Anagen Phase Research Articles

Evaluation of the efficacy and safety of topical procyanidin b2 and placebo in the treatment of androgenetic alopecia in men; A randomized, double-blind, placebo-controlled study

Objective: Androgenetic alopecia (AGA) is a common type of alopecia characterized by the shortening of the anagen phase of hair growth and the miniaturization of hair follicles. TGF-β is a well-known hair cycle catagen phase inducer and is involved in the catagen phase in AGA. Inhibition of TGF-β is recognized as a therapeutic option in the treatment of AGA. Procyanidins are a type of polyphenol that has been shown to inhibit TGF-β activity in vivo, but there haven’t been many studies on their effectiveness. In this study, we aimed to evaluate the efficacy and safety of topical procyanidin B2 in the treatment of male AGA. Materials and Methods: Patients aged between 18 and 50 years who applied to our dermatology outpatient clinic with the complaint of AGA and had Hamilton-Norwood type II-V AGA were included in our study. Those who had received 5-reductase inhibitor or isotretinoin treatment in the previous year, those who had used any medicinal or herbal product that stimulated hair growth, particularly topical minoxidil, in the previous six months, those who had used systemic steroids for more than two weeks in the previous three months, those who had undergone a transplant or scalp reduction, and those who had received radiotherapy or chemotherapy at any point in their lives were excluded from the study. A total of 40 patients who met the current criteria were included in the study. Patients were randomized into two groups to receive 16 weeks of topical procyanidin B2 (n = 20) or placebo (n = 20) therapy. At the end of the treatment, the patients were called for control. The efficacy of topical procyanidin B2 after treatment was evaluated by trichoscan and global photographic evaluation. Results: A total of 40 male patients (mean: 33.32, range: 21–44) with AGA type II-IV were included in the study. There was no significant difference between the two groups in terms of age, duration of hair loss, and AGA type (P > 0.05). At the end of the study, there was a significant increase in total hair count in the topical procyanidin B2 group compared to the placebo group compared to baseline (P < 0.05). Anagen hair count was also significantly increased in the topical procyanidin B2 group (P < 0.05). Conclusion: In this placebo-controlled study, we think that topical procyanidin B2 is an effective and safe treatment option in the treatment of AGA patients.

СВЯЗЬ РЕСПИРАТОРНЫХ ЗАБОЛЕВАНИЙ С ТЕЛОГЕНОВЫМ ВЫПАДЕНИЕМ ВОЛОС У ВОЕННОСЛУЖАЩИХ МУЖСКОГО ПОЛА ПРИЗЫВНОГО ВОЗРАСТА В ПЕРИОДЕ РЕКОНВАЛЕСЦЕНЦИИ

The article presents the results of observation of a group of servicemen (n = 25) in the process of undergoing compulsory military service, who were being treated in the hospital department of a medical company for respiratory diseases during the period of convalescence. To improve the differential diagnosis of hair loss in males aged 18 to 27 years, the relationship between colds and telogen hair loss was studied in this contingent (main group). A comparative analysis of the data obtained from the main group of servicemen undergoing treatment in a hospital department of a medical company with respiratory diseases and a control group of healthy servicemen of draft age (n = 25) showed that even with a mild course of the underlying disease, an accelerated transition of the anagen phase of hair growth can be observed. to telogen.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ВЛИЯНИЯ ИНФЕКЦИИ COVID-19 И ОБЩЕСОМАТИЧЕСКИХ ЗАБОЛЕВАНИЙ НА ТЕЛОГЕНОВОЕ ВЫПАДЕНИЕ ВОЛОС

of performing urgent military service who were treated for general somatic diseases (n = 151), coronovirus infection (n = 50) caused by COVID­19, and healthy individuals (n = 50). The relationship of general somatic diseases and coronovirus infection COVID­19 with telogen hair loss in the study population was studied. The relationship between temperature and body mass index and telogen hair loss has been established. Analysis of the data obtained showed that even with a mild course of the underlying disease, an accelerated transition from the anagen phase of hair growth to the telogen phase can be observed in 12 %, and in the group with COVID­19 infection, such a transition was observed in 94.0 % of patients.

