Hair Counts Research Articles

Topical application of the Wnt/β-catenin activator methyl vanillate increases hair count and hair mass index in women with androgenetic alopecia.

Activation of the WNT/β-catenin pathway has emerged as a potential therapeutic target in androgenetic alopecia (AGA). Methyl vanillate (MV) - a safe plant-derived ingredient - has been recently shown to activate the WNT/β-catenin signaling. Objectives Two distinct substudies were conducted. First, we designed a 6-month, uncontrolled, open-label clinical study to investigate whether topically applied MV may increase hair count and hair mass index (HMI) in female AGA. Second, we conducted a molecular study on the effect of MV on WNT10B mRNA expression in scalp biopsies of women with AGA. A total of 20 Caucasian women (age range: 25-57 years) with AGA (Sinclair grade 1-2) were included. The research product was an alcohol-free formulation supplied in the form of a spray containing 0.2% MV as the active ingredient. In the clinical study, hair count and HMI were found to increase at 6 months by 6% (P < 0.01) and 12% (P < 0.001), respectively, compared with baseline. No participant discontinued treatment due to adverse effects, and the overall patient satisfaction was good. At the molecular level, the topical application of the research product resulted in a 32% increase in WNT10B mRNA expression levels in the temporal scalp area (P < 0.001). Our pilot data suggest that topical MV can increase hair count and HMI by inducing WNT10B expression in the scalp, potentially serving as a novel treatment strategy for female AGA.

Efficacy of a Complex of 5-Aminolevulinic Acid and Glycyl-Histidyl-Lysine Peptide on Hair Growth.

BackgroundPattern hair loss is a very common problem. Although effective therapeutics for the treatment of pattern hair loss have been used, novel therapeutic modalities are still required to enhance hair growth.ObjectiveWe investigated the efficacy and safety of a complex (ALAVAX) of 5-aminolevulinic acid (5-ALA) and glycyl-histidyl-lysine (GHK) peptide for the treatment of pattern hair loss.MethodsForty-five patients with male pattern hair loss were treated with ALAVAX 100 mg/ml (group A), ALAVAX 50 mg/ml (group B) or placebo (group C) once a day for 6 months. Total hair count, hair length, hair thickness, patient's assessment and adverse events were evaluated at month 1, 3, and 6.ResultsAn increase in hair count for 6 months was 52.6 (p<0.05) in group A, 71.5 (p<0.05) in group B, and 9.6 in group C. The ratio of changes in hair count between group B (2.38) and group C (1.21) at 6 months showed a statistically significant difference (p<0.05). The proportion above good satisfaction was higher in group A (26.7%) than in the other groups (group B: 14.3%, group C: 7.1%). There was no statistically significant difference in hair length and hair thickness among 3 groups at 6 months. There was no adverse event in 3 groups.ConclusionOur study showed that a complex of 5-ALA and GHK peptide may be considered as one of the complementary agents for the treatment of male pattern hair loss.

Non-invasive method distinguishes chronic telogen effluvium from mild female pattern hair loss: clinicopathological correlation.

The distinction between chronic telogen effluvium (CTE) and female pattern hair loss (FPHL) is important because of their different prognosis and treatment. Non-invasive methods have been described to be useful in differentiating FPHL from CTE. This prospective study investigated the use of the washing method to differentiate CTE from mild FPHL. Twenty patients with CTE and 17 with FPHL were recruited and followed for 18 months. The diagnosis was established through clinical, laboratory, and histological studies. The patients were asked to abstain from washing their hair for 5 days and then shampoo and collect all hair shed in the process. Hair shafts were then counted and divided into two groups: up to 3 cm in length or longer. In the CTE group, the mean hair count was high (438), and in all cases, <10% were short. In patients with FPHL, the mean count was not as high (215) and in only one patient, short hairs comprised <10% of the total. The greater the number of long hairs, the higher was the density of terminal follicles seen histologically. The CTE group presented a greater number of patients with serum iron values <70 μg/dl. Ferritin levels ranged from 6.98 to 128.33, average of 66.65 (CTE), and 16.5-304.8, average of 114.97 ng/ml (FPHL), but no significant differences were found. The washing test can be useful to avoid biopsy procedures. Iron serum levels are possibly an additional parameter that may improve CTE diagnosis if combined with an earlier test.

