Complete Hair Regrowth Research Articles

Triethylene Glycol Squalene Improves Hair Regeneration by Maintaining the Inductive Capacity of Human Dermal Papilla Cells and Preventing Premature Aging.

De novo hair follicle (HF) regeneration, achieved through the replenishment of the dermal papilla (DP), acknowledged as the principal orchestrator of the hair growth cycle, is emerging as a prospective therapeutic intervention for alopecia. Nonetheless, multiple attempts have shown that these cells lose key inductive properties when cultured in a two-dimensional (2D) monolayer, leading to precocious senescence engendered by oxidative stress and inflammatory processes. Consequently, the three-dimensional (3D) spheroid technique is presently widely employed for DP cell culture. Nevertheless, substantiating the regenerative potential of these cells within the hair follicle (HF) milieu remains a challenge. In this current study, we aim to find a new approach to activate the inductive properties of DP cells. This involves the application of hair-growth-stimulating agents that not only exhibit concurrent protective efficacy against the aging process but also induce HF regeneration. To achieve this objective, we initially synthesized a novel highly amphiphilic derivative derived from squalene (SQ), named triethylene glycol squalene (Tri-SQ). Squalene itself is a potent antioxidant and anti-inflammatory compound traditionally employed as a drug carrier for alopecia treatment. However, its application is limited due to its low solubility. Subsequently, we applied this newly synthesized derivative to DP cells. The data obtained demonstrated that the derivative exhibits robust antioxidant and anti-inflammatory activities while concurrently promoting the expression of genes associated with hair growth. Moreover, to further assess the hair regrowth inductive properties of DP cells, we cultured the cells and treated them with Tri-SQ within a 3D spheroid system. Subsequently, these treated cells were injected into the previously depilated dorsal area of six-week-old male C57BL/6 mice. Results revealed that 20 days postinjection, a complete regrowth of hair in the previously hairless area, particularly evident in the case of 3D spheroids treated with the derivative, was observed. Additionally, histological and molecular analyses demonstrated an upregulation of markers associated with hair growth and a concurrent decrease in aging hallmarks, specifically in the 3D spheroids treated with the compound. In summary, our approach, which involves the treatment of Tri-SQ combined with a 3D spheroid system, exhibited a notably robust stimulating effect. This effect was observed in the induction of inductive properties in DP cells, leading to HF regeneration, and concurrently, it demonstrated an inhibitory effect on cellular and follicular aging.

Treacherous territory: Temple fillers and tissue necrosis

AbstractTemporal region of the face is considered the most promising facial region for inducing panfacial effects, playing an increasingly important role in facial contouring and rejuvenation surgeries, which in turn has led to a rapid growth in the demand for aesthetic correction for temporal hollowing. In order to correct this issue and achieve a more youthful appearance, filler injections can be used. Although this procedure is generally safe and is increasingly popular, complications may happen. Complications include visual loss, neurological deficits, embolism, and non‐thrombotic pulmonary embolism. These complications are thought to result from injection of filler material into facial arteries and veins. We describe here a patient who developed pain in the parieto‐temporal region following hyaluronic acid (HA) injection for temporal augmentation, which was complicated by tissue necrosis and alopecia. This was managed with hyaluronidase injection and aspirin tablets. Patient was followed for 6 months period after which she had complete hair growth and total resolution of skin necrosis without any scar formation. Since complications of HA injection are wide and serious, practitioners should always be aware of potential consequences of such procedures.

Update on pulse corticosteroid therapy for the management of alopecia areata

AbstractAlopecia areata is a nonlife‐threatening autoimmune disorder and often requires systemic treatment to stop the disease from progressing. Pulse corticosteroid therapy (PCT) is a common way to treat severe alopecia areata although the exact benefit on this treatment remains unclear. The aim of this article is to update current knowledge of hair regrowth rates after PCT. Twenty studies with a total of 2144 patients were reviewed. Eight out of 20 studies allow statements on patients who did not respond at all on PCT. From 680 patients in those eight studies, 211 showed no response, which equals a rate of 31.02%. However, nine out of the 20 studies point out how many patients achieved hair regrowth >50% or a reduction in Severity of Alopecia Areata Tool Score by >50%: 131 patients out of 272 achieved a response with >50% hair regrowth, which corresponds to a rate of 48.16%. Complete regrowth of hair was observed and documented in nine studies: Out of the 1757 patients, 677 showed full regrowth leading to a complete response rate of 38.53%. At University Hospital Bonn, Department of Dermatology, Germany, PCT has been an established treatment for severe alopecia areata over the past decades. Nevertheless, many unwanted side effects were observed. A retrospective study on hair regrowth after PCT was performed in 2022 and is also part of this article. Nineteen studies from literature search through the PubMed database and the one own study led to a total of 20 studies being reviewed in this article.