Histological Analysis for the Cause of Kinky Hair after Hair Transplantation

<i><b>Introduction:</b></i> Studies on kinky hair after hair transplantation are rare although kinky hair happens frequently. Commonly referred to in the literature as “post-transplant kinkiness,” we decided to investigate what causes kinky hair using a histologic approach. <i><b>Method:</b></i> A patient, who had a hair transplant at another clinic three years previously, came to our clinic with a complaint of low density of transplanted area. Reduction foreheadplasty was done to reduce the height of her forehead as well as to get rid of low-density parts. We collected some of the severe kinky hairs upon the removal of transplanted areas and observed them at the microscopic level. <i><b>Results:</b></i> We noted fibrotic tissues alongside the kinky hair’s follicle. In addition, distortion of the bulb was observed with the presence of fibrotic tissue at the subcutaneous layer. <i><b>Discussion:</b></i> We usually mention scarring in terms of kinky hair after transplantation. Scars in the subcutaneous layer probably cause kinky hair rather than scars in the dermis. Fibrotic tissue that forms in the subcutaneous layer presses on transplanted hair follicles and causes deformity of follicles. Growing follicles after the telogen phase are likely to be deformed by encountering scar tissue when they grow downward to enter the anagen phase. The resulting deformed bulb causes the kinky hair. Therefore, reducing tissue damage during transplantation is very important. Inflammation aggravates scar formation, so it might be helpful to lessen the factors that lead to inflammation such as infection and bleeding. <i><b>Conclusion:</b></i> Perifollicular scarring after hair transplantation causes hair follicle deformity and results in the hairs growing as kinky hair. Therefore, reducing scarring in the transplant recipient area is essential for the prevention of kinky hair.

The Effects of the Oral Supplementation with a Natural Keratin Hydrolysate (Kera-Diet®) on Hair and Nails: Randomized, Placebo and Benchmark-Controlled Clinical Trial on Healthy Females

Background Telogen effluvium (TE) and its acute form (aTE) are two of the commonest occurrences in a trichology clinic, with patients claiming excessive hair shedding. ATE can occur in people of any age and ethnicity and is considered to be a quite common condition in either sex even if women are more likely to have a lowered quality of life and restricted social contacts as compared to men as a result of hair loss. Brittle nail syndrome (BNS) is a common condition affecting up to 20% of the population, especially women over 50 years of age. Nails affected by BNS appear ragged, thin, and dull. The clinical features of BNS include horizontal splits within the nail plate (onychoschizia) and increased longitudinal ridging or splitting (onychorrhexis). In BNS oral supplementation, trace elements and amino acids (especially L-Cystine) have been reported to be useful to ameliorate the nail plate condition. Objective We hypothesized that a nutritional approach, with nutrients of which the composition is close to the human keratin, could be effective to decrease hair loss during telogen effluvium and to improve brittle nails condition. At this purpose, a clinical study was designed to investigate the efficacy of a natural keratin hydrolysate obtained from a non-human source (feathers) on both aTE and BNS. Methods The in vivo effects of a natural keratin hydrolysate, Kera-Diet® (KD) upon human hair and nails condition was tested in a randomized, double-blind, parallel-group, benchmark (BE) and placebo (PL) controlled study involving 60 women during 90 days. In all subjects, Anagen/Telogen hair, hair volume and density, pull test, global photography, hair and nails brightness, and nail plate growth were measured at baseline and after 45 and 90 days of products use. A self-assessment test was carried out at the end of the study. Results With the KD treatment group, hair density, percentage of hair in anagen phase, hair and nails brightness, and nails growth were significantly increased compared to PL treatment group. Interestingly, with this same group, the diagnosis of aTE by pull testing was negative from 45 days. The efficacy of KD was equal to or greater than PL treatment group. Conclusion In this study, we demonstrated that daily oral administration of 1000 mg during 3 months of a natural extensively keratin hydrolysate, Kera-Diet®, associated to trace elements and specific vitamins was effective to improve both hair and nails condition. Furthermore, it demonstrates the role of nutrients in both aTE and BNS.

