. This was a case with coexisting senile alopecia and alopecia pityroides in which pityriatic scale was seen on the scalp.

(582) After 50 μg/g BNP gel was applied to the frontal region and the crown of this test subject for 2 weeks and suspended for 1 week, when 200 μg/g BNP gel was applied once a day for 5 days, pityriatic desquamation was alleviated, vellus hair became terminal hair and black, and thinning hair was greatly improved (FIG. 51).

(583) Case B28

(584) The test subject was a 59 year old male and had alopecia pityroides. This test subject was in a thinning hair state in which there was hardly any hair from the frontal region to the crown. Thinning hair had occurred 2 years earlier, RiUP X5 (trademark), which contains 0.05 g/mL minoxidil, had been applied twice a day for one and a half years, but dandruff had became worse, itchiness had occurred, and the amount of hair falling out and the thinning hair had rapidly become aggravated 4 months earlier. This test subject was in a state in which a large amount of hair became attached to scale on the scalp and fell out when washing the hair.

(585) When 20 μg/g BNP gel was applied to the frontal region and the crown of this test subject twice a day for 7 days, the effect was very good; there was no itching, dandruff stopped occurring, and the amount of hair falling out when washing the hair decreased to a few hairs. In accordance with application of the BNP gel, scale thickly deposited on the frontal region and the crown disappeared, and quite clear hair growth and hair thickening were observed from the frontal region to the crown (FIG. 53).

(586) 28. Therapeutic Effect of CNP Gel on Alopecia Pityroides

(587) The therapeutic effects of CNP gel on alopecia pityroides are shown in Table 17 (cases C30 and C31).

(588) TABLE-US-00030 TABLE 17 Case C30 (=A6, A13, C3, C4, C33) C31 FIG. FIG. 52 Gender Female Male Age 50 years old 42 years old When developed 40 years old Late 30s Hair loss range S2 Frontal region and crown Treatment site Left temporal region Frontal region and crown Hair loss site other than head None (B0) None (B0) Family history of alopecia Mother: alopecia areata Father: androgenetic alopecia Family history of immune Child: allergic rhinitis, Younger brother: atopic dermatitis disease chronic urticaria Previous history Atopic dermatitis, allergic None rhinitis Scratch Test House dust: 1+ House dust: 3+ Mite: 1+ Mite: 3+ Cedar: — Cedar: 2+ Dactylis: 2+ Dactylis: 2+ Ragweed: 1+ Ragweed: 1+ Effect of minoxidil Not applied Not applied Effect of finasteride Contraindicated Not applied Effect of glycyrrhetinic acid Not applied Not applied Effect of steroid drug No effect No effect on hair falling out or dandruff after 2 years' external application. Effect of cooling therapy Not applied Not applied Antiallergic drug No effect Not applied Effect of carpronium chloride No effect Not applied Effect of cepharanthin Not applied Not applied Dosage form CNP gel CNP gel Dose 100 μg/g 100 μg/g Number of days used 21 days 14 days Degree of improvement in S2.fwdarw.S0 Thick scale markedly improved and symptoms hair thickened. Non-recurrence period 8 months Treatment continuing
Case C30 Case C30 was a case with coexisting alopecia areata and alopecia pityroides and is the same case as cases A6, C3, C4, and A13. It should be noted that CNP ointment was applied to the right frontal region. The details of this case are as described for cases A6, C3, and C4; with application of 100 μg/g CNP gel twice a day for 3 weeks, there was good progress even after application was stopped, and there was no recurrence at the application site even when 8 months had elapsed after the application was stopped.
Case C31

(589) The test subject was a 42 year old male and was a patient with alopecia pityroides. From the late 30s the hair of the frontal region and the crown had become thin. From 2 years earlier, ‘Nitrazen Cream 2% for external application’ (Iwaki Seiyaku Co., Ltd.), which contains 2% ketoconazole, which is an antifungal agent, and ‘Betnoval G Ointment Cream’ (Sato Pharmaceutical Co., Ltd.), which contains 1.2 mg/g betamethasone valerate, which is a synthetic adrenal cortex hormone, and 1 mg/g of gentamicin, which is an antibiotic, had been applied continuously, but not only were there no effects at all, but also dandruff had adhered thickly and the thinning hair had become aggravated from 1 year earlier.

