Hair Counts Research Articles

What's New in Therapy for Male Androgenetic Alopecia?

Male androgenetic alopecia is a common condition and represents a major concern for patients who experience this condition. While there are different treatments to stop hair loss and improve hair density, the 5-alpha reductase inhibitors have demonstrated to be effective in improving androgenetic alopecia in men and can maintain a positive response for many years. Oral finasteride 1mg is a US FDA-approved option, but dutasteride 0.5 mg has been proven to induce better responses, especially in the frontal area. Both have been shown to be safe in clinical trials but there is widespread concern about sexual adverse effects among patients. The use of topical finasteride has increased during the last few years as a useful option to avoid systemic therapy. The efficacy of topical finasteride 0.25% daily has been demonstrated in clinical trials, with a less marked decrease in serum dihydrotestosterone levels than with oral intake. Mesotherapy with dutasteride has also become more widespread recently, although evidence of its effectiveness is limited to retrospective studies in real clinical practice. The use of oral minoxidil in androgenetic alopecia has not been approved by the FDA, however several clinical studies have shown that it is an effective treatment option. The initial dose recommended to treat male hair loss is 2.5 mg daily, although the dose is frequently increased to 5 mg daily. The main adverse effect of oral minoxidil is hypertrichosis, followed by dizziness or lower limb edema, which are much less common. Platelet-rich plasma is a non-pharmacological option to treat male androgenetic alopecia, with some clinical trials demonstrating an improvement in hair count after several months. Among the published studies, the main limitation to compare its efficacy is the heterogeneity of the procedure. The most frequent regimens propose treatment every 4 weeks for 3 months initially to assess the individual response. Another treatment alternative is the use of light devices with wavelengths of between 630 and 660 nm, known as low-level laser therapy. These devices can be used at home every day for 15-30min. Their efficacy has been shown in a limited number of clinical trials; however, there is a lack of evidence about the efficacy of these devices compared with other medical options or as a complementary therapy in hair loss. The pipeline of potential new treatments for male androgenetic alopecia is strong. Pyrilutamide and GT20029 are being studied as topical antagonists of the androgen receptor, while cetirizine is another topical option with some initial promising results. Furthermore, according to isolated studies with heterogeneous treatment schemes, the use of botulinum toxin in the scalp might improve androgenetic alopecia, and lastly, scalp threading might increase the total hair count as growth factors are released during implantation.

Pumpkin Seed Oil-Loaded Niosomes for Topical Application: 5α-Reductase Inhibitory, Anti-Inflammatory, and In Vivo Anti-Hair Loss Effects.

Pumpkin seed oil (PSO)-loaded niosomes were prepared from Tween 20 and cholesterol by ethanol injection. Confocal microscopy showed better skin permeation and hair follicle accumulation of the niosomes compared to the PSO solution. The PSO-loaded niosomes inhibited 5α-reductase activity in DU-145 cells and hindered IL-6 activity in RAW 264.7 cells. These effects indicated the great potential of PSO-loaded niosomes to reduce hair loss. The hair scalp serum with PSO-loaded niosomes did not show irritation to reconstructed human skin. This formulation presented a significant decrease in the percentage of fallen hairs by 44.42% in the in vivo 60-second hair count experiment and a significant increase in the anagen to telogen (A/T) ratio (1.4-fold) in the TrichoScan® evaluation after 8 weeks of treatment compared to the initial conditions, indicating the promising efficacy of PSO-loaded niosomes as a natural alternative for anti-hair loss therapy.

A Long-Term Study of the Safety and Efficacy of a Nutraceutical Supplement for Promoting Hair Growth in Perimenopausal, Menopausal, and Postmenopausal Women.