Possibilities for correcting diffuse alopecia associated with prior coronavirus infection (COVID-19)

Diffuse alopecia (DA) is a disease characterized by a diffuse hair loss associated with alterations in physiological hair cycle due to an exposure of hair follicles to various endogenous and exogenous factors. The disease is mainly caused by alterations in the cyclicity of hair follicle phases anagen, telogen and catagen. Pathogenetic therapy for DA is based on the initiation and lengthening of the anagen phase, in particular, via inhibition of catagen. Given a high prevalence of DA following a new coronavirus infection (COVID-19), the search for an effective medicine for the SARS-CoV-2 virus-associated DA is extremely important. The use of drugs derived from natural products can have a beneficial effect on the disease following COVID-19. The study was aimed to assess the efficacy of the combination of Selencin (homeopathic drug) and Selencin Peptide Active (peptide lotion) for the treatment of DA associated with prior coronavirus infection (COVID-19). A total of 34 patients with a confirmed diagnosis of telogen/anagen DA, who noted the relationship between DA and a new coronavirus infection, were treated with both systemic (pills) and topical (peptide lotion) Selencin for 2 months. The study showed a high efficacy of the treatment, i.e., a significant reduction in hair loss, as well as restoration of their structure and increase in volume. Also, after 2 and 4 months of treatment, there was a normalization of dermatoscopic picture of the scalp and an improvement in the special tests (PULL test). Thus, the use of the combined drug Selencin for SARS-CoV-2 virus-associated DA has a pronounced therapeutic effect. The drug can be used as the main treatment for this disease if it associated with COVID-19.

Ficus benghalensis as Potential Inhibitor of 5α-Reductase for Hair Growth Promotion: In Vitro, In Silico, and In Vivo Evaluation.

The screening of hair follicles, dermal papilla cells, and keratinocytes through in vitro, in vivo, and histology has previously been reported to combat alopecia. Ficus benghalensis has been used conventionally to cure skin and hair disorders, although its effect on 5α-reductase II is still unknown. Currently, we aim to analyze the phytotherapeutic impact of F. benghalensis leaf extracts (FBLEs) for promoting hair growth in rabbits along with in vitro inhibition of the steroid isozyme 5α-reductase II. The inhibition of 5α-reductase II by FBLEs was assessed by RP-HPLC, using the NADPH cofactor as the reaction initiator and Minoxin (5%) as a positive control. In silico studies were performed using AutoDock Vina to visualize the interaction between 5α-reductase II and the reported phytoconstituents present in FBLEs. Hair growth in female albino rabbits was investigated by applying an oral dose of the FBLE formulation and control drug to the skin once a day. The skin tissues were examined by histology to see hair follicles. Further, FAAS, FTIR, and antioxidants were performed to check the trace elements and secondary metabolites in the FBLEs. The results of RP-HPLC and the binding energies showed that FBLEs reduced the catalytic activity of 5α-reductase II and improved cell proliferation in rabbits. The statistical analysis (p < 0.05 or 0.01) and percentage inhibition (>70%) suggested that hydroalcoholic FBLE has more potential in increasing hair growth by elongating hair follicle’s anagen phase. FAAS, FTIR, and antioxidant experiments revealed sufficient concentrations of Zn, Cu, K, and Fe, together with the presence of polyphenols and scavenging activity in FBLE. Overall, we found that FBLEs are potent in stimulating hair follicle maturation by reducing the 5α-reductase II action, so they may serve as a principal choice in de novo drug designing to treat hair loss.

Deficiency of Formyl Peptide Receptor 2 Retards Hair Regeneration by Modulating the Activation of Hair Follicle Stem Cells and Dermal Papilla Cells in Mice.

Hair loss is one of the most common chronic diseases, with a detrimental effect on a patient's psychosocial life. Hair loss results from damage to the hair follicle (HF) and/or hair regeneration cycle. Various damaging factors, such as hereditary, inflammation, and aging, impair hair regeneration by inhibiting the activation of hair follicle stem cells (HFSCs) and dermal papilla cells (DPCs). Formyl peptide receptor 2 (FPR2) regulates the inflammatory response and the activity of various types of stem cells, and has recently been reported to have a protective effect on hair loss. Given that stem cell activity is the driving force for hair regeneration, we hypothesized that FPR2 influences hair regeneration by mediating HFSC activity. To prove this hypothesis, we investigated the role of FPR2 in hair regeneration using Fpr2 knockout (KO) mice. Fpr2 KO mice were found to have excessive hair loss and abnormal HF structures and skin layer construction compared to wild-type (WT) mice. The levels of Sonic hedgehog (Shh) and β-catenin, which promote HF regeneration, were significantly decreased, and the expression of bone morphogenetic protein (Bmp)2/4, an inhibitor of the anagen phase, was significantly increased in Fpr2 KO mice compared to WT mice. The proliferation of HFSCs and DPCs was significantly lower in Fpr2 KO mice than in WT mice. These findings demonstrate that FPR2 impacts signaling molecules that regulate HF regeneration, and is involved in the proliferation of HFSCs and DPCs, exerting a protective effect on hair loss.