Clinical Benefits of Baricitinib Therapy According to Scalp Hair Regrowth in Patients with Severe Alopecia Areata.

The present analyses report integrated results from BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) on the clinical benefits of baricitinib treatment on the basis of the amount of scalp hair regrowth through 52weeks of treatment. This posthoc analysis was conducted with data from patients who were treated continuously for 52weeks with baricitinib 4mg or 2mg. Clinical outcomes were assessed using the Severity of Alopecia Tool (SALT) and Clinician-Reported Outcome (ClinRO) for Eyebrow (EB) and Eyelash (EL) hair. Secondary measures included the Hospital Anxiety and Depression Scale and Skindex-16 adapted for alopecia areata. At week52, patients were classified into three subgroups: SALT ≤ 20 response, intermediate response (achieved a 30% improvement from baseline (SALT30) without a SALT score ≤ 20), or nonresponse (never achieved SALT30). The criterion of SALT30 approximates a minimal clinical meaningful response to therapy. At week52, with baricitinib 4 mg treatment, the greatest (70%) improvement in EB and EL was observed in responders, but approximately 50% of patients with intermediate response and 20% of nonresponders experienced complete/nearly complete EB and EL regrowth. Improvement in emotional distress was directionally related to improvements in scalp hair regrowth, while impact on quality of life was proportionately greater for the responder subgroup. Clinically meaningful regrowth in eyebrow and eyelash hair can occur in the absence of complete scalp hair regrowth after treatment with baricitinib. Emotional distress and quality of life improvement is most associated with obtaining a clinical meaningful improvement in scalp hair. BRAVE-AA1, ClinicalTrials.gov number, NCT03570749, start date, 24September2018; BRAVE-AA2, ClinicalTrials.gov number, NCT03899259, start date, 8July2019.

A Retrospective Review of Anthralin in Petrolatum in the Treatment of Alopecia Areata in the Pediatric Population.

Alopecia areata (AA) is a T-cell driven autoimmune disease, which results in hair loss. This study aims to determine the efficacy, tolerability and safety of different concentrations of anthralin in the treatment of pediatric AA. A retrospective cohort study of patients < 18 yo diagnosed with AA treated with anthralin at SickKids Hospital, Toronto dermatology outpatient clinic in 2016 - 2018. Anthralin used at 0.1%, 0.2%, 0.5% and 1% in petrolatum at short contact, at increments of 15 minutes every week until a 1 hr maximum contact achieved. No other treatment was used in conjunction. Severity of Alopecia Tool (SALT) scores (SS) were determined using photographs and descriptions to assess severity of alopecia at baseline and post anthralin treatment. A total of 11 charts were reviewed in this retrospective cohort. Hair loss pattern; 3 patients with patchy, 6 had mixed (patchy and ophiasis), and 2 were totalis. All except for 1 patient had failed traditional treatments. One patient had complete hair regrowth, 3 showed more than 85% hair re-growth and 7 patients showed more than 75% hair regrowth, the average time for this to occur was 6.5 months. None of the patients experience serious side effects. Our study demonstrated the efficacy and tolerability of topical anthralin 0.1% to 1% in pediatric alopecia areata. In our study, anthralin 0.2% appears to offer the best performance and tolerability profile among the different concentrations used, with treatment course of at least 6 months in order to achieve more than 75% hair regrowth.

Complete hair regrowth in a young male with severe atopic dermatitis and alopecia areata after dupilumab: probably more than a coincidence

Complete hair regrowth in a young male with severe atopic dermatitis and alopecia areata after dupilumab: probably more than a coincidence

Major improvement of very severe alopecia areata in patients treated with the combination of baricitinib and low doses of corticosteroids: an eight-case series.