The prevalence of female hair loss and hair thinning increases with advancing age and is most common among post-menopausal women. Recent statistics show that by age 60, an estimated 80% of women experience hair loss. A previous publication detailing the results of the 6-month randomized, double-blind, placebo-controlled phase of this study demonstrated the ability of a nutraceutical supplement to significantly improve hair growth and shedding compared to placebo. Here, we present results from a subsequent 6-month, open-label extension phase assessing the continued safety and efficacy of this nutraceutical for promoting and improving hair growth and evaluate potential long-term benefits on quality of life and menopausal symptoms. After a total of 12 months with the active nutraceutical, subjects had progressive improvements in hair growth, quality, and shedding. Quality of life measures and menopausal symptoms also improved over the duration of the study. When transitioned to daily intake of the supplement, subjects previously treated with placebo achieved significant increases in all hair counts, a significant decrease in shedding, and significant improvement in blinded investigator global hair growth and quality assessments. The results of this long-term study demonstrate that continued use of a novel nutraceutical provides significant incremental improvement over the beneficial effects achieved during the initial 6-month randomized, placebo-controlled phase. Continued use may provide ongoing improvements in hair growth and exert a positive effect on secondary symptoms of menopause, and quality of life in perimenopausal, menopausal, and postmenopausal women with selfperceived thinning hair (ClinicalTrials.gov Identifier: NCT04048031). J Drugs Dermatol. 2022;21(7):776-783. doi:10.36849/JDD.6912.

Effects on Oral Supplementation of Nutraceuticals formulations - Trichovitals® in young adults for healthy maintenance of hair growth

Nutrition is a major factor in affecting the health and appearance of hair. In addition to how one eats dietary supplementation plays very critical role in overall maintenance of healthy hair. Precisely Trichovitals® contains Natural Egg Shell Membrane as source of Collagen type (I, III, V, X) and Elastin, Ellagic acid an extract from Pomegranate red pigment, Sabbery (10% beta- glucogallin) an extract of Amla fruit, Biotin (Water soluble vitamin), Tetra hydro curcumin (Derivate of Curcumin) and Murraya koenigii (an extract of the curry leaf as natural source of the iron). With respected to the prior art data each ingredient has several independent clinical studies to support the growth of the healthy hair and influences strong impact on hair thickness, reduction in hair breakage and improvement in hair growth. This study leads to evaluate the impacts of synergy of nutritional and compared to control group (without oral supplements intake) for the healthy maintenance of the hair in healthy young-aged adults. Pilot studies were conducted to assess Trichovitals® on hair parameters. 1. Self-assessment questionnaire intended to perform an assessment on hair after 90 days of treatment for a group of 50 young aged volunteers. 2. Evaluated the efficacy of Trichovitals® for 90 days’ treatment by measurement of mean hair count, Pull test, Wash test, Comb and count test. In this pilot study, Volunteers expressed best results and the scores of self-assessment questionnaire were high for Overall hair volume, Scalp coverage, Thickness of hair body, Softness of hair body, Hair shine, Number of Hairs Lost on Average Day. Oral Trichovitals® consumption was associated with significant improvement in count of terminal hairs and reduction in hair loss after 90 days of treatment. Trichovitals® achieved significant change improvement in hair than placebo group (without oral supplements intake) by 90 days of the study. From the result analysis, Trichovitals® is deemed to be one of the most effective anti-hair fall supplements. For healthy beautiful hair, enhance the appearance of hair with precision of Trichovitals® and its unique composition helps to protect hair damage, prevents hair fall and promotes hair growth. The study confirms and concludes that the Oral supplementation of 500mg/day of Trichovitals® for 12 weeks is associated with significant impact on hair thickness, reduces split ends, hair loss, hair breakage and improvement in hair growth after 90 days of treatment.

Comparison of submillisecond pulse (FRAC3) and long-pulse 1064 nm Nd:YAG laser hair removal.