(590) When 100 μg/g CNP gel was applied to the frontal region and the crown of this test subject twice a day for 2 weeks, scale that had been thickly adhering disappeared considerably, and hair started to thicken on the crown (FIG. 52).

(591) 29. Therapeutic Effect of CNP Ointment on Alopecia Pityroides

(592) The therapeutic effects of CNP ointment on alopecia pityroides are shown in Table 18 (case C33).

(593) TABLE-US-00031 TABLE 18 Case C33 (=A6, A13, C3, C4, C30) FIG. Gender Female Age 50 years old When developed 40 years old Hair loss range S2 Treatment site Right frontal region Hair loss site other than head None (B0) Family history of alopecia Mother: alopecia areata Family history of immune disease Child: allergic rhinitis, chronic urticaria Previous history Atopic dermatitis, allergic rhinitis Scratch Test House dust: 1+ Mite: 1+ Cedar: — Dactylis: 2+ Ragweed: 1+ Effect of minoxidil Not applied Effect of finasteride Contraindicated Effect of glycyrrhetinic acid Not applied Effect of steroid drug No effect Effect of cooling therapy Not applied Antiallergic drug No effect Effect of carpronium chloride No effect Effect of cepharanthin Not applied Dosage form CNP ointment Dose 100 μg/g Number of days used 14 days Degree of improvement in symptoms S2.fwdarw.S1 Non-recurrence period 1 year
Case C33

(594) Case C33 was a case with coexisting alopecia areata and alopecia pityroides and is the same case as cases A6, C3, C4, A13, and C30. It should be noted that CNP ointment was applied to the right frontal region. The details of this case are as described for cases A6, C3, and C4, and by applying 100 μg/g CNP ointment twice a day for 2 weeks clear hair growth was observed and the erythema and scale on the scalp disappeared.

(595) 30. Therapeutic Effect of ANP Gel on Senile Alopecia

(596) The therapeutic effects of ANP gel on senile alopecia are shown in Table 19 (case A15).

(597) TABLE-US-00032 TABLE 19 Case A15 FIG. FIG. 54 Gender Male Age 74 years old When developed Unknown Treatment site Frontal region and crown Hair loss state Hair thinning was conspicuous all over. Hair loss site other than head None Family history of alopecia None Family history of immune disease None Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not applied Effect of cooling therapy Not applied Antiallergic drug Not applied Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form ANP gel (CNP gel) Dose ANP gel: 100 μg/g (CNP gel: 50 μg/g) Number of days used 1 week Degree of improvement in symptoms Erythema, scale, and itching aggravated, no hair thickening effect, and hair loss increased somewhat. Non-recurrence period Treatment continuing
Case A15

(598) The test subject was a 74 year old male who had senile alopecia in which there was dandruff, there was a large amount of hair falling out, there was thinning hair over the entire head part, and white hair was conspicuous. This test subject had intense itchiness on the scalp, the amount of dandruff was large, and the amount of hair falling out was large.

(599) When 100 μg/g ANP gel was applied to the crown of this test subject twice a day for 1 week, erythema, scale, and itching were aggravated, there was no hair thickening effect, and the hair loss increased somewhat (FIG. 54).

(600) When ANP gel was stopped after 1 week and from the following day 50 μg/g CNP gel was applied twice a day for 2 days, erythema, scale, and itching were alleviated. For a further 4 weeks after that, 50 μg/g CNP gel continued to be applied twice a day, clear hair thickening was observed in the frontal region in particular, and hair stopped falling out (FIG. 54). Hair that had grown was black terminal hair and did not fall out even when rubbed strongly. It was surprising to observe the hair thickening effect of the CNP gel for such an old age of 74.

(601) 31. Therapeutic Effect of BNP Gel on Senile Alopecia

(602) The therapeutic effects of BNP gel on senile alopecia are shown in Table 20 (B24).

