Hair Counts Research Articles

The Battle begins: Is strip surgery really necessary?

To measure the effects of previous Follicular Unit Transplantation (FUT) procedure. The study was conducted in a private hair transplant clinic after obtaining informed consent. Only those patients were included who had a previous strip harvest surgery (FUT) and opted for Follicular Unit Excision/Extraction (FUE) procedure. In all the patients, the donor hairs were trimmed to about 1-2mm length. The width of the scar, the hair density above and below the scar, and hair angles above and below the scar were measured. All the patients underwent FUE procedure using 0.9mm serrated punch. Twenty attempts were made above and below the scar (about 0.5cm), and the total number of hair and transections was measured. All the data were analyzed statistically. Ten patients were included. The average width of the scar was 2.47 mm. The mean hair density was found to be 155.4 hairs per cm2 above the scar and 130.8 per cm2 below the scar. The mean hair angle was found to be 28.21 degrees above the scar and 39.19 degrees below the scar in midline occipital above the scar (P < .05). The average hair count was found to be 49.8 hairs above the scar and 47.2 hairs above the scar (P < .05). The transection of hair was doubled below the scar (P < .05) CONCLUSION: The Follicular Unit Transplantation (FUT) procedure does leave some impacts on the donor area other than the scar only. The change in angle results in higher transection of hair above the scar.

Cell Enriched Autologous Fat Grafts to Follicular Niche Improves Hair Regrowth in Early Androgenetic Alopecia.

BackgroundAdipose and adipose derived regenerative cells (ADRCs) play an increasing role in androgenetic alopecia.ObjectivesThe authors sought to evaluate the safety and feasibility of fat grafts enriched with ADRCs in early androgenetic alopecia.MethodsSeventy-one patients were treated: 16 with Puregraft fat and 1.0 × 106 ADRCs/cm2 scalp; 22 with Puregraft fat and 0.5 × 106 ADRCs/cm2 scalp, 24 with Puregraft fat alone, and 9 with saline control. Treatments were delivered into the skin and subcutaneous layer of the scalp. A total of 40 cm2 of scalp was treated and macrophotography and global photography were obtained at baseline and at 6, 24, and 52 weeks.ResultsA total of 71 patients tolerated the procedures well. No unanticipated associated adverse events were reported. When evaluating all patients at 24 weeks, there were no statistical differences between any of the treatment groups with respect to nonvellus (terminal) hair counts or width. There were increases (mean change from baseline) in terminal hair count for the low-dose ADRC group in the Norwood Hamilton 3 subgroup at week 6 (13.90 ± 16.68), week 12 (11.75 ± 19.42), week 24 (16.56 ± 14.68), and week 52 (2.78 ± 16.15). For this subgroup, the difference in hair count between the low-dose ADRC group and no-fat saline control was statistically significant (P = 0.0318) at week 24.ConclusionsPuregraft fat and ADRCs are safe and well tolerated. In early male hair loss, this therapy demonstrated a statistically significant increase in terminal hair counts relative to the control population at 24 weeks and represents a promising approach for early androgenetic alopecia.Level of Evidence: 2

Autologous Micrografts from Scalp Tissue: Trichoscopic and Long-Term Clinical Evaluation in Male and Female Androgenetic Alopecia.

Tissue engineering in hair regrowth aims to develop innovative and not-invasive procedures to advance the hair regrowth. A placebo-controlled, randomized, evaluator-blinded, half-head group study to compare hair regrowth with micrografts containing human hair follicle mesenchymal stem cells (HF-MSCs) vs. placebo was reported. After 58 weeks, 27 patients displayed in the targeted area an increase of hair count and hair density, respectively, of 18.0 hairs per 0.65 cm2 and 23.3 hairs per cm2 compared with baseline, while the control area displayed a mean decrease of 1.1 hairs per 0.65 cm2 and 0.7 hairs per cm2 (control vs. treatment: P < 0.0001). After 26 months, 6 patients revealed dynamic hair loss and were retreated. More broad controlled examinations are required. HF-MSCs contained in micrografts may represent a safe and viable treatment alternative against hair loss.

Effect of fractional carbon dioxide (CO2) laser on improving minoxidil delivery for treatment of androgenetic alopecia

Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment. Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment. Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin & thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness. Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA.