BackgroundLaser hair reduction gained popularity in the last decade and is presently the most frequently used long‐term hair removal method. It works on the principle of selective photothermolysis—the laser damages the hair follicle without damaging the skin. Shorter Nd:YAG pulses are also effective in hair reduction, while maintaining better comfort for the patient.AimsThe aim of this study was to compare the short and long pulsed methods of Nd:YAG for facial hair removal on darker Fitzpatrick skin types (IV–V).Patients/MethodsThis prospective split face, evaluator‐blinded comparison of short‐pulse Nd:YAG laser versus long‐pulse Nd:YAG laser study included 10 untanned healthy women. There were two outcome measers, two blinded dermatologists compared baseline photographs with those taken 3 months after last session and FotoFinder was used to compare the terminal hair count reduction at the baseline and 3 months after 6th session.ResultsBoth blinded assesors observed significant hair reduction with both lasers; excellent results were achieved in 20% with long pulse and in 55% with short pulse. Both treatment options showed reduction in number of terminal hair with statistical significance using FotoFinder. Comparison of the efficacy of the two pulse durations measured by percent reduction in the number of terminal hair 3 months after the last session showed no significant difference between the groups.ConclusionHair reduction using 1064 nm Nd:YAG is a safe and effective method of hair reduction especially in darker skin types. We have shown that short pulses are better or at least equally safe and effective as the “gold standard” long pulses.

Lagerstroemia indica extract regulates human hair dermal papilla cell growth and degeneration via modulation of β-catenin, Stat6, and TGF-β signaling pathway.

Lagerstroemia indica (L.indica) is reported to have diverse biological activities including anti-inflammatory, anti-cancer, neuro-regulatory, antidiabetic, and antioxidant activity. The purpose of this study is to examine the potential of hair growth promotion and/or hair loss prevention by L.indica extract. The effects of L.indica on hair growth have been studied in human hair follicle dermal papillary (hHFDP) cells and follicular organ culture ex vivo by cell proliferation assay, PCR, western blot analysis, and reporter gene activity assay. Moreover, a clinical trial was conducted in healthy volunteers. Lagerstroemia indica significantly promoted the proliferation of hHFDP cells, which was associated with increased expression of TCF/LEF, VEGF, and Gli1 mRNA, and inhibition of STAT6 and Smad2 mRNA. Treatment with L.indica also increased the TCF/LEF reporter gene activity but downregulated the SBE- and STAT6-luciferase activities. The expression of total β-catenin, CDK4, and CDK2 were elevated, while that of STAT6 and SMAD2/3 was suppressed upon treatment with L.indica. In human hair follicles organ culture, L.indica significantly inhibited hair follicular degeneration. The clinical trial showed a statistically significant rise in total hair count in test group (n=24) after 24 weeks of applying the hair tonic enriched with L.indica (141.46 ± 21.27 number/cm2 , p < 0.05). We suggest that L.indica extract prevents hair loss as well as stimulate hair growth by regulating the Wnt-β-catenin, JAK3-STAT6, and TGF-β1-Smad signaling pathways, and may be further developed as a novel functional cosmetic for preventing hair loss.

Photobiomodulation Effectiveness in Treating Androgenetic Alopecia.

Background: Androgenetic alopecia (AGA) is a genetically determined condition, which leads to progressive hair loss (HL) of the vertex, affects hair follicles, and promotes partial or total HL. It may be related to important psychological and social distress. Objective: The aim of the study was to evaluate the effects of photobiomodulation (PBM) in patients with AGA. Methods: Twenty-five men 20-54 years of age participated in this study. The irradiations were punctual, in contact mode, with 1 cm between each point covering the entire affected area. A red low-level laser (λ = 660 nm) (Recover®, MMOptics, São Carlos, Brazil) was used with 100 mW, 30 sec, and 3 J per point, twice a week on alternate days for 10 weeks. Evaluations were made by photographic records from the same area before any intervention (T1), after 5 weeks (T2), after 10 weeks (T3). Two blinded evaluators using the ImageJ® software assessed the hair density. Results: The hair density evaluation showed a significant increase in hair count between T1 and T2 (p = 0.0004) and between T1 and T3 (p = 0.0285), however between T2 and T3 no statistical difference was found (p > 0.05). Conclusions: PBM provides a stimulus for hair density in 5 weeks. After this period, we observed that after five extra sessions, it does not increase hair density in the treated region. This study showed that the PBM is effective and promoted safe results with a reduced number of sessions for the AGA treatment.