(603) TABLE-US-00033 TABLE 20 Case B24 FIG. FIG. 51 Gender Male Age 81 years old When developed About 78 years old Treatment site Frontal region and crown Hair loss state Hair thinning was conspicuous all over. Hair loss site other than head None Family history of alopecia None Family history of immune disease None Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not applied Effect of cooling therapy Not applied Antiallergic drug Not applied Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form BNP gel Dose 50 μg/g, 200 μg/g Number of days used 14 days + 5 days Degree of improvement in symptoms Pityriatic scale improved, vellus hair turned into terminal hair and became thick and black, and hair thinning improved. Non-recurrence period Treatment continuing
Case B24

(604) Case B24 was a case with coexisting senile alopecia and alopecia pityroides, and is the same case as case B23. Details of this case are as described for case B23.

(605) When 200 μg/g BNP gel was applied to the frontal region and the crown of this test subject once a day for 5 days, pityriatic desquamation was alleviated, rich black terminal hair grew, and the thinning hair was greatly improved (FIG. 51). Most of the hair was white before the application, but hair that grew after the application was black.

(606) 32. Therapeutic Effect of CNP Gel on Senile Alopecia

(607) The therapeutic effects of CNP gel on senile alopecia are shown in Table 21 (case C34).

(608) TABLE-US-00034 TABLE 21 Case C34 FIG. Gender Female Age 70 years old When developed About 68 years old Treatment site Crown Hair loss state Hair thinning was conspicuous from frontal region to crown. Hair loss site other than head None Family history of alopecia None Family history of immune disease None Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of finasteride Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug No effect Effect of cooling therapy Not applied Antiallergic drug Not applied Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form CNP gel Dose 50 μg/g Number of days used 7 days Degree of improvement in Hair became supple, and thinning symptoms hair on crown improved to unnotice- able level. Hair falling out decreased, and there was no pain on scalp during external application. Non-recurrence period 2 weeks
Case C34

(609) The test subject was a 70 year old female and had thinning hair on the crown from 68 years old. According to the test subject, the skin of the crown with the thinning hair became atrophic and was too painful to touch. When 50 μg/g CNP gel was applied twice a day for 3 days, the pain of the scalp was alleviated, and the amount of hair falling out decreased. After that, when the application was continued for a further 3 days, erythema of the scalp disappeared, itching and pain became unnoticeable, and there was hair thickening.

(610) When the medication was changed to only ‘Dermosol G lotion (Dermosol-G Lotion)’ (Iwaki Seiyaku Co., Ltd.), which contains 1200 μg/mL betamethasone valerate and 1000 μg/mL gentamicin sulfate, the skin of the crown started tingling after 3 days, a slight degree of erythema reappeared, and there was thinning hair.

(611) When 100 μg/g BNP gel was applied once a day for 1 week, the erythema on the crown disappeared, the hair thickened, and the thinning hair became inconspicuous.

(612) When a 50 μg/g BNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied for 1 week, the symptoms of erythema on the crown and thinning hair, which were exhibited with application of Dermosol G lotion alone, did not appear, and a state with hair thickening was maintained even when 3 weeks had elapsed after the application was started.

(613) 33. Therapeutic Effect of BNP Gel on Cancer Chemotherapy Drug-Induced Alopecia

(614) The therapeutic effects of BNP gel on cancer chemotherapy drug-induced alopecia are shown in Table 22 (case B25).

(615) TABLE-US-00035 TABLE 22 Case B25 FIG. Gender Female Age 54 years old When developed 54 years old Cancer chemotherapy R-CHOP therapy Treatment site Hairline part in frontal region Hair loss state White hair all over. Left-hand side hairline part retreated and had hair thinning. Hair loss site other than head Whole body Family history of alopecia None Family history of immune disease None Previous history None Scratch Test Not tested Effect of minoxidil Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug Not used Effect of cooling therapy Not applied Antiallergic drug Not applied Effect of carpronium chloride Not applied Effect of cepharanthin Not applied Dosage form BNP gel Dose 100 μg/g Number of days used 7 days Degree of improvement in symptoms Growth and restoration of black terminal hair was observed in left front temporal region, which had white hair and was thin, after 2 weeks. Non-recurrence period 3 months
Case B25

