Bald Area Research Articles

Scalp Reduction in the Treatment of Androgenic Alopecia

Scalp reductions represent an advance in the surgical treatment of male-pattern baldness. The initial enthusiasm that is shared by both the patient and the surgeon should be tempered by the knowledge that there will be some stretch-back and distortion of the bald area and that the scar may present a problem with styling.

Use of topical minoxidil in the treatment of male pattern baldness

This 12-month, double-blind, randomized study evaluated the safety and efficacy of topical minoxidil in the treatment of male pattern baldness. Three formulations were compared: 2% minoxidil solution, 3% minoxidil solution, and placebo. After 4 months all placebo patients crossed over to treatment with the 3% solution. Of the 96 patients randomized into the study, 79 were evaluable at month 12; 25 of these were in the 2% minoxidil group, 24 were in the 3% minoxidil group, and 29 were in the placebo-to-3% solution switchover group. At monthly intervals a hair count was obtained within a 1-inch diameter area on the scalp vertex. In addition, a gross visual estimate of the degree of new hair growth over the entire balding area was made independently by the investigator and the patient. At the end of 4 months there was significant regrowth of nonvellus (terminal and indeterminate) hairs in the patients using the 2% and 3% solutions (p = 0.0001). The mean nonvellus hair count at month 4 was 162.8 in the 2% minoxidil group, 155.4 in the 3% minoxidil group, and 107.1 in the placebo group. The mean increase in the 2% and 3% treatment groups was 58.2 and 48.8, respectively, whereas the mean increase in the placebo group was 4.0. Total hair counts at month 4 demonstrated significantly more growth of hair in the 2% minoxidil group than in the placebo group (p = 0.013), with no significant difference between the 3% minoxidil group and the other two treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term efficacy of topical minoxidil in male pattern baldness

A 24-month clinical trial, begun on a double-blind basis, was conducted in 153 men with discernible male pattern baldness of the crown with the use of either topically applied placebo, 2% minoxidil, or 3% minoxidil solution. After 4 months the patients using placebo were switched to 3% minoxidil solution. At 12 months, there were statistically significant increases in terminal hair growth within a 1-inch target area in those treated with 2% or 3% minoxidil solution, in comparison with baseline counts. However, there were few patients who had appreciable cosmetic restoration. At 12- and 24-month intervals, progressive regression or stabilization of the size of the bald area was noted in the majority of patients. This therapeutic or preventive effect was statistically significant. The data on actual target area hair counts suggested that the 2% minoxidil solution was equal to or more efficacious than the 3% minoxidil solution. Baseline vital signs and laboratory parameters remained essentially unchanged. Topical minoxidil was well tolerated, with no serious drug-related adverse reactions noted during the study.

The bilateral occipito-parietal flap.

The "bilateral occipito-parietal flap" is a technique whereby the entire occipito-parietal, donor dominant scalp is undermined past the galeal attachment and advanced forward into the balding areas. Use of this method for the treatment of bitemporal recessions and type 6 male pattern baldness is discussed in detail.

Scalp expansion flaps

A mean 5 year review of 20 patients who had surgery for localised alopecia of the scalp is presented. The technique of using scalp expansion flaps is described and evaluated: it is associated with a low morbidity and high patient satisfaction rate; it provides an excellent one-stage procedure for intermediate size defects and, in the frontal area, for larger defects. Particular emphasis is laid on making incision lines at right angles to the direction of hair growth in order to cover stretched scars, and in performing Z-plasties when closing small scalp defects. Finally, a rationale for the treatment of localised areas of baldness according to their size is put forward.

Percutaneous absorption of malathion in the guinea-pig: Effect of repeated topical application

The effects of daily repeated topical application and of washing on the percutaneous absorption of malathion have been investigated in guinea-pigs. Skin absorption was determined indirectly by measurement of radioactivity excreted into the urine following topical administration of 14C-labelled malathion, with correction of these values for incomplete renal elimination. Malathion was applied at a concentration of 5 mg/cm 2 every 24 hr to the same site on the post-auricular bald area for 15 days. Doses 1, 8 and 15 were radiolabelled. The effect of multiple application and washing was assessed by Newman-Keuls multiple range test for statistical significance. The percutaneous absorption of malathion was 2–3 times higher with washing than without. There was no significant increase ( P > 0.05) in the percutaneous absorption of malathion with repeated application without washing. These studies suggest that the total penetration of malathion resulting from daily topical dosing without daily washing may be predicted from a single-dose application to the same unwashed site at an equivalent surface concentration, and also that repeated washing with soap and water may significantly decrease the barrier function of guinea-pig skin.