Efficiency of Hair Detection in Hair-to-Hair Matched Trichoscopy

Introduction: Precise evaluation of changes in hair count is crucial for monitoring progression of hair loss and the effects of treatment. The focus of this study is the comparison of the various examination and assessment techniques in terms of the precision of hair count change observed in trichoscopy images. Methods: Controlled hair extraction of the same scalp spot was used to simulate hair loss, and the different examination techniques were performed to detect this change. The investigators who performed the counting were blinded. Results: For trichoscopy images, the average error in determining the terminal hair count change (relative to total hair count) was 9 ± 1% for automatic assessment with manual correction and 0.4 ± 0.2% for hair-to-hair matched images. For phototrichogram, the automatic measurement results were found to deviate from truth on average by 12 ± 2%. The manually corrected hair count results were much closer to the truth with average deviation at the level of 7 ± 1%. The hair-to-hair matched results corresponded to approximately 0.6 ± 0.3% average discrepancy. Conclusion: Combination of manually corrected image processing, follicular mapping, and hair-to-hair matching appears to be the most precise way of evaluating the change in hair count over time. These novel techniques should be considered valuable, especially in research and clinical trials.

Comparison Between Trichoscopic and Histopathological Evaluations of Hair Parameters.

BackgroundCollecting data on hair counts helps dermatologists diagnose hair diseases more accurately. Quantitative trichoscopy analysis and pathologic examination are two common ways to evaluate hair parameters.PurposeThe study aims to compare the effect of quantitative trichoscopy analysis and pathologic examination in hair counting and quantify the hair density of average Chinese people.MethodsTrichoscopy was performed in four scalp regions with a total of twenty-three volunteers without alopecia: frontal, vertex, occipital, and parietal. Hair density parameters were recorded. A 4-mm punch biopsy was performed in the occipital area, and all specimens were transversely sectioned serially and observed to calculate the hair densities.ResultsThe average hair density, hairs per follicle unit, and vellus hair ratio from quantitative trichoscopy analysis in the occipital region were 163.07±28.17/cm2, 1.87±0.25 and 6.60±3.95%, lower than those from biopsy significantly (214.97±48.73/cm2, 2.24±0.30 and 10.48±6.43%). The hair shaft diameter measured by quantitative trichoscopy analysis was 74.52±8.02μm, higher than that by histopathologic examination (68.65±8.00μm) (p<0.05).ConclusionQuantitative trichoscopy is a noninvasive, quick, and convenient way to evaluate hair density. Histopathologic examination is an invasive way but provides more accurate data. The data obtained from trichoscopy and pathological examination are different to some extent, which cannot be substituted entirely for each other. This study established the reference for hair density in the adult Chinese population.

Combination of platelet-rich plasma and platelet gel in treatment of resistance androgenic alopecia: A case series study.

Androgenic alopecia is a common genetic disorder that characterized by progressivehair follicles and hair atrophy. Despite all available therapeutic techniques, there is low patient satisfaction rate. It seems finding new treatment options for androgenic alopecia is necessary. In the past decade, platelet-rich plasma (PRP), an autologous collection of concentrated platelets with hemostatic and tissue repairing effects, has received developing attention for androgenetic alopecia treatment as a valuable therapeutic technique. In this study, 8 patients suffering from resistance androgenic alopeciawere enrolled. The PRP and platelet gel were prepared, and a total volume of 10cc of the combination of PRP and platelet gel were injected in the scalp androgen-related areas using 23-gauge syringe. The treatment was performed one month and 3months after first injection (three times). The hair pull test was done before treatment. The outcome was evaluated 3, 6, and 9months after treatment by hair pull test, dermoscopy, photography, and patient's satisfaction. A significant reduction in hair loss was observed before and after treatment. Hair count (density) increased from average number of 72 (hair/cm2 ) to 210hair/cm2 ). Also, the hair diameter was significantly increased before and after treatment for all patients (p<0.05).After the treatment, the pull test was significantly decreased in 8 patients (p<0.05). This study supports the combination therapy of PRP and platelet gel for resistance androgenic alopecia treatment. This technique is an uncomplicated, feasible, and cost-effective treatment option for resistance androgenic alopecia, with high patient satisfaction.