Hair Growth Activity of Seeds and Fruit Pulp of Eugenia jambolana (Jamun)

Abstract Objective: Alopecia is a psychologically distressing condition. Androgenetic alopecia, which affects millions of men and women, is an androgen-driven disorder. This paper evaluates the use of Eugenia jambolana seeds and fruit pulp for hair growth activity. Aim: The present study was aimed to investigate the efficacy of seeds and pulp extracts of Eugenia jambolana as a potential hair growth promoter. Method: Ethanolic extracts of seeds and fruit pulp were incorporated in oleaginous base that was applied topically on shaved skin of albino mice. Albino mice were screened for hair growth activity, on four parameters; the hair initiation time, hair completion time, hair length and hair count. Treated groups were compared with 2% ethanolic solution of minoxidil. Result: From this study, it can be concluded that the ethanolic extract of fruit pulp exhibited more pronounced effects when compared to the seeds extract. Conclusion: The generated data proved that the Eugenia jambolana fruit pulp extract exhibit a significant potency in promoting hair growth

Adjuvant eflornithine to maintain IPL-induced hair reduction in women with facial hirsutism: a randomized controlled trial.

Photoepilation is the treatment of choice for hair removal in patients with hirsutism, but it remains a challenge to prevent regrowth of hairs. The objective of this study was to investigate whether topical eflornithine maintains hair reduction in hirsute patients after cessation of intense pulsed light (IPL) therapy. A randomized, split-face, single-blinded controlled trial on topical eflornithine vs. no eflornithine treatment (control) after 5-6 IPL-treatments in 22 women with facial hirsutism. Application of eflornithine was initiated after the final IPL-treatment (baseline) and applied twice daily for 6 months to half of the face. Patients were assessed at baseline and 1, 3 and 6 months after the final IPL-treatment. The primary endpoint was difference in facial hair counts between eflornithine vs. no treatment. Secondary endpoints were patient-evaluated efficacy, patient satisfaction and safety. A total of 18 patients completed the study protocol. At 1 month after final IPL-treatment, eflornithine reduced hair regrowth by 14% (P = 0.007, n = 20 patients), at 3 months by 9% (P = 0.107, n = 19) and at 6 months by 17% (P = 0.048, n = 18) compared to no treatment. Patient-evaluated efficacy supported blinded hair counts and patients were satisfied with eflornithine treatment throughout the study (median VAS 5-6). Eflornithine was generally well tolerated, but blinded evaluation demonstrated deterioration of acne in two patients at final assessment. Topical eflornithine provides a self-administered treatment with a potential to maintain IPL-induced hair reduction in hirsute patients.

Effect of minoxidil topical foam on frontotemporal and vertex androgenetic alopecia in men: a 104-week open-label clinical trial.

Topical minoxidil formulations have been shown to be effective in treating androgenetic alopecia (AGA) for 12months. Efficacy and safety in both frontotemporal and vertex regions over longer application periods have not been studied so far. To evaluate the effect of 5% minoxidil topical foam (5% MTF) in the frontotemporal and vertex areas in patients with moderate AGA over 104weeks. An 80-week, open-label extension phase was performed, following a 24-week randomized, double-blind, placebo-controlled study in men with AGA grade IIIvertex to VI. Group 1 (n=22) received ongoing 5% MTF for 104weeks, Group 2 (n=23) received placebo topical foam (plaTF) until week 24, followed by 5% MTF until week 104 during the extension phase. Frontotemporal and vertex target area non-vellus hair counts (f-TAHC, v-TAHC) and cumulative hair width (f-TAHW, v-TAHW) were assessed at baseline and at weeks 24, 52, 76 and 104. In Group 1, f-TAHW and f-TAHC showed a statistically significant increase from baseline to week 52 and week 76, respectively, returning to values comparable to baseline at week 104. No significant differences were found between baseline and week 104 in v-TAHC in Group 1 as well as f-TAHC, v-TAHC, f-TAHW and v-TAHW values in Group 2. 5% MTF is effective in stabilizing hair density, hair width and scalp coverage in both frontotemporal and vertex areas over an application period of 104weeks, while showing a good safety and tolerability profile with a low rate of irritant contact dermatitis.