Alopecia areata (AA), especially very severe types, causes patients severe psychological and social distress. Although baricitinib alone has been shown to be effective in conferring complete hair regrowth (HR) in severe AA [Severity of Alopecia Tool (SALT) score 50-94], it gave poor therapeutic results in very severe AA (SALT score ≥ 95). Methotrexate alone is similarly ineffective, but in a recent study of patients with areata totalis or universalis, low-dose prednisone with methotrexate gave a 20% rate of HR, and was effective and well tolerated. In our study of baricitinib 4 mg + prednisone 20 mg per day tapered over 3 months to treat eight women with very severe AA, seven of eight achieved complete HR (SALT score 0) and one had partial HR (SALT score 30).

Treatment Response to Diphenylcyclopropenone in Patients with Alopecia Totalis/Universalis.

Alopecia totalis (AT) and Alopecia universalis (AU) are forms of Alopecia areata (AA) which represent the strongest predictor of poor prognosis since spontaneous regrowth is <10%. Topical immunotherapy agent, diphenylcyclopropenone (DPCP) has shown clinical efficacy with limited side effects in severe forms of AA. However, its specific role in AT/AU characterized by complete hair loss over the scalp can help highlight the efficacy of the drug with fewer confounders. Data were collected from 18 patients diagnosed with AT/AU and treated with topical immunotherapy with DPCP as per protocol by Happle et al. Baseline Severity of Alopecia Tool (SALT) score and subclass was recorded. In the case of AU, baseline body hair loss score was also recorded. Patients were reassessed after 6 months of treatment in terms of change in SALT score and hair regrowth was assessed using the Global Assessment Score. The side effects during treatment were also assessed and recorded. Eighteen patients of whom eleven (61.1%) were diagnosed as AU and seven (38.9%) as AT were treated. The mean age was 21.6, with a male: female ratio of 3:2. The comorbidities noted were atopy in six (33.3%), atopy and hypothyroidism in one (5.5%), Down's syndrome in two (11.1%), and hypothyroidism alone in one (5.5%) patient. The mean duration of disease at the time of presentation was 3 years and all patients had remained refractory to various other modalities of treatment. All patients had a baseline SALT score of 100 corresponding to S5. After 6 months of treatment, 27.7% of patients did not show any response (SALT score S5), 16.6% had a score of S4, 11.1% had a score of S3, 11.1% had a score of S2, 22.2% had a score of S1, and 11.1% had a score of S0. On assessing improvement in body hair loss score, 36.3% of patients showed no improvement, 36.3% showed partial improvement, and 27.2% of patients showed complete body hair regrowth. About 55.5% of patients developed notable side effects that included severe local reactions, cervical lymphadenopathy, acne and pigmentation at the site of application as well as untreated sites. The AT/AU subtypes of AA, was amenable to treatment with contact immunotherapeutic agent DPCP with a >75% hair regrowth in 33.3% of patients. The castling phenomenon was seen in 63.6% of AU patients. The adverse effects noted were not severe enough to deter treatment.

Comparison of Clinical Efficacy and Trichoscopic Changes in Alopecia Areata of the Scalp following Treatment with Intralesional Triamcinolone Acetonide and Autologous Platelet-Rich Plasma

Background: Alopecia areata (AA) is an autoimmune disease affecting the scalp and body, resulting in hair loss. The fundamental goal of management is to keep the pathology under control. Intralesional corticosteroids suppress T-cell-mediated attacks on hair follicles. Platelet-rich plasma (PRP) contains growth factors that stimulate hair follicle stem cells and have anti-inflammatory properties with fewer side effects. Trichoscopy shows exclamation hair and black dots in the acute stage, yellow dots in long-standing cases, and short vellus hair in regrowing patches. Objective: The aim of this study was to evaluate and compare the efficacy of intralesional triamcinolone acetonide with autologous PRP in the treatment of two different scalp AA patches in the same individual. Materials and Methods: This was a hospital-based prospective follow-up study. Patients with two different patches of alopecia were selected. One was treated with intralesional triamcinolone acetonide (10 mg/ml) and the other with PRP given at 3-week intervals for four treatment sessions. Comparison of results was based on MacDonald Hull and Norris grading system and trichoscopy. Results: Out of 32 patients, 8 (25%) in triamcinolone-treated patches and 3 (9.4%) in PRP-treated patches showed complete hair regrowth at 12 weeks. Furthermore, a faster response was seen with triamcinolone. On trichoscopy, both patches showed an increase in short vellus and terminal hair and a reduction in yellow dots and exclamation hair. No changes in black dots were seen. Conclusion: Intralesional triamcinolone acetonide is more effective than PRP in the treatment of AA of the scalp and is safe. Trichoscopic findings indicate response to treatment and reduction of disease activity.