Transcutaneous application of ultrasound enhances the effects of finasteride in a murine model of androgenic alopecia.

PurposeThe purpose of this study was to evaluate if transcutaneous application of low-intensity ultrasound can locally enhance the effects of finasteride on hair growth in a murine model of androgenic alopecia (AA).MethodsAA mice (injected twice per week with testosterone enanthate, n=11), under daily oral administration of finasteride, received 1-MHz ultrasound for 1 hour at the unilateral thigh area five times per week for 5 weeks. Non-thermal and non-cavitational ultrasound was delivered in a pulsed manner (55-ms pulse duration with a repetition frequency of 4 Hz). Skin temperature was measured during sonication, and the measurements were validated with numerical simulations of sonication-induced tissue temperature changes. Hair growth was assessed both photographically and histologically.ResultsWe found more hair growth on the sonicated thigh area than on the unsonicated thigh, beginning from week 3 through the end of the experiment. Histological analyses showed that the number of hair follicles doubled in the skin sections that received sonication compared to the unsonicated zone, with thicker follicular diameter and skin. An over five-fold increase was also observed in the anagen/telogen ratio in the sonicated area, suggesting an enhanced anagen phase. Skin temperature was unaltered by the administered sonication.ConclusionThe findings of the present study suggest that pulsed application of ultrasound promotes hair growth, potentially by disrupting the binding of albumin to finasteride. This may suggest further applications to enhance the pharmacological effects of other relevant drugs exhibiting high plasma protein binding.

Hair Growth-Promoting Effect of Resveratrol in Mice, Human Hair Follicles and Dermal Papilla Cells.

BackgroundOxidative damage has been found in various types of hair loss. As a polyphenolic phytoalexin, resveratrol (RSV) is known as an antioxidant, anti-inflammatory and anti-apoptotic agent.ObjectiveThus, we aim to examine the effects of RSV on hair growth.MethodsIn vivo C57BL/6 mice were used to evaluate the effects of RSV on hair cycle, hair length, skin thickness, hair follicle diameter, hair cycle score and the percentage of hair cycle stage. Then hair shaft length and hair cycle were evaluated by human hair follicles (HFs) ex vivo. The proliferative activities of human dermal papilla cells (hDPCs) cultured in vitro with RSV were assessed using RTCA. The ability of RSV to protect hDPCs against H2O2-induced oxidative damage is examined by a ROS assay kit.ResultsTopical application of RSV significantly promoted hair growth and stimulated the transition of hair cycle from telogen into the anagen phase on shaved C57BL/6 mice. Ex vivo experiments showed that RSV increased the hair shaft length of HFs and delayed the entry into catagen. In vitro experiments indicated that RSV proliferated hDPCs and prevented hDPCs from oxidative damage caused by H2O2.ConclusionRSV can promote hair growth and may be a potential candidate for the treatment of hair loss.

Depilatory creams increase the number of hair follicles, and dermal fibroblasts expressing interleukin-6, tumor necrosis factor-α, and tumor necrosis factor-β in mouse skin.

Besides using for hair removal, depilatory agents have been considered to be used as a penetration enhancer for transepidermal drug delivery. To examine the effect in hair follicles (HFs), two commercially available depilatory creams were tested on the dorsal skin of mice to monitor the effect deep into the skin structure. Fifteen male BALB/c mice were used in this study. Depilatory creams were applied to the dorsal skin of the same animal using shaved and untouched treatments as controls to minimize individual differences. Skin samples were collected at three days, one week and two weeks (n = 5 for each) after the treatment, and subjected for hematoxylin-eosin staining, and immunohistochemical analysis for proinflammatory cytokines. The morphological examination showed an increase in the thickness of epidermal layer of the depilatory cream-treated skin at early time points and in the subcutis at two weeks. Depilatory cream promoted entry of anagen phase and increased the number of hair follicles in the subcutis at one and two weeks. Immunohistochemistry showed elevated percentages of dermal fibroblasts expressing interleukin-6, tumor necrosis factor-α, and tumor necrosis factor-β. Shaving process increased the thickness of epidermis and dermis as depilatory creams did, but did neither induce the expression of proinflammatory cytokines in the dermal fibroblasts nor the number of HFs. The results suggested that the commercially available depilatory creams caused a transient minor inflammatory response of the skin and increased the levels of cytokines that might subsequently affect hair growth.