Relative Efficacy of Minoxidil and the 5-α Reductase Inhibitors in Androgenetic Alopecia Treatment of Male Patients

There are knowledge gaps regarding the relative efficacy of 3 commonly used drugs for androgenetic alopecia (AGA), namely, minoxidil and the two 5-α reductase inhibitors dutasteride and finasteride. To examine the relative efficacy of any dose and administration route of minoxidil, dutasteride, and finasteride for the treatment of male AGA. Systematic searches were performed in PubMed on March 5, 2021, without date restrictions. Eligible studies included those that investigated monotherapy with any dose and administration route of minoxidil, dutasteride, and finasteride. Data on the mean (SD) difference and sample size were used for the bayesian network meta-analyses. League tables and surface under the cumulative ranking curve values were used to examine the relative efficacy of the interventions. Study end points were change in total and terminal hair count after 24 and 48 weeks of therapy. The 4 end points were quantified in hairs per square centimeters. The PubMed search yielded 848 records; after the 2 stages of screening, 23 studies were eligible for quantitative analyses. Mean (SD) age of patients ranged from 22.8 (3.3) years to 41.8 (12.3) years. The greatest increase in total hair count at 24 weeks (ie, first end point) was with 0.5 mg/d of dutasteride, which was significantly more efficacious than 1 mg/d of finasteride (mean difference, 7.1 hairs/cm2; 95% CI, 5.1-9.3 hairs/cm2) and minoxidil (0.25 mg/d [mean difference, 23.7 hairs/cm2; 95% CI, 9.5-38.0 hairs/cm2], 5 mg/d [mean difference, 15.0 hairs/cm2; 95% CI, 3.9-26.1 hairs/cm2], and 2% solution [mean difference, 8.5 hairs/cm2; 95% CI, 4.8-12.3 hairs/cm2]). The greatest increase in terminal hair count at 24 weeks (ie, second end point) was with 5 mg/d of minoxidil, which was significantly more efficacious than the 0.25-mg/d dose (mean difference, 43.6 hairs/cm2; 95% CI, 29.7-57.7 hairs/cm2) and its topical forms (in 2% [mean difference, 29.3 hairs/cm2; 95% CI, 21.1-37.5 hairs/cm2] and 5% [mean difference, 29.8 hairs/cm2; 95% CI, 19.7-39.8 hairs/cm2]); 5 mg/d of minoxidil was significantly more efficacious than 1 mg/d of finasteride (mean difference, 10.4 hairs/cm2; 95% CI, 2.2-18.6 hairs/cm2). The greatest increase in total hair count at 48 weeks (ie, third end point) was with 5 mg/d of finasteride, which was significantly more efficacious than 2% topical minoxidil (mean difference, 20.7 hairs/cm2; 95% CI, 9.5-31.9 hairs/cm2). The greatest increase in terminal hair count at 48 weeks (ie, fourth end point) was with 1 mg/d of finasteride, which was significantly more effective than topical minoxidil (in 2% [mean difference, 32.1 hairs/cm2; 95% CI, 23.9-40.3 hairs/cm2] and 5% [mean difference, 26.2 hairs/cm2; 95% CI, 16.2-36.2 hairs/cm2]). As efficacy data from head-to-head trials accumulate, there could be a better sense of the relative efficacy of the different doses of the 5-α reductase inhibitors and minoxidil. The findings of this meta-analysis contribute to the comparative effectiveness literature for AGA therapies with regard to the compared interventions.

Weekly treatment with SAMiRNA targeting the androgen receptor ameliorates androgenetic alopecia