Use of nutricosmetic based on proteoglycan in non-cicatricial alopecia in children and adolescents

Nutricosmetics have been used as supplements for hair growth in the treatment of non-cicatricial alopecia. However, there are no studies on using of these products in individuals under 18 years of age. Objective: To assess the efficacy and tolerability of using a nutricosmetic product based on proteoglycans in individuals under 18 years of age with non-cicatricial alopecia. Methods: This is a clinical, uncontrolled, and prospective trial. Patients with non-cicatricial alopecia, of both sexes, aged between 6 years and 18 years, received nutricosmetics containing proteoglycan for six months. Three dermatologists independently evaluated standardized pre and post-treatment photos. A hair count was performed in a scalp area of 1 cm2 , and the patients answered a questionnaire about improvement or worsening. Results: Eleven patients (100% women) were included. Ten (91%) showed improvement after six months, observed through photographic evaluation, hair count, and self-assessment. No patient presented allergies. Two patients had transient epigastric pain. Conclusions: The use of proteoglycans-based nutricosmetics was effective and well-tolerated in children and adolescents with non-cicatricial alopecia

A Histological and Clinical Evaluation of Plasma as a Graft-holding Solution and Its Efficacy in Terms of Hair Growth and Graft Survival.

Background:There is a time lag between hair follicle harvesting and implantation; during this time, hair follicles have ischemic injury. We need a holding media or a solution to minimize or neutralize ischemic injury.Aim and Objectives:The aim of this study was to evaluate plasma as a graft-holding solution in terms of its efficacy in hair growth and hair graft survival.Materials and Methods:A split-scalp study was carried out. The left side was designated as the control area (Group A), where graft implanted was kept in Ringer's lactate (RL), and the right side behaved as the test area (Group B), which received grafts preserved in autologous plasma. The P value was calculated.Observations:MTT [3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide] staining for graft stored in RL at 12–72h showed poor hair follicles cells survival, whereas graft kept in plasma showed viable cells even after 72h. The hair count and density in plasma group were significantly higher than the RL group. There was an improvement in hair thickness in both groups from 6 to 12 months.Conclusion:Autologous plasma is an easily available graft-holding solution. Platelets along with the plasma provide multiple growth factors promoting epithelialization, neovascularization, and action on hair follicle stem cells to improve growth. The fibrin coating around graft makes it sticky and prevents dehydration. The split-scalp controlled study certainly shows the advantages of using plasma over other extracellular graft-holding solutions.

Review of Topical Therapies for Beard Enhancement

Beards and facial hair are part of males. It may be a sign of masculinity and attraction. Topical therapy for beard enhancement may be desired by some men to improve beard growth and density. A review of all reports on topical treatment options for beard enhancement is presented here. Reports on topical treatment for beard enhancement were searched using The United States National Library of Medicine PubMed, exploring all titles containing beard, facial hair or mustache as of July 22 2020. A total of 445 articles resulted from the search after reviewing the publications for potential relation to beard enhancement. Three studies match the aim of the review regarding topical therapy for beard enhancement in men. Two of which were double-blind clinical trials and one was a case report. Topical 3 % minoxidil, as studied by Ingprasert et al., showed a significant increase in hair count, photographic scoring and patient self-assessment. Saeedi et al. studied the use of 2.5 % testosterone gel for men with thalassemia major with an increase in terminal hair. Vestita et al. published a case report demonstrating unexpected improvement of beard density for a patient using tretinoin 0.05 % cream. Only limited evidence could be presented on topical treatments for beard enhancement. Topical minoxidil is an off-label treatment to enhance the beard. Other topical options such as testosterone, tretinoin, bimatoprost could constitute potential treatment options. Further studies needed to recommend the best topical options for men who desire to enhance their beards.

Efficacy of Platelet-Rich Plasma and Concentrated Growth Factor in Treating Androgenetic Alopecia - A Retrospective Study.