329 In vitro co-culture models of merkel cell-neurite complex in touch domes

Touch dome, a specialized epidermal structure comprised from mechanosensory Merkel cell-neurite complex, has been known to change their numbers in the spontaneous hair cycle in mice. At the anagen phase, the number of Merkel cells are dramatically reduced with the loss of terminal neurites in touch dome afferents, indicating neuronal plasticity in healthy skin during hair-follicle regeneration. In this study, we focused on the role of Merkel cell-neurite complex in hair growth on the basis of the reports that the mechanical stimulation of human scalp by a massage improves hair thickness.

Clinical, Trichoscopic And Immunohistochemical Evaluation of Autologous Adipose Derived Adult Stem Cell Injection in the Treatment of Female Pattern Hair Loss

Abstract Background Cellular and cell-derived components of adipose-derived tissue for the purposes of dermatologic and aesthetic rejuvenation applications have become increasingly studied and integrated into clinical practice. The hair follicle goes through phases of growth, regression, and quiescence, and it is suspected that adipocytes secrete factors to promote activation of hair follicles dermal papilla cells, increasing migration, and proliferation in vitro; as well as increasing conversion of hair follicles from the telogen to anagen phase in vivo. Objectives Evaluation of efficacy and safety of adipose-derived adult stem cells (ADSCs) injection in hair follicle regeneration in female pattern hair loss (FPHL). Methods 33 patients were included and divided into 3 groups according to Sinclair’s classification according to severity. ADSCs were extracted from lipoaspirate and injected into the frontoparietal scalp. Patients were assessed clinically, trichoscopically and immunohistochemically. Results At week 24, there was improvement of hair thickness and count, both in frontal and occipital areas. Histopathological and immunohistochemical assessment at week 12 showed decrease of perifollicular inflammation and decrease of DKK-1 immunostaining. Conclusion The use of ADSCs in treatment of FPHL in subjects included in this study showed improvement of perifollicular inflammation, in addition to density and thickness of hair.

Assessment of the Oxidative Stress Status in Androgenetic Alopecia in Egyptian Men

Abstract Background Androgenetic alopecia (AGA) is the most common type of hair loss in men. It is commonly known as a male pattern baldness. It is characterized by a stepwise miniaturization of the hair follicle, resulting from alteration in the hair cycle dynamics, leading to vellus transformation of terminal hair follicle. In AGA, the duration of anagen phase gradually decreases and that of telogen phase increases, the maximum length of the new anagen hair becomes shorter than that of its predecessor, leading to miniaturization and eventually a bald appearance. Aim of the Work To assess the expression of NRF2 in the scalp of men with androgenetic alopecia. Patients and Methods This case control study included 28 male patients whose age ranged from 18 to 45 years old. They were diagnosed as having AGA according to Norwood-Hamilton scale. Further, 28 age and sex matched healthy male controls were recruited. All patients and controls were recruited from the dermatology outpatient clinic of Ain-Shams University Hospitals, during the period of September 2018 to April 2019. Results A group of Twenty-eight male patients with AGA were recruited to the study. The of patients ranged from 18 to 45 years (mean = 33.46 years ± 9.9 SD). Twenty-eight age matched male healthy volunteers without AGA were e recruited. The majority of AGA patients had positive family history of AGA in their first degree relatives. None of our patients had a medical history of systemic diseases like diabetes mellitus or hypertension. Conclusion The current study showed that alteration of Nrf2 levels may play an important role in the pathogenesis of AGA.

Assessment of Human Nuclear Factor Erythroid 2 Related Factor 2 (NRF2) in Androgenetic Alopecia in Egyptian Men