(616) The test subject was a 54 year old female. The test subject was diagnosed with malignant lymphoma and had received 6 courses of R-CHOP therapy from April to September 2011. The R-CHOP therapy referred to here is one type of cocktail therapy using a plurality of chemotherapy drugs in which 1 course of the administration schedule consisted of an intravenous drip of rituximab, which is a mouse-human-chimeric monoclonal antibody against CD20, which is a human B cell surface antigen, on the 1.sup.st day, oral administration, after each meal, of prednisolone tablet, which is a synthetic adrenal cortex hormone drug, intravenous injection of vincristine, which is a microtubule inhibitor, intravenous injection of doxorubicin, which is an inhibitor of DNA and RNA synthesis, and intravenous injection of cyclophosphamide, which is a prodrug of an inhibitor of DNA synthesis, on the 2.sup.nd day, only oral administration, after each meal, of prednisolone tablet from the 3.sup.rd day to the 6.sup.th day, and a drug suspension period from the 7.sup.th day to the 21.sup.st day, and this administration cycle is repeated. With regard to the test subject, the hair started to fall out from the 2.sup.nd week of the first course, and all the hair had fallen out in July when the 4.sup.th course had ended. When the treatment was completed in September, the hair started to grow gradually; the hair that grew was pure white, and the left-hand side hair line part had retreated and had become very thin.

(617) When 100 μg/g BNP gel was applied to this left-hand side hair line part twice a day for 1 week, black terminal hair started to grow in the thinning hair part with white downy hair after 2 weeks, the hair gradually thickened, and black hair seemed to have grown in a round shape in the hair line part that had retreated in an M-shape. In the site to which the BNP gel had been applied in the left-hand side hair line M-shaped site, all the hair that had grown was black. Although no application was carried out for 3 months after that hair did not fall out again and there was no formation of white hair.

(618) 34. Therapeutic Effect of CNP Gel on Cancer Chemotherapy Drug-Induced Alopecia

(619) The therapeutic effects of BNP gel on cancer chemotherapy drug-induced alopecia are shown in Table 23 (case C35).

(620) TABLE-US-00036 TABLE 23 Case C35 FIG. FIG. 56-1, FIG. 56-2 Gender Female Age 47 years old When developed 47 years old Cancer chemotherapy Cisplatin Treatment site Frontal region, crown Hair loss state Hair thinning was conspicuous from frontal region to crown, mainly with fine vellus hair. Hair loss site other than head Whole body Family history of alopecia Unknown Family history of immune disease Child: atopic dermatitis Previous history Cancer of body of uterus, alopecia areata, atopic dermatitis, allergic rhinitis Scratch Test House dust: 3+ Mite: 3+ Cedar: — Dactylis: — Ragweed: 1+ Effect of minoxidil Not applied Effect of glycyrrhetinic acid Not applied Effect of steroid drug No effect Effect of cooling therapy Not applied Antiallergic drug No effect Effect of carpronium chloride No effect Effect of cepharanthin No effect Dosage form CNP gel Dose 50 μg/g Number of days used 6 weeks Degree of improvement in Hair thickened, and hairs symptoms became thick and dark, and was restored. Non-recurrence period Treatment continuing
Case C35

(621) The test subject was a 47 year old female. The test subject had received an operation to remove cancer of the body of the uterus in November 2009, had 6 courses of treatment with cisplatin, which is a cancer chemotherapy drug, and had completed the cancer chemotherapy in March 2010. The test subject showed hair loss of the entire head accompanying the treatment with cisplatin, and although fine soft short hair grew around May 2011 when almost 1 year had elapsed since the treatment with cisplatin was completed, an area from the frontal region to the crown recovered only to a state with thin hair. There had been no effect on the test subject when carpronium chloride had been applied thereto for 6 months.