Introduction:Plasma derivatives have been practiced a lot in orthopedics, burns, and sport medicine. Microneedling (MN) with platelet-rich plasma (PRP) therapy has been proven to improve the micro-circulation and thus improve hair growth. The role of concentrated growth factor (CGF) for hair growth has not been mentioned anywhere in the literature for hair growth which we tried to prove in our article by comparing it with various other studies.Materials and Methods:This is a retrospective randomized study involving 20 male patients whose ages ranged from 21 years to 56 years. PRP was prepared using the dual-spin method and injected after activation; post-MN, CGF gel was applied topically. Four sessions were performed, and a follow-up was done after 6 months. Statistical analysis was done using the Statistical Package for the Social Sciences software version 21 for Windows (SPSS, IBM Corp, Armonk, NY, USA). Paired t-test was used for the various comparisons.Results:Hair loss reduced by the end of the first month. At the end of 6 months, postfirst session, microscopic examination showed statistically significant difference in the hair count compared to those during the baseline.Discussion:PRP having platelet-derived growth factor and vascular endothelial growth factor acts on stem cells in the follicles, stimulating the development of new follicles and promoting neovascularization. CGF helps stimulating cell proliferation and matrix remodeling due to numerous growth factors in a concentrated form. Thus, this therapy combined helps to boost the hair growth in a very significant way.Summary:This study provides the preliminary evidence of efficacy of PRP along with MN and CGF in treating androgenetic alopecia by promoting angiogenesis along with vascularization and promotes hair follicles to enter and extend the anagen phase. Most of the results obtained show improved results with this therapy. A larger case study for the same can further be done for a stronger recommendation of the use of CGF for hair growth therapy further.

Treatment of Male-Pattern Alopecia with Platelet-Rich Plasma

Background: Androgenetic alopecia (AGA) affects up to 80% of men and 50% of women throughout their lifetime, causing significant discomfort. Minoxidil, finasteride, and low-level laser light therapy are the only Food and Drug Administration-approved treatments for AGA, and they have shown positive results in randomized controlled trials and meta-analyses. However, their efficacy is limited, and new therapies are needed. Injection of platelet-rich plasma (PRP), a minimally invasive technique, has been described by several authors as a promising treatment for AGA. Although many studies report beneficial effects of PRP on AGA, there is no standardized practice for PRP preparation and administration or a standard method to evaluate results. Objective: The aim of this study was to evaluate the efficacy of manually prepared PRP in the treatment of male AGA. Materials and Methods: We treated 20 male patients with AGA with 3 monthly injections of PRP and analyzed results by TrichoScan®. Results: In this study, there was no statistically significant improvement in hair count or proportion of anagen hairs. Conclusions: This lack of response could be related to any of the variables during PRP preparation described above and also to the limited number of patients in the study.

Hair Growth Promotion by Extracts of Inula Helenium and Caesalpinia Sappan Bark in Patients with Androgenetic Alopecia: A Pre-clinical Study Using Phototrichogram Analysis

Inula helenium (IH) is known to possess antifungal, anti-bacterial, anti-helminthic, and anti-proliferation activities. Caesalpinia Sappan (CS) is known to reduce inflammation and improve blood circulation. Based on their folkloric use, these plants are expected to be promising candidates for promoting hair growth and preventing hair loss. Moreover, these plants are rich sources of certain phytochemicals, which have been reported to promote hair growth. In this clinical trial, we investigate the efficacy of a scalp shampoo formulated by mixing extracts of IH and CS in preventing hair loss and promoting hair growth in patients with androgenetic alopecia. Using a phototrichogram (Folliscope 2.8, LeadM, Korea), we compared the hair density and total hair counts in patients receiving the scalp shampoo at baseline, and at 8, 16, and 24 weeks after use of the shampoo. We found a statistically significant increase in the total hair count in the test group (n = 23) after 16 and 24 weeks of using the scalp shampoo (2.17 n/cm2 ± 5.72, p &lt; 0.05; and 4.30 n/cm2 ± 6.37, p &lt; 0.01, respectively) as compared to the control subjects. Based on the results of this clinical study, we conclude that the IH and CS extract complex is a promising remedy for preventing hair loss and promoting hair growth.

Lasers for reduction of unwanted hair in skin of colour: a systematic review and meta-analysis.