Abstract Background Androgenetic alopecia (AGA) is the most common type of hair loss in men. It is commonly known as a male pattern baldness. It is characterized by a stepwise miniaturization of the hair follicle, resulting from alteration in the hair cycle dynamics, leading to vellus transformation of terminal hair follicle. In AGA, the duration of anagen phase gradually decreases and that of telogen phase increases, the maximum length of the new anagen hair becomes shorter than that of its predecessor, leading to miniaturization and eventually a bald appearance. Aim of the work To assess the expression of NRF2 in the scalp of men with androgenetic alopecia. Patients and Methods This case control study included 28 male patients whose age ranged from 18 to 45 years old. They were diagnosed as having AGA according to Norwood-Hamilton scale. Further, 28 age and sex matched healthy male controls were recruited. All patients and controls were recruited from the dermatology outpatient clinic of Ain-Shams University Hospitals, during the period of September 2018 to April 2019. Results A group of Twenty-eight male patients with AGA were recruited to the study. The of patients ranged from 18 to 45 years (mean = 33.46 years ± 9.9 SD). Twenty-eight age matched male healthy volunteers without AGA were e recruited. The majority of AGA patients had positive family history of AGA in their first degree relatives. None of our patients had a medical history of systemic diseases like diabetes mellitus or hypertension. Conclusion The current study showed that alteration of Nrf2 levels may play an important role in the pathogenesis of AGA.

Dexpanthenol Promotes Cell Growth by Preventing Cell Senescence and Apoptosis in Cultured Human Hair Follicle Cells.

Dexpanthenol (D-panthenol) is a precursor of vitamin B5 (pantothenic acid) and is widely used for dietary supplements and topical applications. D-panthenol has long been used in hair care products for the purpose of anti-hair loss, its effects and the underlying mechanisms, however, were barely reported. In this study, the effects of D-panthenol on human hair follicle cells, including dermal papilla cells (hDPCs) and outer root sheath cells (hORSCs), were investigated. D-panthenol enhanced the cell viability, increasing the cellular proliferation marker Ki67 in cultured hDPCs. The markers for apoptosis (Caspase3/9) and cell senescence (p21/p16), reported to be expressed in aged or resting phase follicles, were significantly reduced by D-panthenol. Anagen-inducing factors (ALP; β-catenin; versican), which trigger or elongate the anagen phase, were stimulated by D-panthenol. On the other hand, D-panthenol reduced TGF-β1 expressions in both mRNA and protein levels. The expression of VEGF, which is important for peripheral blood vessel activation; was up-regulated by D-panthenol treatment. In cultured hORSCs, cell proliferation and viability were enhanced, while the mRNA expression of cell senescence markers (p21/p16) was significantly down-regulated. The expressions of both VEGF and its receptor (VEGFR) were up-regulated by D-panthenol. In conclusion, our data suggest that the hair growth stimulating activity of D-panthenol was exerted by increasing the cell viability, suppressing the apoptotic markers, and elongating the anagen phase in hair follicles.

Role of proteoglycans in the treatment of alopecia of various genesis

Hair loss has always been and remains an urgent challenge in the world today. Although this condition is not life-threatening, it still has a strong impact on the patients’ quality of life. Hairlines are affected by multiple factors including age, family history, smoking, nutrition, etc. Alopecia can take many forms, and the specialist’s objective is to determine the correct cause of the disorder of hair growth cycle by taking a medical history from a patient.The key role in the pathogenesis of androgenetic alopecia is assigned to changes in hormonal status. Telogen effluvium can be triggered by stress, medication, pregnancy, or other medical conditions. For instance, the high number of patients who have had COVID-19 are now faced with hair loss a few months after recovery.Despite the variety of underlining causes of hair loss, the principle of therapy is the same – the elimination of the trigger and the selection of drugs to normalize the natural hair growth cycle. In this case, the use of drugs containing proteoglycans that are specific proteins involved in the regulation of the hair growth cycle looks promising. Numerous studies demonstrate the efficacy of such proteoglycans as versican, decorin, and syndecan. They activate hair growth and help prolong the anagen phase. This effect of proteoglycans affords to speak about their good therapeutic and even prophylactic properties applied to the problem of hair loss.

Short anagen syndrome: A case series and algorithm for diagnosis

The short anagen syndrome (SAS) is a rare idiopathic pediatric disorder characterized by the short duration of the anagen phase. SAS mainly affects Caucasian children. Parents complain of their child's inability to grow long hair. Topical minoxidil may be an effective treatment for SAS; however, a slow spontaneous improvement is typical. Our aim was to collect data on out cases of SAS and create an algorithm to facilitate diagnosis of SAS. A retrospective review of 25 patients with SAS was performed within the Dermatology Department of the University of Bologna. We collected data regarding symptoms, pull test, hair card test, trichoscopy, trichogram, treatments, including biotin and minoxidil, and clinical outcome. Characteristic findings included parental reporting that the hair had not required a haircut, hair card test showing hairs with conical-shaped tips, and hair shafts of different diameters, with more 10%-20% of hair shafts less than 60μm thick on trichoscopy. Trichogram revealed an increased percentage of telogen hair with normal hair shafts and tapering ends. The mean anagen-to-telogen ratio was 66:34 (normal ratio 90:10). We developed an algorithm to facilitate the diagnosis of this rare hair disease using clinical examination and invasive and non-invasive testing to differentiate SAS from other forms of pediatric alopecia. In conclusion, the collected data of the therapy showed that biotin alone or in combination with topical minoxidil is an effective treatment for SAS.