(622) The application of carpronium chloride was therefore stopped. When, 2 months after stopping, 50 μg/g CNP gel was applied twice a day for 6 weeks to the area from the frontal region to the crown, the number of hairs increased and the hair thickened considerably from the frontal region to the crown, and the hair became thick and long (FIG. 56-1).

(623) When application of the CNP gel was stopped after 6 weeks, and 3 weeks after that a CNP:betamethasone:gentamicin combination was applied twice a day for 2 weeks, the hair thickened further.

(624) At this point, new alopecia areata occurred in the left temporal region; a 50 μg/g CNP:600 μg/mL betamethasone:500 μg/mL gentamicin combination was applied twice a day, hair growth was confirmed after 2 weeks, and marked growth of terminal hair was confirmed after 3 weeks (FIG. 56-2).

(625) Conclusions from Case Test Results

(626) As is clear from the above-mentioned test cases, the agent for the treatment of alopecia of the present invention had a very high recovery rate for hair loss, and the period taken to express its hair growth promoting effect was short. In most cases, hair growth was confirmed by applying the agent for the treatment of alopecia of the present invention for 1 week to 2 weeks, and clear hair growth was observed during the 3.sup.rd week. Furthermore, the treatment agent of the present invention restored white hair to black hair, decreased dandruff in an alopecia pityroides patient, and improved seborrheic scalp in a seborrheic alopecia patient.

(627) When the agent for the treatment of alopecia of the present invention contained CNP or BNP as an active ingredient, the therapeutic effects were marked, hair grew almost certainly with application twice a day for 1 week, terminal hair was observed with application for 2 weeks, and it became difficult to see the skin with application for 4 weeks. Worthy of special note is that it was unnecessary to continue application after vellus hair grew; the vellus hair became dark and thick, became terminal hair, and continued to grow.

(628) In particular, when the agent for the treatment of alopecia of the present invention contained CNP as an active ingredient it could more reliably suppress inflammation of a hair loss site than one containing BNP as an active ingredient, the amount of hair falling out decreased dramatically in 1 day to a few days, and hair grew earlier. On the other hand, the agent for the treatment of alopecia of the present invention containing BNP as an active ingredient was characterized by black terminal hair often growing. Furthermore, when the agent for the treatment of alopecia of the present invention contained ANP as an active ingredient, it was effective only for alopecia in which there was no erythema, scale, seborrheic desquamation, etc. on the scalp, but there were many cases in which erythema and itchiness occurred and the state became worse than that before application.

(629) Moreover, the agent for the treatment of alopecia of the present invention exhibited marked effects on alopecia areata and androgenetic alopecia, could suppress inflammation of seborrheic alopecia and alopecia pityroides so that hair could grow, dramatically decreased dandruff, and could suppress itchiness. Furthermore, it promoted restoration of hair in female pattern alopecia, postpartum alopecia, and senile alopecia, and it was also confirmed that it promoted growth of black hair in cancer chemotherapy drug-induced alopecia.

(630) The agent for the treatment of alopecia of the present invention exhibited an improvement effect with long duration for androgenetic alopecia, female pattern alopecia, seborrheic alopecia, alopecia pityroides, and senile alopecia, and there was no recurrence of hair loss at the application site for at least 2 months after the application was stopped.

(631) These therapeutic effects of the present invention in the treatment of androgenetic alopecia were in marked contrast to the fact that in a group that has had orally administered finasteride for 1 year and has then stopped administration, the improvement effect disappears and androgenetic alopecia progresses. That is, the effect of finasteride is seen only while it is being orally administered, whereas with external application of the agent for the treatment of alopecia of the present invention for 1 to 3 weeks, the improved hair growth state could be maintained for about 2 months after its use was stopped. After 3 months had elapsed since application of the agent for the treatment of alopecia of the present invention was stopped, there was a case in which the original hair loss state returned, but even in this case reapplying the agent for the treatment of alopecia of the present invention allowed the same black terminal hair to grow as previously without side effects.

(632) Moreover, with regard to alopecia areata and cancer chemotherapy drug-induced alopecia, with external application of the agent for the treatment of alopecia of the present invention for 1 to 3 weeks, the hair growth state kept improving even after its use was stopped and there was a cure, and there was no recurrence of alopecia at the application site.