Effectiveness of 308-nm Excimer Laser Therapy in Treating Alopecia Areata, Determined by Examining the Treated Sides of Selected Alopecic Patches

Background: Some studies have reported the use of 308-nm excimer laser therapy for treating alopecia areata (AA); however, the effectiveness of this therapy on a theoretical basis has not yet been comparatively analyzed. Objectives: To determine the therapeutic effect of excimer laser therapy on AA. Methods: One alopecic patch was divided into control and treated sides in 10 patients with AA. Then, 308-nm excimer laser therapy was administered twice a week for 12 weeks. Photograph and phototrichogram analyses were performed. Results: Photographic assessments by both dermatologists and individuals of the general population showed objective improvements after excimer laser therapy. On the treated side, the hair count and hair diameter had statistically increased after treatment. However, only the hair diameter was found to be significantly high in the treated half when it was compared with the control side. Conclusion: The 308-nm excimer laser has a therapeutic effect on AA, which is proven by photograph and phototrichogram analysis by a side-by-side comparison.

The value of middle phalangeal hair as an anthropometric marker: A review of the literature

Middle phalangeal hair (MPH) is a trait frequently examined in anthropological studies throughout the 20th century. MPH is found on the back of the middle segment of the fingers, excluding the thumb. Typically, researchers examined the presence and absence of hair in various populations, and described it in terms of age, ancestry, and sex. Recently MPH has been examined as a potential anthropometric indicator of: androgen levels, androgen-related side effects in women, gene homozygosity, and disease resistance. Given the potential value of this marker, the present paper provides a comprehensive overview of MPH and its associated characteristics (i.e., ethnicity, sex, age, and hormonal variations) and presents new data on the reliability of MPH assessment. Findings suggest that ethnicity, sex, and age need to be controlled in any studies examining MPH and its relationship with other variables. Two measures of MPH (i.e., presence/absence of MPH and actual hair count) are both acceptable to use in MPH assessment; and the use of a hand lens to examine MPH provides high reliability when MPH is assessed by expert raters. However, researchers should avoid participant self-assessment. Future avenues for research are suggested (e.g., measurement issues and studies on hormonal correlates in women). MPH could be useful in research or for clinical purposes as a possible non-invasive indicator of hormone levels or hormonal sensitivity, or of predisposition toward androgen-related or gene-homozygosity-related health issues or behaviors.

A Single-Centre, Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Investigate the Efficacy and Safety of Minoxidil Topical Foam in Frontotemporal and Vertex Androgenetic Alopecia in Men

Background: 5% minoxidil formulations twice daily are effective in treating vertex male androgenetic alopecia (AGA); however, efficacy and safety data in frontotemporal regions are lacking. Objectives: To assess the efficacy of 5% minoxidil topical foam (5% MTF) in the frontotemporal region of male AGA patients after 24 weeks of treatment compared to placebo treatment and to the vertex region. Methods: Seventy males with moderate AGA applied 5% MTF or placebo foam (plaTF) twice daily for 24 weeks in frontotemporal and vertex regions. Target area non-vellus hair count (TAHC) was the primary end point. Results: Frontotemporal and vertex TAHC and target area cumulative non-vellus hair width (TAHW) showed similar responses to 5% MTF with significant increases up to week 16 compared to baseline (p < 0.001). After 24 weeks of treatment, frontotemporal TAHW increased significantly in the 5% MTF group compared to the plaTF group (p = 0.017), while TAHC showed a similar non-significant increase from baseline in both regions. At 24 weeks, 5% MTF users rated a significant improvement in scalp coverage for the frontotemporal (p = 0.016) and vertex areas (p = 0.027). Conclusions: 5% MTF twice a day promotes hair density and width in both frontotemporal and vertex regions in men with moderate stages of AGA.

Loss of normal anagen hair in pemphigus vulgaris.