Light-based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favourable safety profile. However, subjects with pigmented skin are found to be more prone to laser-related adverse events. While prolonged pulse-width and longer treatment duration were proposed to minimize adverse events, the optimal treatment option among available phototherapy modalities - long-pulsed (Nd:YAG), pulsed diode and alexandrite lasers as well as intense pulsed light (IPL) - remains unclear, particularly for skin of colour. To determine superiority in terms of effectiveness and tolerability, we conducted a systematic review of literature on different types of in-office laser and IPL for hair removal in subjects with Fitzpatrick skin types III-VI. The meta-analysis was performed using Review Manager (RevMan) version 5.3 and included 12 eligible comparative trials (nine randomized controlled trials and three quasi-randomized). In terms of hair count reduction, pooled effect estimates for long-pulsed ND:YAG laser [OR: 0.26, 95% CI (0.1, 0.78)] and diode laser [standardized mean difference (SMD): -0.11, 95% CI (-0.62, 0.39)] were not statistically significant from those of IPL; in contrast, alexandrite laser was found to be superior to IPL in reducing hair count [SMD: -1.7, 95% CI (-2.6, -0.78)]. In terms of adverse events, the pooled effect estimates favoured long-pulsed Nd:YAG laser to IPL with respect to postinflammatory hyperpigmentation [OR: 0.26, 95% CI: (0.1, 0.78)]. However, both pulsed diode and alexandrite lasers exhibited a comparable safety profile to IPL, despite higher pain scores with lasers. In conclusion, this systematic review suggests that treatment outcomes for different in-office laser devices and IPL in subjects with skin type III-VI are broadly similar; nevertheless, we observed a trend towards greater hair reduction following laser therapy compared with IPL.

Progenitor-cell-enrichedmicrografts as a novel option for the management of androgenetic alopecia.

Regenerative medicine is a multidisciplinary field that combines engineering and life science principles to promote regeneration, potentially restoring the physiological condition in diseased tissues. Specifically, the developments of complex grafts enhance the intrinsic regenerative capacity of the host by altering its environment. Autologous micrografts obtained through Rigenera® micrografting technology are able to promote derma and bone regeneration. Androgenetic alopecia (AGA) leads to a progressive thinning of scalp hair affecting 60-70% of the adult population worldwide. Pharmacological treatment offers moderate results and hair transplantation represents the only permanent treatment option. The aim of this study was to demonstrate the role of dermis micrografting in the treatment of AGA by clinical and histological evaluations after 4, 6, and 12 months. Hair growth and density were improved at all indicated times. Those outcomes were also confirmed by the TrichoScan® analysis, reporting an increase of total hair count and density with an increase and reduction of anagen and telogen phases, respectively. Scalp dermoscopic analysis showed an improvement of hair density and histological analysis indicated a clear amelioration of the scalp, development of hair follicles, and a beginning of cuticle formation. Collectively, those results suggest a possible use of the micrografts as a novel therapeutic option in the management of AGA.

The Clinical Efficacy and Safety of Autologous Activated Platelet-Rich Plasma Injection in Androgenetic Alopecia

Introduction: Androgenetic alopecia (AGA) is a common, chronic hair loss disorder. Platelet-rich plasma (PRP) is a novel therapeutic tool for AGA. The objective of this study was to assess the clinical efficacy and safety of autologous activated PRP injections in AGA. Methods: Twenty-four AGA patients were enrolled in the study. All the patients received 4 PRP treatments at baseline (T1), 3 weeks (T2), 6 weeks (T3), and at 14 weeks (T5). We evaluated hair density (hairs/cm²) at 6 time points (T1–T3, T4 [9 weeks], T5, and T6 [7 months]) and patient satisfaction was assessed at T6 with a patient satisfaction questionnaire. Hair count (hairs/0.48 cm²) was assessed using dermoscopic photographs and hair density (hairs/cm²) was calculated accordingly. Results: Twenty-three men and one woman were included with baseline hair density of 102.25 ± 18.463. Hair density significantly increased at all time points with p < 0.001 compared to the baseline. Patients were satisfied with a mean result rating of 72.92 on a linear analogue scale of 0–100. Other than mild pain felt during injections, no remarkable adverse effects were noted. Conclusions: PRP injections may have a positive therapeutic effect on AGA without major side effects.