(633) Moreover, BNP and CNP did not exhibit any adverse events such as local symptoms of irritation, skin atrophy, or an itching sensation resulting from their application, and there were no systemic side effects.

(634) Since it was confirmed that the agent for the treatment of alopecia of the present invention exhibited marked effects in the treatment of alopecia areata, androgenetic alopecia, seborrheic alopecia, alopecia pityroides, female pattern alopecia, postpartum alopecia, senile alopecia, and cancer chemotherapy drug-induced alopecia, it was substantially proved that it was effective not only for the treatment of the above but also for the treatment of almost all types of alopecia.

(635) That is, since the above-mentioned respective types of alopecia have completely different development mechanisms from each other, being effective for these various different types of alopecia clearly means being useful for the treatment of all types of alopecia.

(636) Furthermore, as is disclosed in the present specification, since the test subjects for whom the effectiveness of the agent for the treatment of alopecia of the present invention had been confirmed include many test subjects both with and without a history of, or coexisting, immune disease, and test subjects having a biological family both with and without a history of, or coexisting, immune disease, the agent for the treatment of alopecia of the present invention is useful for targets both with and without a genetic background or a history of, or coexisting, immune disease. Furthermore, with regard to the relationship between the test subjects and an allergic predisposition, there was no systematic relationship between the effectiveness of the agent for the treatment of alopecia of the present invention and the results of the scratch test of the test subjects for whom the effectiveness was confirmed; the agent for the treatment of alopecia of the present invention is effective for targets both with and without an allergic predisposition, regardless of the presence or absence of an allergic predisposition.

(637) It was confirmed that the agent for the treatment of alopecia of the present invention has a marked effect on the treatment of alopecia areata and androgenetic alopecia. The period taken to confirm hair growth subjectively was short not only for alopecia areata monolocularis but also even for intractable alopecia areata multilocularis, in which the hair loss period is long and the hair loss range is wide, and even for intractable alopecia areata ophiasis; there is no pain accompanying the treatment, it is therefore possible to recover from emotional distress and regain QOL (quality of life) at an early stage, and it can be said to be a completely new therapy that can be highly recommended.

(638) It is clear that the agent for the treatment of alopecia of the present invention is very effective not only for alopecia areata monolocularis but also for S2 or greater alopecia areata multilocularis, which is severe, a case in which hair loss occurs in another place in addition to the head, a case with a coexisting atopic disease, which is said to be intractable, and alopecia ophiasis.

(639) The agent for the treatment of alopecia of the present invention could restore the hair of a patient with postpartum alopecia that did not cure spontaneously even over half a year after childbirth to the same state as that before childbirth, and it became clear that it was effective for a target having resistance to treatment with a steroid or carpronium chloride.

(640) The agent for the treatment of alopecia of the present invention was also effective for female pattern alopecia and could restore the hair to such an extent that it became unnoticeable in appearance with 1 to 2 weeks' application, and it was effective for a patient having resistance to treatment with carpronium chloride, a steroid, and an antifungal agent. It was confirmed that, when the agent for the treatment of alopecia of the present invention was used for female pattern alopecia, there was a case in which thinning hair reoccurred about 1 month after the application was stopped, but re-application thereof could restore the hair in the same manner as that of the previous application, and no side effects were seen.

(641) It became clear that the agent for the treatment of alopecia of the present invention could markedly improve erythema, seborrheic scale, and itching of a hair loss site of seborrheic alopecia and decrease the amount of hair falling out.

(642) It was confirmed that the agent for the treatment of alopecia of the present invention could make erythema and scale of alopecia pityroides disappear, make black terminal hair grow, and prevent recurrence even when 1 month had elapsed after the application was stopped. Furthermore, the agent for the treatment of alopecia of the present invention exhibits marked effects on alopecia pityroides having resistance to treatment with an antifungal agent or a steroid.

(643) It was shown that the agent for the treatment of alopecia of the present invention could relieve pain and itching of the scalp in senile alopecia, alleviate erythema and pityriatic desquamation, and make black terminal hair grow.