Pemphigus vulgaris (PV) is a known cause of loss of 'normal' anagen hair; that is, shedding of intact anagen hairs covered by root sheaths. However, studies on this subject are limited. To investigate anagen hair shedding in patients with PV, and ascertain its association with disease severity. In total, 96 consecutive patients with PV (new patients or patients in relapse) who were admitted to the dermatology wards of a tertiary hospital were enrolled in this study. Demographic data, PV phenotype, disease severity and presence of scalp lesions were recorded. A group of 10-20 hairs were pulled gently from different areas of the scalp (lesional and nonlesional skin) in all patients, and anagen hairs were counted. Disease severity was graded according to Harman score. Anagen hair was obtained by pull test in 59 of the 96 patients (61.5%), of whom 2 had normal scalp. The mean ± SD anagen hair count was 5.9 ± 7.6 (range 0-31). In univariate analysis, anagen hair loss (P < 0.01) and the presence of scalp lesions (P = 0.01) were associated with severe disease. Mean anagen hair count was significantly higher in the severe (mean 6.83 ± 7.89) than the moderate (mean 1.06 ± 1.94) subgroup (P < 0.001). Multivariate analysis confirmed anagen hair loss (OR = 1.16, 95% CI = 1.05-1.28, P < 0.01), but not scalp lesions (P = 0.69) as an independent predictor of disease severity. According to our study, normal anagen effluvium is a frequent finding in patients with PV, and interestingly, this was observed in nonlesional as well as lesional scalp. In addition, severe anagen hair loss was an independent predictor of the disease severity.

Body hair counts during hair length reduction procedures: a comparative study between Computer Assisted Image Analysis after Manual Processing (CAIAMP) and Trichoscan™

To compare two measurement methods for body hair. Calibration of computer assisted image analysis after manual processing (CAIAMP) showed variation <4% for thickness and <2.3% for densities. Images from 6 body sites with 'good natural contrast between hair and skin' were taken before hair dye, after hair dye or after hair length reduction without hair extraction or destruction. Data in the same targets were compared with Trichoscan(™) quoted for 'unambiguous evaluation of the hair growth after shaving'. CAIAMP detected a total of 337 hair and showed no statistically significant differences with the three procedures confirming 'good natural contrast between hair and skin' and that reduction methods did not affect hair counts. While CAIAMP found a mean number of 19 thick hair (≥30μm) before dye, 18 after dye and 20 after hair reduction, Trichoscan(™) found in the same sites respectively 44, 73 and 61. Trichoscan(™) generated counts differed statistically significantly from CAIAMP-data. Automated analyses were considered un-specifically influenced by hair medulla and natural or artificial skin background. Quality control including all steps of human intervention and measurement technology are mandatory for body hair measurements during experimental or clinical trials on body hair grooming, shaving or removal.

The Effect of Novel Low Energy Pulsed Light Combined with Galvanic Energy for Home-Use Hair Removal of Dark Skin

Background and Objectives: Permanent reduction of unwanted hair on skin types V and VI is the most challenging procedure among all hair removal technologies based on selective absorption of light or laser. The objective of this study is to evaluate the safety and efficacy of a low energy pulsed-light device combined with galvanic energy, intended for home-use hair removal on dark skin. Materials and Methods: Fifteen women with skin types V and VI and dark terminal hair in axillaarea self-administrated 6 treatments at 2 week intervals, using a hand-held IPL combined with galvanicenergy device, using HPL (Home Pulsed Light) technology. Hair count and photographs were performed pre-treatment and 1 and 3 months after the last sixth treatment. Adverse events and subject satisfaction scores were recorded. Results: All patients showed a positive clinical response to treatment, with reduction of unwanted hair. Hair counts were significantly reduced by 57.3% 1 month following last treatment and by 44.5% 3 months following last treatment. No adverse events were recorded. Subject satisfaction scores of the device usability and the treatment outcome were high. Conclusions: Low energy pulsed light combined with galvanic energy may be applied safely and effectively for at-home hair removal for people with dark skin types V and VI.