Alopecia Universalis in an Adolescent Successfully Treated with Upadacitinib-A Case Report and Review of the Literature on the Use of JAK Inhibitors in Pediatric Alopecia Areata.

Alopecia areata (AA) is a cell-mediated autoimmune disease in which a cytotoxic T-cell response against hair follicles occurs. AA has been demonstrated to frequently co-exist with atopic dermatitis (AD), and the coincidence of atopy predisposes to a more severe course of the disease. To date, therapeutic options in AA, especially in the pediatric population, are mainly limited to corticosteroids, irritants, sensitizers, and immunosuppressive agents. Recently, innovative therapies have emerged, among which Janus kinase (JAK) inhibitors, effective in both AD and AA, appear to be the most promising. Here, a 14-year-old girl with alopecia universalis (AU) and mild AD is demonstrated, who was successfully treated with a selective JAK1 inhibitor, upadacitinib, which has been approved for the treatment of AD in adults and children aged 12years and older. Resolution of eczema and complete hair regrowth was achieved after 3months of therapy. Apart from transient mild leukopenia at weeks 4 and 8, no adverse events were noted. Data in the literature on the efficacy and safety of JAK inhibitors in the treatment of AA in the pediatric population is based on single case reports and case series. So far, topical tofacitinib and ruxolitinib, as well as systemic tofacitinib, ruxolitinib, and baricitinib have been used off-label in this indication in children. Upadacitinib is another effective treatment option with a good benefit-risk ratio for patients with AA, including cases coexisting with AD.

The Efficacy, Safety, and Recurrence Rate of Diphenylcyclopropenone Topical Immunotherapy for Alopecia Areata: A Systemic Review and Meta‐Analysis

Background and Objective. Diphenylcyclopropenone topical immunotherapy is widely used in the treatment of alopecia areata. However, previous studies have shown significant differences in its efficacy. We conducted this systemic review and meta‐analysis to investigate the efficacy, safety, and recurrence rate of diphenylcyclopropenone topical immunotherapy for alopecia areata. Methods. Literatures related to diphenylcyclopropenone topical immunotherapy for alopecia areata between January 1st, 2002, and July 2nd, 2022, were searched in the following databases: PubMed, Embase, Cochrane Library, Sinomed, WanFang Data, and Chinese Medical Journal Network. Results. This meta‐analysis included a total of 40 moderate to high quality studies involving 3,002 patients. The overall rate of any hair regrowth was 69%, and the overall rate of complete hair regrowth was 23%. The rate of any hair regrowth in patients with alopecia totalis or alopecia universalis was 42%, and the rate of any hair regrowth in patients with other types of alopecia areata was 75%. Common side effects were mild contact dermatitis (36%), severe contact dermatitis (31%), regional lymphadenopathy (22%), hyperpigmentation (22%), and hypopigmentation (7%). The recurrence rate was 37%. Conclusion. Diphenylcyclopropenone topical immunotherapy is an effective treatment for various types of alopecia areata, and most of its common side effects are acceptable.

Intramuscular Corticosteroid Therapy in the Treatment of Alopecia Areata: A Time-to-Event Analysis.