Androgenetic alopecia (AGA) is the most common type of hair loss in men and women. Dihydrotestosterone (DHT) and androgen receptor (AR) levels are increased in patients with AGA, and DHT-AR signaling correlates strongly with AGA pathogenesis. In this study, treatment with self-assembled micelle inhibitory RNA (SAMiRNA) nanoparticle-type siRNA selectively suppressed AR expression in vitro. Clinical studies with application of SAMiRNA to the scalp and massaging to deliver it to the hair follicle confirmed its efficacy in AGA. For identification of a potent SAMiRNA for AR silencing, 547 SAMiRNA candidates were synthesized and screened. SAMiRNA-AR68 (AR68) was the most potent and could be efficiently delivered to human follicle dermal papilla cells (HFDPCs) and hair follicles, and this treatment decreased the AR mRNA and protein levels. We confirmed that 10 µM AR68 elicits no innate immune response in human PBMCs and no cytotoxicity up to 20 µM with HFDP and HaCaT cells. Clinical studies were performed in a randomized and double-blind manner with two different doses and frequencies. In the low-dose (0.5 mg/ml) clinical study, AR68 was applied three times per week for 24 weeks, and through quantitative analysis using a phototrichogram, we confirmed increases in total hair counts. In the 24-week long high-dose (5 mg/ml) clinical study, AR68 showed average additional hair growth of 1.3-1.9 hairs/cm2 per month, which is comparable to finasteride. No side effects were observed. Therefore, SAMiRNA targeting AR mRNA is a potential novel topical treatment for AGA.

Clinical Study To Assess The Efficacy of A Novel Hair Loss Treatment

Background: Hair loss affects men and women around the world.&#x0D; Objective: This study analyzed the efficacy of a hair formula named Lotus 39 by Valentino De Salva (Lotus 39) on hair loss. &#x0D; Methods: Men and women between ages 42 and 72 applied Lotus 39 to their scalp every day for 8 weeks. For ethical reasons, a nonrandomized controlled study protocol was selected&#x0D; Results: According to the data, Lotus 39 stops hair loss, causes an increase in vellus hair, and an increase total hair count. &#x0D; Limitations: No control was assigned due to funding, baseline pictures were taken at the onset of the study, during, and at the end of the study to draw a depiction of hair improvement over time.&#x0D; Conclusion: This study suggests that Lotus 39 improves the health of the scalp and hair.&#x0D; &#x0D; IRB Approval Status: &#x0D; Reviewed and approved by IntegReview IRB; approval #CRLNJ2019-0198

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

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

Superficial Cryotherapy versus Intralesional Corticosteroids Injection in Alopecia Areata

Background:Alopecia areata (AA) is an autoimmune disease leading to noncicatricial alopecia. Topical or intralesional corticosteroid (ILCS) is the accepted therapeutic option for mild cases; however, adverse effects are sometimes difficult to reverse. When the exposure to liquefied nitrogen is limited to a few seconds “superficial” cryotherapy, reactive vasodilation may improve microcirculation and nutritional status around hair follicles.Objective:This study aimed to evaluate and compare superficial cryotherapy and ILCS in the treatment of patchy AA.Materials and Methods:This prospective comparative study included 21 patients with patchy AA. Every patient received superficial cryotherapy on one patch, every 2 weeks for 3 months, and ILCS injection for another patch, once monthly for 3 months.Results:Clinical improvement was higher in cryotherapy group compared to ILCS group with a statistically significant difference (P = 0.002). On trichoscopic evaluation, terminal hair count was improved in lesions treated with cryotherapy more than lesions treated with ILCS but without statistical significance (P = 0.595) and vellus hair count was improved in lesions treated with cryotherapy more than lesions treated with ILCS with a statistical significance (P = 0.002).Conclusions:Cryotherapy is more effective and less painful than ILCS in the treatment of patchy AA.

A Summary of Pre-Clinical and Clinical Evidence for Cannabinoid Hair Follicle Effects