Diagnostic Modalities in Trichology - An Update

Hair and scalp examination has earned a deserved place in dermatology, the techniques for which can be divided into 3 categories: Non-invasive methods (e.g: questionnaire, general examination, inspection and palpation of the scalp, daily hair counts, standardized wash test, 60-s hair count, global photographs, hair weight, trichoscopy, phototrichogram, trichoscan and polarizing and surface electron microscopy), semi-invasive methods (e.g., trichogram and unit area trichogram) and invasive methods (e.g., scalp biopsy). This article reviews an update on all these modalities.

Autologous Platelet Rich Plasma as a Treatment of Male Androgenetic Alopecia: Study of 14 Cases

In this study, we report 14 cases of androgenetic alopecia (AGA) in men treated by autologous platelet rich plasma (PRP). Each patient had several injections of non-activated PRP (PRPn) on the sclap. The quantitative assessment of hair density was performed by hair count with TrichoScan and the cosmetic assessment by Canfield stereotaxic system (Standardized photographs seen by 3 independent assessors). A slight improvement of hair density was observed in 11 cases while a cosmetic improvement on the vertex was noticed only in 2 cases according to 3 assessors.

Efficacy of platelet-rich plasma in treatment of androgenic alopecia.

Background:Platelet-rich plasma (PRP) has shown remarkable beneficial effects without any major adverse reactions in the treatment of androgenic alopecia. The growth factors in activated autologous PRP induce the proliferation of dermal papilla cells.Objectives:The objective was to investigate the clinical efficacy of PRP in treatment of androgenic alopecia.Materials and Methods:Ten patients were given autologous PRP injections on the affected area of alopecia over a period of 3 months at interval of 2-3 weeks and results were assessed.Results:Three months after the treatment, the patients presented clinical improvement in the hair counts, hair thickness, hair root strength, and overall alopecia.Conclusion:PRP appears to be a cheap, effective, and promising therapy for androgenic alopecia with no major adverse effects.

Safety and Efficacy of Rice Bran Supercritical CO2 Extract for Hair Growth in Androgenic Alopecia: A 16-Week Double-Blind Randomized Controlled Trial.

We conducted a 16-week double-blind randomized controlled single-center trial to evaluate the safety and efficacy of dermal rice bran supercritical CO2 extract (RB-SCE) in the treatment of androgenic alopecia. Fifty alopecia patients were randomly assigned to the experimental and placebo groups. The experimental group received a dermal application of 0.5% RB-SCE (8 mL/d) to the head skin for 16 weeks while the control group received a dermal application of placebo. Changes in hair count, diameter, and density were evaluated with a Folliscope(®). Patient satisfaction was evaluated via questionnaire and clinical photographs were rated by dermatologists. The results showed that RB-SCE significantly increased hair density and hair diameter in male subjects. Patient satisfaction and the evaluation of photographs by dermatologists also confirmed the effectiveness of RB-SCE in the treatment of alopecia. No adverse reactions related to RB-SCE were reported. Therefore, RB-SCE shows promise for use in functional cosmetics and pharmaceuticals.

A New Era of 5α-Reductase Inhibitors for Androgenetic Alopecia

In addition to these therapies, a new oral drug dutasteride has been reported to be efficient for AGA in a large-scale (n=917) randomized controlled trial (RCT) [2]. This reagent is a 5α-reductase inhibitor similarly to finasteride. Importantly, dutasteride suppresses both type I and II 5α-reductases while finasteride significantly suppresses only type II. Therefore, dutasteride is referred as a “dual inhibitor”. In the RCT the effect for hair growth in AGA was compared between 0.5mg/day dutasteride and 1mg/day finasteride. As a result, dutasteride significantly increased hair count and width and hair photographic assessment compared with finasteride [2]. Additionally, dutasteride improved the global photography in Korean men with AGA recalcitrant to finasteride [3]. On the other hand, a meta-analysis study indicated no significant difference in efficacy for AGA between these two drugs [4]. Collectively, it is still controversial whether there is significant difference in clinical efficiency by dutasteride and finasteride.

Quantitative assessment of growing hair counts, thickness and colour during and after treatments with a low-fluence, home-device laser: a randomized controlled trial.