IntroductionIntramuscular corticosteroids (IMC) have gained popularity for the treatment of severe alopecia areata (AA) in recent years; however, evidence on their efficacy and safety is still limited.ObjectiveTo evaluate the efficacy, relapse rate, and tolerability of IMC in the treatment of AA, as well as factors associated with treatment outcomes.MethodsTime-to-event analysis was performed on patients with severe, extensive, or rapidly progressive AA receiving IMC. The IMC regimen comprised triamcinolone acetonide 20–40 mg/mL injected every 4–6 weeks. The evaluated outcomes included initial (25% regrowth), significant (75% regrowth), and complete hair regrowth (100% regrowth). Relapse and adverse events were also noted. Factors associated with treatment outcomes and relapse were analyzed using the Cox proportional hazards model.ResultsA total of 101 patients were eligible for analysis. Significant hair regrowth was obtained in 80.2% of the patients (n = 81), in a median time of 3.4 months (95% confidence interval [CI] = 2.9–4.4). Complete hair regrowth was achieved in 48.5% of the subjects (n = 49), and relapse was observed in 47.5% (n = 48). Acneiform eruption was the most common adverse effect. Multivariable analysis revealed that nail involvement was a negative predictor of significant hair regrowth (adjusted hazard ratio [HR] = 0.04, 95% CI = 0.01–0.55; P = 0.015), whereas duration of AA longer than 6 months was associated with disease recurrence (adjusted HR = 4.02, 95% CI = 1.52–4.66; P = 0.005).ConclusionThis study demonstrated the efficacy and safety of IMC in the treatment of severe or active AA; however, the relapse rate remained relatively high after discontinuation of the therapy. Nail involvement was a negative predictor of significant hair regrowth, while disease duration longer than 6 months predicted AA relapse.

A systematic review on the treatment of pediatric severe alopecia areata by topical immunotherapy or Anthralin (contact sensitization) or low-level light/laser therapy (LLLT): focus on efficacy, safety, treatment duration, recurrence, and follow-up based on clinical studies.

Alopecia areata (AA) in its extensive and severe forms is treatment-challenging, especially in pediatrics. A PRISMA-compliant systematic review of seven electronic databases was searched by the terms "alopecia areata," "pediatric," "topical immunotherapy," "Anthralin," and "light therapy" from inception until March 2021. All the alternative names of the disease and therapies have been included in the search terms. 790 articles went to title abstract review by two independent reviewers. In the subsequent level, a review of the full text of studies was conducted. Finally, 10 relevant articles in terms of content structure, subject coverage, and purpose, were selected for further review. The highest percentages of complete hair regrowth were 79.6% and 63.61% by SADBE (topical immunotherapy) and laser therapy. By Anthralin (contact sensitization), the complete response rate was below 50% (between 30 and 35%). Regarding average response, the most effective methods were local immunotherapy (with an average effectiveness of 53.8%), laser therapy (52.55%), and the use of Anthralin-induced contact dermatitis (30.86%), respectively. However, recurrence rate-after treatment with induced contact dermatitis by topical medications like Anthralin (contact sensitization)-was lower (mean 43.53%) in comparison with local immunotherapy (57%). In topical immunotherapy, light base therapy, and contact sensitization, the highest percentage of complete hair regrowth and the average response rate were (63.61% and 52.55%), (79.6% and 53.8%) and (32% and 30.8%), respectively. These methods are considered safe in children. A high and more than 50% efficacy in hair regrowth could be expected by topical immunotherapy and light/laser therapy method. No serious side effects have been observed by these methods that are well tolerated in children. Therefore, a combination of local immunotherapy and light/laser therapy could be suggested for the treatment of extensive AA in children. The use of Anthralin could be associated with a lower but more durable response. These points are important for patient selection in individualized situations.

Discoid Lupus Erythematosus of the Scalp in a Patient with Systemic Lupus Erythematosus: A Case Report with Complete Hair Regrowth

Scalp involvement with hair loss is common in systemic lupus erythematosus. Discoid lupus erythematosus may cause scarring alopecia, characterized by well-delimited erythematous plaques with scales, follicular hyperkeratosis and atrophy, which is considered a trichological emergency. Early diagnosis and treatment are necessary in order to prevent permanent hair loss. We describe a 44 years’ old female patient with systemic lupus erythematosus for 4 years, with multiple areas of occipitoparietal alopecia, erythematous plaques, atrophy, scales and some bloody crusts. Trichoscopy, histopathology and direct immunofluorescence led to the diagnosis of discoid lupus erythematosus. After 9 months treatment with thalidomide there was complete hair regrowth.

Candida antigen immunotherapy versus steroid in the treatment of alopecia areata.