The endocannabinoid system (ECS), discovered in the 1990s, is a system involved with maintaining cellular homoeostasis by down-regulating the damaging inflammatory responses and upregulating regenerative processes. Tetrahydrocannabinol (THC), Cannabidiol (CBD), tetrahydrocannabivarin (THCV) and cannabidivarin (CBDV) are all phytocannabinoids that have novel therapeutic effects on hair growth through the ECS receptors on hair follicles. These cannabinoids are fat-soluble and poorly absorbed past the epidermis, but topical application easily reaches hair follicles where CBDV, THCV and CBD act as partial or full CB1 antagonists and agonists of vanilloid receptor-1 (TRPV1) and vanilloid receptor-4 (TRPV4). All these ECS receptors relate to hair follicle function. THC on the other hand has the opposite effects decreasing hair shaft elongation and matrix production. A summary of the pre-clinical and clinical cannabinoid research is reviewed. The studies confirm that for androgenetic alopecia (AGA) the method of action is different from and synergistic with current hair regrowth therapies. Blocking the CB1 receptor on the hair follicle has been shown to result in hair shaft elongation and matrix production via keratinocytes, in addition, the hair follicle cycle (anagen, catagen, and telogen phases) is controlled by TRPV1. The effects of CBD on hair growth are dose dependent and higher doses may result in premature entry into the catagen phase via a different receptor known as TRPV4. CBD has also been shown to increase Wnt signaling, which causes dermal progenitor cells to differentiate into new hair follicles and maintains anagen phase of the hair cycle. Two recent six-month duration clinical trials of adults with androgenetic alopecia (AGA) have revealed an average 93.5% increased hair count with CBD alone, and 164% increased hair count with hemp extract high in CBD, THCV, CBDV and menthol. A current study is underway to look at punch biopsies of the areas of hair regrowth in patients treated with a combination of CBD, THCV isolate, menthol and caffeine. Another study is underway looking at using hexahydrocannabinol (HHC) a hydrogenated version of THC to decrease facial hair growth as a cosmetic effect

Efficacy of QR678 Neo® hair growth factor formulation for the treatment of hair loss in Covid-19-induced persistent Telogen Effluvium-A prospective, clinical, single-blind study.

Telogen Effluvium (TE) in a post-Covid-19 patient causes excessive shedding of hair. No definite treatment is available till now. Past studies demonstrates that QR678Neo® has shown promising results in various types of Alopecia. In this study, we aim to establish efficacy of QR678Neo® hair growth factor formulation administration in Covid-19-induced persistent TE for treatment of hair loss and for hair regrowth. Twenty adult patients (all females) presenting with persistent TE starting few weeks after recovery from Covid-19 infection, and continuing beyond 6months were included for the study. A 1.5mL solution of QR678Neo® hair growth factor formulation was administered in the scalp per session. A total of 8sessions (one session every 4weeks) were done. The results were assessed at the baseline, after 4thsession, and 1month after 8th session. Most of the patients showed significant reduction in hair fall; 89% patients showed excellent hair growth. Global photographic assessment score showed marked improvement, which maintained even post therapy. Videomicroscopic assessment showed increase in the hair count (mean =29.32) after 8th session, that further improved even post therapy. The subjective assessment scores for overall hair growth, appearance of hair, reduction in visibility of the scalp, and hair loss were 4, 4.5, 4.25, and 5, respectively. Management of Covid-19-induced persistent Telogen Effluvium has been unclear and futile so far. Intra-dermal administration of QR678Neo® hair growth factor formulation in the scalp, reduces hair fall, improves hair regrowth, and increases the hair density.

Microneedling and Its Use in Hair Loss Disorders: A Systematic Review.

IntroductionMicroneedling (MN) is a minimally invasive procedure involving the induction of percutaneous wounds with medical-grade needles. In this literature review, we investigate clinical data on MN for the treatment of hair loss disorders.MethodsA literature search was conducted through PubMed up to November 2021 to identify original articles evaluating the use of MN on hair loss disorders. The database was searched using the following keywords: “microneedling,” “micro needling,” “micro needle,” “microneedle,” “needle,” “dermaroller” and “alopecia,” “hair loss,” “alopecia,” “areata,” “cicatricial,” or “effluvium.”ResultsA total of 22 clinical studies featuring 1127 subjects met our criteria for inclusion. Jadad scores ranged from 1 to 3, with a mean of 2. As an adjunct therapy, MN improved hair parameters across genders and a range of hair loss types, severities, needling devices, needling depths of 0.50–2.50 mm, and session frequencies from once weekly to monthly. Across 17 investigations totaling 911 androgenic alopecia (AGA) subjects, MN improved hair parameters when paired with 5% minoxidil, growth factor solutions, and/or platelet-rich plasma (PRP) topicals, or when introduced to subjects whose hair count changes had plateaued for ≥ 6 months on other treatments. Across four investigations on 201 alopecia areata (AA) subjects, MN improved hair parameters as a standalone therapy versus cryotherapy, as an adjunct to 5-aminolevulinic acid and photodynamic therapy, and equivalently when paired with topical PRP versus carbon dioxide laser therapy with topical PRP. Across 657 subjects receiving MN, no serious adverse events were reported.ConclusionsClinical studies demonstrate generally favorable results for MN as an adjunct therapy for AGA and AA. However, data are of relatively low quality. Significant heterogeneity exists across interventions, comparators, and MN procedures. Large-scale randomized controlled trials are recommended to discern the effects of MN as a standalone and adjunct therapy, determine best practices, and establish long-term safety.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00653-2.