Do Kimchi and Cheonggukjang Probiotics as a Functional Food Improve Androgenetic Alopecia? A Clinical Pilot Study.

PurposeProbiotic supplementation demonstrates beneficial effects on serum lipid profiles. We hypothesized that probiotics could benefit patients presenting with alopecia, secondary to improved blood flow to the scalp.Materials and MethodsOur study included men with stage II to V patterns of hair loss based on the Hamilton–Norwood classification and women with stage I to III patterns of hair loss based on the Ludwig classification. All patients were administered 80 mL of Mogut® (a kimchi and cheonggukjang probiotic product) twice a day. Hair growth and numbers were measured using the Triple Scope System® (KC Technology, Korea) at baseline and after 1 and 4 months of administration of a kimchi and cheonggukjang probiotic product.ResultsAt baseline, the mean hair count was 85.98±20.54 hairs/cm2 and the mean thickness was 0.062±0.011 mm in all patients (n=46). Hair count and thickness had significantly increased at 1 month (90.28±16.13 hairs/cm2 and 0.068±0.008 mm, respectively) and at 4 months (91.54±16.29 hairs/cm2 and 0.066±0.009 mm, respectively). In this study, we found that a kimchi and cheonggukjang probiotic product could promote hair growth and reverse hair loss without associated adverse effects such as diarrhea.ConclusionsWe suggest that the observed improvements in hair count and thickness resulted from initiation of the anagen phase in hair follicles in response to probiotics.

Platelet-Rich Plasma and Stem Cells for Hair Growth: A Review of the Literature.

The prevalence of hair loss, its psychological consequences, and historically subpar treatments present a unique challenge to the physician. The current Food and Drug Administration-approved treatments for hair loss are plagued by ineffectiveness, noncompliance, and adverse effects. Recent advances in our understanding of hair physiology have fueled the development of more efficacious, minimally invasive, and safer treatment options for hair restoration including plasma-rich protein and stem cell therapy. Platelet-rich plasma, the autologous preparation of concentrated platelets in plasma, when injected into the scalp of patients with both androgenetic alopecia (AGA) and alopecia areata (AA), has been shown to increase hair count and density. The clinical findings have been supported by histologic evaluation of the scalp skin. These findings have been recapitulated in numerous randomized controlled trials. Stem cell therapy, although newer in its application in hair restoration, has also been effective for treating both AGA and AA. The isolation techniques for stem cells are varied, but regardless have shown promising results in early prospective and retrospective studies.

The Analysis of Hair Count in Healthy Taiwanese Persons by Trichoscope

The Analysis of Hair Count in Healthy Taiwanese Persons by Trichoscope

A Histological and Clinical Evaluation of Plasma as a Graft Holding Solution and Its Efficacy in Terms of Hair Growth and Graft Survival

Background There is a time lag between hair follicle harvesting and implantation, during this time hair follicles suffer ischemic injury. We need a holding medium or a solution to minimize or neutralize ischemic injury. Aims and Objective To evaluate plasma as a graft holding solution in terms of its efficacy in hair growth and hair graft survival. Method and Material A split scalp study was performed. The left side was designated as the control area (Group A) where grafts implanted were kept in Ringer’s lactate, and the right side behaved as the test area (Group B) and received grafts preserved in autologous plasma. The p -value was calculated. Observations MTT staining for grafts stored in Ringer’s lactate at 12 and 72 hours showed poor hair follicle cells’ survival while grafts kept in plasma showed viable cells even after 72 hours. The hair count and density in plasma group were significantly higher than those in the Ringer’s lactate group. There was an improvement in hair thickness in both groups from 6 months to 12 months. Conclusion Autologous plasma is an easily available graft holding solution. Platelets along with the plasma provide multiple growth factors promoting epithelialization, neovascularization, and action on hair follicle stem cells to improve growth. The fibrin coating around the graft makes it sticky and prevents dehydration. The split scalp controlled study certainly shows the advantages of using plasma over other extra cellular graft holding solutions.

Platelet-Rich Plasma and Micrografts Enriched with Autologous Human Follicle Mesenchymal Stem Cells Improve Hair Re-Growth in Androgenetic Alopecia. Biomolecular Pathway Analysis and Clinical Evaluation.