At-home laser and intense pulsed-light hair removal continues to grow in popularity and availability. A relatively limited body of evidence is available on the course of hair growth during and after low-fluence laser usage. To assess growing hair counts, thickness and colour quantitatively during and after cessation of low-fluence laser treatment. Thirty-six women with skin phototypes I-IV and light to dark-brown axillary hairs were included. Entire axillary regions were randomized to zero or eight self-administered weekly treatments with an 810-nm home-use laser at 5·0-6·4 J cm(-2). Standardized clinical photographs were taken before each treatment and up to 3 months after the final treatment for computer-aided quantification of growing hair counts, thickness and colour. Thirty-two women completed the study protocol. During sustained treatment, there was a reduction in growing hair that reached a plateau of up to 59%, while remaining hairs became up to 38% thinner and 5% lighter (P < 0·001). The majority of subjects (77%) reported 'moderately' to 'much less hair' in treated than untreated axilla, and assessed remaining hairs as thinner and lighter (≥ 60%). After treatment cessation, hair growth gradually returned to baseline levels, and 3 months after the final treatment the count and thickness of actively growing hair exceeded pretreatment values by 29% and 7%, respectively (P ≤ 0·04). Sustained usage of low-fluence laser induced a stable reduction of growing hair counts, thickness and colour. The reduction was reversible and hairs regrew beyond baseline values after cessation of usage. Computer-aided image analysis was qualified for quantification of hair counts, thickness and colour after laser epilation.

The Evaluation of Efficacy and Safety of Topical Saw Palmetto and Trichogen Veg Complex for the Treatment of Androgenetic Alopecia in Men

Gulhane Askeri Tip Akademisi, Deri ve Zuhrevi Hastaliklar Anabilim Dali, Ankara, Turkiye *Golcuk Asker Hastanesi, Deri ve Zuhrevi Hastaliklar Klinigi, Kocaeli, Turkiye @Telif Hakki 2014 Turk Dermatoloji Dernegi Makale metnine www. turkdermatolojidergisi.com web sayfasindan ulasilabilir. @Copyright 2014 by Turkish Society of Dermatology Available on-line at www.turkdermatolojidergisi.com Gurol Acikgoz, Gulhane Askeri Tip Akademisi, Deri ve Zuhrevi Hastaliklar Anabilim Dali, Ankara, Turkiye E-posta: gacikgoz@gata.edu.tr Gelis Tarihi/Submitted: 18.07.2014 Kabul Tarihi/Accepted: 04.08.2014 Yazisma Adresi/ Correspondence: Objective: Androgenetic alopecia (AGA) is a special type, characterized with the follicular miniaturization of the frontal and parietal areas of scalp. In this study, we intended to evaluate the efficacy and safety of a hair lotion including saw palmetto and 10% trichogen veg complex (TVC) within male patients with AGA. Methods: Male patients, who treated with topical saw palmetto and TVC for four months between 2011-2012 were included to our study. Among the patient files, records of 25 patient were accepted available and taken into consideration according to the vertex photographs and tricoscan evaluations. Derived data were analyzed with SPSS program. Results: Total hair count was increased 11.9% compared with the pretreatment period. The final ratio of anagen/telogen hair was compared with the initials and the increase in ratio was 38%. According to the evaluation of vertex photographs, the observers declared that enhancement was noted in 48% of the patients and no difference was not noted in 36% of the patients. Conclusion: At the end of the study, topical saw palmetto and TVC were evaluated efficient and safe for the treatment of AGA. Randomized controlled trials among patient groups will reveal more conclusive data associated with topical saw palmetto and TVC.

The Science of Light Biostimulation and Low Level Laser Therapy (LLLT)

We are very pleased to have the lead article in this issue by our incoming ISHRS President, Dr. Sharon Keene. This article is the first of her three-part series on low level laser light therapy (LLLT): Part 1, “The Science of LLLT,” Part 2, “Regulation of LLLT Devices from a U.S. and International Perspective,” and Part 3, “Controlled Trials and Understanding the Methods for Accurate Hair Counts.” —RHT