Topical minoxidil in early male pattern baldness

One-hundred twenty-six healthy men with early male pattern baldness completed a 12-month double-blind, controlled trial of 2% and 3% topical minoxidil. Subjects were initially randomly assigned to use placebo or 2% or 3% topical minoxidil. After 4 months of study, the placebo group was crossed over to 3% topical minoxidil. Both objective measurement of hair growth by counting of vellus, terminal, and total hairs in a vertex target balding area and subjective assessment by subject and investigator were done. Treatment of subjects with topical minoxidil for 4 months resulted in a statistically significant increase in terminal hair growth in comparison with placebo therapy. In addition, subjects initially treated with placebo, when crossed over to topical minoxidil, showed a significant increase in the number of terminal hairs. No subject had a net hair loss in the target area during the study. These results indicate that topical minoxidil can increase terminal hair growth in early male pattern baldness.

Upjohn 'Cautiously Optimistic' On Minoxidil for Baldness

One-hundred twenty-six healthy men with early male pattern baldness completed a 12-month double-blind, controlled trial of 2% and 3% topical minoxidil. Subjects were initially randomly assigned to use placebo or 2% or 3% topical minoxidil. After 4 months of study, the placebo group was crossed over to 3% topical minoxidil. Both objective measurement of hair growth by counting of vellus, terminal, and total hairs in a vertex target balding area and subjective assessment by subject and investigator were done. Treatment of subjects with topical minoxidil for 4 months resulted in a statistically significant increase in terminal hair growth in comparison with placebo therapy. In addition, subjects initially treated with placebo, when crossed over to topical minoxidil, showed a significant increase in the number of terminal hairs. No subject had a net hair loss in the target area during the study. These results indicate that topical minoxidil can increase terminal hair growth in early male pattern baldness.

Hair transplantation for male pattern baldness: aesthetic considerations and current status.

The multiple punch technique of hair transplantation, utilizing the principle of donor dominance, has proven to be a cosmetically acceptable procedure in properly selected patients in the presenter's 24-year experience. Careful planning with attention to aesthetic principles, especially in frontal hairline placement, in donor site selection and with regard to the ratio between the donor supply and the existing or potential future extent of baldness, together with meticulous surgical technique, are essential for satisfactory results. Scalp reduction, in which bald areas of crown and midscalp are serially excised, with extensive subgaleal undermining is a highly useful adjunct to grafting in many patients with moderately extensive male pattern baldness who have adequate scalp mobility by enabling the available donor supply to be concentrated and thus provide more effective coverage in the frontal scalp.

Punch grafting the crown and vertex.

Several different methods exist for surgical hair replacement of the vertex region of the scalp. Despite the more recent addition of alopecia reduction and flaps, small areas of crown baldness frequently, can best be handled cosmetically by well-planned and technically well-executed punch autografts. The methodology of hair transplantation of the vertex region of the scalp and the avoidance of cosmetic problems are discussed.

Topical Minoxidil Therapy in Hereditary Androgenetic Alopecia

• A randomized double-blind trial of topical minoxidil therapy was carried out on 56 patients with hereditary male pattern baldness. The subjects selected were required to have a discernible balding patch, a minimum of 2.5 cm in diameter on the vertex of the head where the hairs could be counted and photographed. Minoxidil, 1.0 mL, was applied twice a day to the scalp beginning at the balding vertex and spreading centrifugally around the scalp. Cosmetically acceptable hair growth was achieved in 18 patients (32%). The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area. No serious systemic or cutaneous side effects were noted. (<i>Arch Dermatol</i>1985;121:197-202)

Topical minoxidil therapy in hereditary androgenetic alopecia

A randomized double-blind trial of topical minoxidil therapy was carried out on 56 patients with hereditary male pattern baldness. The subjects selected were required to have a discernible balding patch, a minimum of 2.5 cm in diameter on the vertex of the head where the hairs could be counted and photographed. Minoxidil, 1.0 mL, was applied twice a day to the scalp beginning at the balding vertex and spreading centrifugally around the scalp. Cosmetically acceptable hair growth was achieved in 18 patients (32%). The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area. No serious systemic or cutaneous side effects were noted.

Percutaneous Absorption of Minoxidil in Man

The percutaneous absorption and excretion of 1% and 5% solutions of minoxidil labeled with carbon 14 were measured in 12 adult male subjects. These subjects were randomly assigned to the 1% and 5% minoxidil testing groups, and all received nine topical applications to a bald area on the scalp, with the radioactive solutions applied on days 1 and 9. Urinary excretion of radioactivity was low, with mean values ranging from 1.6% to 3.9% of applied dose. No radioactivity could be detected in fecal samples. Recovery of radioactivity from the skin surface and from scalp and pillowcase washes was in the range of 41% to 45% of applied dose. No adverse reactions or notable abnormalities were noted in the subjects during the study. Although minoxidil is poorly absorbed through the skin, systemic doses in the range of 2.4 to 5.4 mg/day can be anticipated if application is made to entire scalp.