Platelet rich plasma (PRP) and Micrografts containing human follicle mesenchymal stem cells (HF-MSCs) were tried as a potential treatment for androgenetic alopecia (AGA). However, little to no work has yet to be seen wherein the bio-molecular pathway of HF-MSCs or PRP treatments were analyzed. The aims of this work are to report the clinical effectiveness of HF-MSCs and platelet-rich plasma evaluating and reviewing the most updated information related to the bio-molecular pathway. Twenty-one patients were treated with HF-MSCs injections and 57 patients were treated with A-PRP. The Wnt pathway and Platelet derived-growth factors effects were analyzed. 23 weeks after the last treatment with mean hair thickness increments (29 ± 5.0%) over baseline values for the targeted area. 12 weeks after the last injection with A-PRP mean hair count and hair density (31 ± 2%) increases significantly over baseline values. The increment of Wnt signaling in Dermal Papilla Cells evidently is one of the principal factors that enhances hair growth. Signaling from mesenchymal stem cells and platelet derived growth factors positively influences hair growth through cellular proliferation to prolong the anagen phase (FGF-7), inducing cell growth (ERK activation), stimulating hair follicle development (β-catenin), and suppressing apoptotic cues (Bcl-2 release and Akt activation).

The Effect of the Fractional Carbon Dioxide Laser on Improving Minoxidil Delivery for the Treatment of Androgenetic Alopecia.

Introduction: Recently, laser treatment for hair loss has become very popular. Laser-assisted drug delivery (LAD) is an evolving technology with potentially broad clinical applications. This work aims at inspecting the effect of the fractional carbon dioxide laser (CO2 ) on improving the delivery of minoxidil in patients with androgenetic alopecia and detecting the role of the fractional CO2 laser in its treatment. Methods: We enrolled 45 Egyptians with male androgenetic alopecia (MAGA); clinical grading was assessed based on Norwood-Hamilton classification. The patients were divided into 3 groups: the first group (combined group) received the fractional CO2 laser session followed by topical application of minoxidil and also in between sessions; the second group received fractional CO2 laser sessions only and 6 sessions with 2-week intervals were performed; the third group applied topical minoxidil only for 3 months. Global photographs and dermoscopic assessments were performed before treatment and 3 months after the treatment. Results: Several dermoscopic findings were detected, including peripilar sign, hair diversity, yellow spot, white dots, and arborizing red lines. The number of double hair units significantly increased after the treatment in the combined group. The mean number of hair after the treatment in the 3 groups significantly increased, mostly in the combined group. The hair thickness (thin & thick) significantly increased after the treatment in the combined group and the fractional group; however, in the minoxidil group, only thin hair thickness increased. In all the 3 groups, there was a significant improvement in hair count and thickness. Conclusion: The ablative fractional CO2 laser alone or combined with minoxidil may serve as an additional treatment for MAGA.

Efficacy of Off-Label Topical Treatments for the Management of Androgenetic Alopecia: A Review.

Androgenetic alopecia (AGA) is characterized by non-scarring follicle miniaturization. Despite the success of approved therapies, commonly reported side effects and the need for continual use has led to the investigation of alternative therapies. The aim of this paper is to critically review the success of off-label, topical monotherapies for treatment of AGA in men. A literature search was conducted to obtain randomized, controlled and blinded studies that investigated off-label, topical, monotherapies in male patients. Hair density, hair diameter and hair growth were used to evaluate treatment success. Fourteen off-label topical therapies were investigated among the 16 studies that met inclusion criteria. Nine off-label therapies were reported to produce a significantly greater improvement in hair restoration parameters (e.g. mean change from hair count and hair diameter) as compared to placebo (p < 0.05 for all treatments). In two studies, procyanidin oligomers exhibited greater efficacy over vehicle with response to mean change in hair density (hairs/cm2) (ps < 0.0001 at Week 24). In conclusion, prostaglandin analogs and polyphenols, such as latanoprost and procyanidin oligomers, can improve hair restoration parameters in male AGA patients, possibly through targeting mechanisms proposed in the etiology of AGA. The current evidence suggests short-term (24weeks) use may provide benefit for hair loss patients; however, long-term efficacy and safety data are required.