28383 The effectiveness of thread-embedding therapy for treating scarring and nonscarring alopecia

Background: Thread embedding therapy has recently gained attention as a safe and noninvasive treatment for hair loss. Although the mechanism of action is unclear, current hypothesis suggests that embedded polydioxanone (PDO) threads stimulate microcirculation and neo-collagenesis, thereby enhancing anagen phase in hair follicles. However, the clinical evidence on the effectiveness of PDO threading on hair regrowth is scarce.

Hair loss

A significant number of men and women experience hair loss. Up to 80% of white men and 40% to 50% of white women are affected at some point in their lives. White men are more likely to experience hair loss than men of other ethnicities. Many factors potentially contribute to hair loss, including hormonal changes, physiologic stress, some chronic illnesses, medications, dietary changes, genetics, and local trauma. People affected by hair loss often experience low self-esteem; personal, social, and work-related challenges; and psychiatric disorders, such as depression and anxiety. The economic impact of hair loss is approximately $3.5 billion each year through purchases of products and procedures. Hair loss is broadly categorized as either nonscarring or scarring alopecia. Forms of nonscarring alopecia include androgenetic alopecia (AGA), also known as hereditary pattern hair loss; alopecia areata (rapid-onset, patchy hair loss); anagen effluvium (rapid shedding of growing hairs); telogen effluvium (rapid shedding of resting hairs); cosmetic hair damage; trichotillomania (a compulsive pulling out of one's hair); and tinea capitis (fungal infection/ringworm of the scalp). AGA is the most common form of hair loss and the only type of alopecia for which FDA-approved nonprescription medications are available. AGA is characterized by progressive, male or female pattern hair loss from the scalp. The goal of self-treatment is to achieve an appearance that the patient considers acceptable with a corresponding decrease in the emotional distress experienced. If a self-treatment approach to hair loss is appropriate, the treatment objectives can be accomplished through cosmetic camouflage and/or the use of topical minoxidil to stimulate hair growth, where applicable. Minoxidil is the only FDA-approved agent for self-treatment of AGA. It is available as 2% and 5% hydroalcoholic solutions and as a 5% solvent-free foam. Minoxidil can be applied by various methods depending on the applicator (i.e., spray or dropper). Administration guidelines for the dosage forms differ, and it is important to instruct patients accordingly. This product is labeled for baldness at the crown of the head in men and for hair thinning in the frontoparietal area in women. The 2% and 5% solutions (1 mL twice daily) and 5% foam (half capful twice daily) are approved for use by men, whereas only the 2% solution (1 mL twice daily) and 5% foam products (half capful once daily) are approved for use by women. When used topically for hair loss, minoxidil appears to increase cutaneous blood flow, promote and maintain vascularization of hair follicles, directly stimulate follicular hypertrophy, and prolong the anagen (active hair follicle) phase. After initiation of minoxidil treatment, an increase in hair loss may occur within the first few weeks of product use. Several months may elapse before hair growth is apparent. In many cases, increased hair density is minimal, and treatment response is difficult to assess. The patient must continue to use the product indefinitely to maintain new growth. The most common adverse effects associated with minoxidil, such as local itching, irritation, and dryness or scaling at the site of application, may be related to the hydroalcoholic/propylene glycol in the product. Use of the 5% minoxidil topical formulation in a propylene glycol–free foam reduces the risk of local adverse effects. Patients with scalp damage from psoriasis, severe sunburn, or abrasions should avoid topical minoxidil. All women, regardless of pregnancy or breastfeeding status, should consult a primary care provider before initiating a minoxidil regimen. Other scalp drugs or hair care products should not be used concomitantly with minoxidil. This medication is not indicated for use on infants, children 18 years or younger, or those with heart disease except under the supervision of a primary care provider. If hair fails to appear within the time specified on the product (generally 4-6 months) despite consistent use of the product, the patient should stop treatment and seek care from their physician.