(644) It was confirmed that the agent for the treatment of alopecia of the present invention was effective for cancer chemotherapy drug-induced alopecia and could make black hair grow even in an area in which hair had become white and maintain a hair growth state even when 2 months or longer had elapsed after the application was stopped.

(645) The agent for the treatment of alopecia of the present invention exhibited a very marked therapeutic effect for alopecia if either of BNP or CNP was an active ingredient. Furthermore, when there was no erythema, scale, seborrheic erythema, seborrheic desquamation, or pityriatic desquamation on the scalp, one containing ANP as an active ingredient exhibited a hair growth effect.

(646) Therefore, it can be appreciated that a chimeric peptide of 2 or more NPs selected from ANP, BNP, and CNP also exhibits a therapeutic effect for alopecia. Moreover, when taking into consideration that it is generally thought that ANP and BNP activate the NPR-A receptor so as to bring about vasodilatory action, diuretic action, and cytostatic action, and CNP shows a growth-inhibitory action on vascular smooth muscle cells via the NPR-B receptor, it is surprising that the agent for the treatment of alopecia of the present invention containing CNP or BNP as an active ingredient exhibited a particularly marked therapeutic effect for alopecia, and it is sufficient to appreciate that a chimeric peptide of BNP and CNP exhibits the same therapeutic effect for alopecia.

(647) Alopecia areata occurs in young females at the same frequency as in males, and in spite of the appearance being greatly impaired, there are only rough treatment methods involving local injection of a steroid or intentionally irritating the skin in anticipation of producing immune modulation.

(648) Moreover, the therapeutic effects of the above methods are not high, and there might be adverse events such as skin atrophy due to steroid local injection or systemic contact dermatitis from local immunotherapy. On the other hand, the agent for the treatment of alopecia of the present invention exhibits remarkable effects on alopecia areata in particular, there are no side effects from BNP and CNP, the effects are not only seen during application but the improved state is also maintained after application is stopped, and although a new bald area might occur at a site to which no application is made, there was no recurrence in the application sites as far as the cases that have been experienced are concerned, and this is great hope for a patient suffering from alopecia areata.

INDUSTRIAL APPLICABILITY

(649) The agent for the treatment of alopecia of the present invention containing a natriuretic peptide (NP) as an active ingredient promotes hair regeneration, hair growth, and hair thickening on a hair loss site of an alopecia areata patient, an androgenetic alopecia patient, a female pattern alopecia patient, a postpartum alopecia patient, a seborrheic alopecia patient, an alopecia pityroides patient, a senile alopecia patient, a cancer chemotherapy drug-induced alopecia patient, and a patient with alopecia due to radiation exposure, can improve the alopecia outstandingly, does not cause side effects such as an itching sensation, irritation, or feminization, and the therapeutic effects for alopecia are not lost over a long period even when its use is stopped.

(650) Furthermore, it shows therapeutic effects on androgenetic alopecia that exhibits resistance to treatment with minoxidil or finasteride, and shows marked therapeutic effects on alopecia areata that exhibits resistance to treatment with steroid local injection or local immunotherapy.

(651) Therefore, the agent for the treatment of alopecia of the present invention can be anticipated to be useful as a very effective treatment drug for alopecia for which sufficient therapeutic effects cannot be obtained by the conventional minoxidil or finasteride, and alopecia that develops in relation to an immune overreaction or an immune abnormality.

(652) In particular, the agent for the treatment of alopecia of the present invention can dramatically improve severe alopecia on the adult head that has been very difficult to treat and causes problems in social life, without any side effects at all. The agent for the treatment of alopecia of the present invention is not only effective for intractable alopecia but also exhibits the same effects regardless of gender and is not limited to adults but is also effective for patients in their teens.

(653) Therefore, practical use of the agent for the treatment of alopecia of the present invention as a new agent for the treatment of androgenetic alopecia that replaces minoxidil or finasteride can be anticipated, and the practical use thereof as an agent for the treatment of alopecia areata, which has had no effective therapy for a long time, is very promising.

(654) [Sequence Listing]