Alopecia areata (AA) is an autoimmune hair follicle disorder that is challenging to treat. Although there are multiple topical immunotherapeutic agents, their side effects limit their use. Candida antigen can serve as another immunotherapeutic treatment, with an easier application and fewer side effects. To evaluate the efficacy of Candida antigen versus intralesional steroids for the treatment of AA. About 48 adult patients with AA were divided into two groups. The Candida group included 24 patients who were injected monthly with 0.1 mL of Candida albicans antigen in one patch of alopecia, and the intralesional corticosteroid group included 24 patients who were injected monthly with 0.1 mL of triamcinolone acetonide, as a control group, in all alopecia patches. After 5 months, there was a highly significant decrease in the severity of AA in both groups with no significant difference between them. In the Candida group, 8 patients showed complete hair regrowth and 9 patients showed partial regrowth. Side effects were mild and transient such as pain during injection, which was significantly lower in the Candida group than in the corticosteroid group. Intralesional Candida antigen is a promising effective treatment for AA with differing severities.

Combining 308-monochromatic excimer phototherapy with monthly IM triamcinolone acetonide for the treatment of resistant alopecia totalis

Background: Treatment of resistant alopecia totalis AT is a major problem in general practice. Some studies reported the use of either excimer-308 or intra-muscular triamcinolone acetonide as a monotherapy, with conflicting results. Objective: To evaluate the therapeutic effect of combining 308-excimer phototherapy and intramuscular triamcinolone acetonide for the treatment of alopecia totalis. Methods and Material: Ten patients with alopecia totalis were evaluated in this prospective interventional study. All patients were assigned to receive the thera-peutic regimen that includes monthly IM triamcinolone acetonide (TAC) for a maximum of six pulses and twice-weekly excimer phototherapy for 24 sessions. Results: The overall response rate for this regimen was 90%, with four patients 40% achieving complete regrowth of hair (100%). Three patients have exhibited a satisfactory response (&gt;70% regrowth). Unsatisfactory response ( &gt;10-&lt; 70% regrowth) was reported in two patients . Younger patients responded better, as did those with a shorter history of the disease P &lt; 0.05. At follow-up, which continued for 8–12 months, recurrence was noted in two (22.2%) of the nine responders. Conclusions: Combining excimer phototherapy with triamcinolone acetonide showed a promising effect on resistant AT. This treatment modality was effective and well tolerated particularly in young patients.

A Retrospective Comparative Study of Two Concentrations of Intralesional Triamcinolone Acetonide in the Treatment of Patchy Alopecia Areata on the Scalp.

BackgroundAlopecia areata (AA) usually manifests as patches of non-scarring hair loss due to immune dysregulation. Intradermal injection of steroids is considered a first-line treatment of patchy AA.PurposeTo compare the efficacy and safety of two commonly used concentrations of intralesional triamcinolone acetonide (ILT) (5 mg/mL vs 10 mg/mL) in the treatment of patchy AA on the scalp.Patients and MethodsA retrospective comparative study that included 85 patients diagnosed with patchy AA on the scalp, who were treated with monthly injections of ILT. Patients were divided into Group 1 that received 5 mg/mL and Group 2 that received 10 mg/mL. The response rate (defined as the percentage of patients who achieved complete hair regrowth) and the side effects were compared between the two groups after completion of three treatment sessions, and recurrence was assessed after 1−3 years.ResultsDemographic composition of the two groups was comparable. The difference in response rate and the side-effects between the two groups were not statistically significant. Complete hair regrowth was noted in 43.5% of patients in Group 1 and 53.8% of those in Group 2 (P=0.340). About 17% and 25% of patients in Group 1 and Group 2, respectively, developed minor local side-effects (P=0.354), and almost 45% of patients from both groups had recurrence after 1−3 years. Disease duration exceeding 6 months correlated with poor treatment response.ConclusionIntralesional injection of triamcinolone acetonide 5 mg/mL is equally effective and safe compared to 10 mg/mL in the treatment of patchy alopecia areata.

Topical immunotherapy in combination with anthralin in the treatment of refractory alopecia areata.