Increase of mast cells in the alopecia lesion of mice

A histological investigation was made of the quantitative behavior of mast cells in bald areas on mice and in human alopecia areata. C57BL,W/Wv and +/+ mice with alopecia lesions were examined. In C57BL mice and +/+ mice, the number of dermal mast cells (per square mm) in the bald areas was greater than that in controls. The mean number of mast cells was slightly higher in human alopecia areata than in the controls. Since W/Wv mice lacking mast cells developed alopecia lesions, it seems that mast cells are not necessary for the onset of alopecia areata but could play some part in regrowth.

Scalp kinetics in multiple excisions for correction of male pattern baldness.

The author placed tattoo marks in the scalp in a certain pattern in seven patients with male pattern baldness to ascertain the complex movement of the scalp due to serial longitudinal midline excision of the bald area.

Preservation of the female sideburn.

Routine face-lift incisions in the temporal hair line may be unsatisfactory because of one or all of the following reasons: Production of an area of baldness immediately in front of the ear; presence of wide unsightly scar in the temporal hairline; loss of hair in the temporal area; and disfigurement of the temporal hair and sideburn. In order to conceal the deformity, the patient is limited to certain hairstyles. The problem is exaggerated in patients with sparse hair or who undergo a secondary rhytidectomy. A solution is an incision at or in the edge of the hairline in the temporal hairline. The technique has been used in over 200 patients during the past 3 years with excellent results. Specific points including location of incision, caveats in technique, and pre- and postoperative results are discussed.

A novel approach to assessment in the treatment of childhood trichotillomania

The present study describes the successful treatment of a 9-year-old girl with trichotillomania. Intervention involved (1) praising attractive hair and ignoring hair loss, (2) education in hair hygiene, (3) response prevention for night-time hair pulling, and (4) a variable schedule of monetary rewards for criterion hair growth. Progress was assessed by counting hairs in random scalp areas and measuring bald areas. Hair growth increased from three hairs per area sampled at baseline to such dense hair growth that individual hairs could not be counted and no bald spots were noted. Results maintained at 2, 6 and 10 months follow-up.

Updating reduction and flap procedures for baldness.

Corrective surgery for baldness now includes scalp reduction, hair-bearing flaps, and punch autografts. When baldness is mild to extreme in the vertex or anterior vertex, scalp reduction is usually indicated. By reducing the bald area of patient with extreme alopecia, a dense back-ground of hair is provided for implants in both the anterior vertex and frontal regions. Hair-bearing flaps are recommended for those with a marginal outline pattern of excessive baldness and for those with very fine, sparse hair who wish to attain strong and dense frontal growth. Using these advancements results in immediate or "instant" hair. All available adjuncts should be considered for adequate coverage and a natural appearance in the extremely bald patient.

The Strip Scalp Graft

Hair transplantation for male pattern baldness has been done on many patients by dermatologists and plastic surgeons during the past 20 years. In selected cases, hair transplantation has been successful for adequate replacement of hair in bald areas of the scalp. In most cases, the punch graft technique alone is used. However, in selected cases, especially in younger individuals desiring a dense growth in the frontal area, the strip graft in conjunction with punch grafts can be used. When the strip graft operation is properly executed, the results are very gratifying. My most impressive results have been with those who have had the strip graft operation combined with the punch graft method (Figs. 13 and 14). The strip graft, like the punch graft, has proved to be extremely versatile. It can be transplanted in any conceivable direction and in any area of the scalp. It may be twisted into any desired shape so as to conform to any recipient site. It can also be made short or long and may be cut into smaller strips or even into small square grafts. If careful attention is paid to the simple steps of the operation discussed in this article, a surgeon will usually be rewarded with a good take of the strip graft.

Juri Flap Procedure for the Treatment of Baldness: Two-Year Experience

I report a two-year experience using Juri procedure of transferring twice-delayed parietal-occipital flaps to balding areas of the scalp. These operations allow massive transfer of genetically determined permanent hair to the cosmetically deficient areas of the scalp, whether the condition of baldness is the result of injury or hereditary factors. These procedures require careful thought in planning the hairline and necessitate minor secondary procedures to achieve the most satisfactory results. I discuss concepts for the design of the flap, and describe modifications in the surgical techniques as compared with a previous report. The Juri operation, although extensive, gives the greatest amount of hair transfer in the shortest period of time and has resulted in satisfactory cosmetic results in all patients operated on.