Treatment is often challenging in patients with alopecia areata. We often try topical immunotherapy to treat alopecia areata in Japan. Anthralin is sometimes used in other countries. The aim of this study was to examine effectiveness of combination therapy with both topical immunotherapy with squaric acid dibutylester or diphenylcyclopropenone and anthralin in the treatment of refractory alopecia areata. We treat four patients with refractory alopecia areata by topical immunotherapy and anthralin. Two patients had alopecia areata multilocularis and the other two patients had alopecia totalis. The entire scalp was treated with weekly application of squaric acid dibutylester or diphenylcyclopropenone and daily 0.5% anthralin ointment. Patients were followed up weekly, and adverse effects were recorded. One patient with multifocal patches of alopecia areata got complete hair regrowth at week 30, the other patient with multifocal patches of alopecia areata turned for the worse at week 30 and recovered at week 52. Hair regrowth was not seen in the other two patients with alopecia totalis. Localized pruritis and hyperpigmentation of the scalp were seen in two patients. To treat alopecia areata unresponsive to topical immunotherapy alone, topical immunotherapy in combination with anthralin is worth a try.

A Novel Effect of Acyclovir on Hair Growth in BALB/c Mice: A Promising Future for Finding a New Topical Drug for the Treatment of Hirsutism.

PurposeHirsutism (ie, terminal hair growth on the face and body in a male-like pattern in women) is a common dermatological disorder in women, with psychosocial implications. Consequently, there is demand for finding novel pharmacological treatments and agents that can safely reduce hair growth. This study aimed to investigate the potential effect of topical acyclovir on hair growth in mice.MethodsIn this study, twenty-four female BALB/c mice were randomly divided into three groups in order to evaluate the hair growth-reducing effects of acyclovir (control group, vehicle group, and acyclovir group). Topical acyclovir 5% was applied on the shaved denuded skin of mice. Topical application onto the backs of the animals was performed twice daily for 28 consecutive days. The time (in days) required for hair growth initiation as well as completion of hair growth in dorsal skin of animals were recorded. On day 28, horizontally cut biopsy samples were removed and the numbers of hair follicles were counted, and the diameter of hair follicles was measured under high-field microscopy by a specialist blinded to the treatments.ResultsHair growth initiation time was significantly increased with acyclovir, as compared to control and vehicle groups. The time required for complete hair growth in control and vehicle groups were 18±0.68 and 19±1.41 days, respectively; however, the hair growth completion in acyclovir-treated animals was not observed at the end of the experiment. Furthermore, the length of hairs in treatment group was significantly shorter than the control group at the end of the study (P < 0.001). In histologic examination, the count and the diameter of hair follicles in deep subcutis were significantly decreased.ConclusionThe results of this study, for the first time, showed that topical administration of acyclovir might have inhibitory effects on hair growth in experimental animals; however, further studies are required to understand its mechanism.

Elucidation of demographic, clinical and trichoscopic features for early diagnosis of self-healing acute diffuse and total alopecia.

The term "acute diffuse and total alopecia" (ADTA) has been often used as a synonym for self-regressing severe alopecia areata (AA). However, ADTA is originally defined as a rapidly-progressive subtype of AA (RP-AA) with short recovery time and favorable prognosis irrespective of interventions. Indeed, a subpopulation of ADTA recovers spontaneously. We focused on this unique subset of AA, which we coined as "self-healing ADTA" (sADTA). Prompt and accurate differentiation of sADTA from other RP-AA is important to avoid unnecessary treatments, which is still challenging due to the lack of predictive diagnostic hallmarks. In this study, 18 sADTA patients were retrospectively analyzed to delineate their demographics and clinical features, including gentle hair pull test and trichoscopic findings, followed by statistical comparison with those of RP-AA. All sADTA cases were female and the average age was 38.1±15.9years. The progression of hair loss areas peaked at 3.6±1.5months, and complete hair regrowth was achieved in 7.9±1.7months. The identified factors supporting the diagnosis of sADTA included being female; the absence of scalp pain and itch; the absence of extra-scalp hair loss; club hair predominance in hair pull test; predominant short vellus hairs; and increase in vacant follicular ostia on trichoscopy. Subsequently, a scoring system for early diagnosis of sADTA was developed by counting the number of six identified factors present in a tested case. When analyzed by the developed system, all sADTA cases, including an additional four cases, had scores of 4 or above, while all RP-AA cases had scores below 3 except one case. Therefore, the system successfully differentiated sADTA from RP-AA (P<0.01). Despite some technical limitations, the current study suggested that sADTA is a distinctive entity with unique pathophysiology and that early diagnosis before intervention is feasible based on the characteristics.