Histopathological Evidence of Occipital Involvement in Male Androgenetic Alopecia.

Background: The occipital region of the scalp is generally accepted as an unaffected area of androgenetic alopecia (AGA) for both genders. However, evidence of AGA involving the occipital scalp has been demonstrated in women; meanwhile, it is unclear whether occipital involvement also occurs in men.Objective: We aimed to determine if there is occipital involvement in men with AGA.Methods: This case-control study compared hair counts of scalp biopsy specimens from the occipital region of 82 men with Hamilton-Norwood III-VII and 82 unaffected men.Results: The mean ages of men with AGA and controls were 40.1 ± 8.9 and 38.6 ± 10.5 years, respectively (P = 0.291). A significant decrease in total hair follicles, terminal hair follicles, follicular units and terminal to vellus (T:V) ratio, along with a significant increase in follicular stelae was indicated in the AGA group compared to controls (all P < 0.05). Subgroup analyses revealed that average counts of total hair follicles, terminal hair follicles and T:V ratios were also significantly lower in males with Hamilton-Norwood VI and VII than in controls (all P < 0.05). There were no correlations between increasing age and hair count parameters, but a significant negative association was found between total follicle numbers and disease duration (r = −0.23, P = 0.02).Conclusions: AGA can involve the occipital area of male patients with advanced disease. Therefore, the occiput of particular cases should not be used to determine reference data for normal scalp hair, and preoperative measurements of miniaturized hairs in the donor site are strongly recommended in all persons undergoing hair transplantation.

Platelet rich plasma application by dermapen microneedling and intradermal point-by-point injection methods, and their comparison with clinical findings and trichoscan in patients with androgenetic alopecia.

Androgenetic alopecia (AGA) is a progressive hair loss disease that occurs with the effect of androgens and genetic predisposition. Hair thinning and hair loss affect people's self-confidence and self-image more than is thought. In these patients, platelet rich plasma (PRP) treatment is used in addition to the limited medical treatments available. However, there is a lack of standardization for the application method of PRP treatment in the literature. The number of studies in which objective data and hair analysis parameters were revealed to demonstrate the effectiveness of PRP treatment is also very limited. In this study, it was aimed to show the efficacy of PRP treatment with trichoscan data in AGA patients and to compare dermapen-mediated microneedling and point-by-point technique injection application methods. The study was conducted with 62 male AGA patients, aged between 18 and 55 years, who applied to the University Faculty of Medicine, Department of Dermatology, and ranged from Norwood-Hamilton Stage II-V. The patients were randomly divided into two groups and one group was given microneedling with a dermapen, an electrical device that makes automatic needling, and the other group was given manual injection with point-by-point technique with a 30-gauge needle. Before the first treatment, each patient underwent a trichoscan hair analysis evaluation. A total of four sessions of PRP treatment were performed, as three sessions at 2-week intervals and the fourth session 1 month after the last session. The mean age of the cases was 33.13 ± 6.36. According to Norwood-Hamilton staging, stage III was detected with the highest rate of 46% (29). Hair pulling test became significantly negative after treatment (p < 0.05). Statistically significant differences were found in trichoscan analysis parameters for hair count, hair density, terminal hair count, and terminal hair density in both groups compared to pretreatment (p < 0.05). Between the groups, a statistically significant difference was found between the averages of anagen hair, telogen hair, and hair length in the dermapen treated group compared to the group treated with the point-by-point technique. In our study, the efficacy of PRP treatment for AGA patients was demonstrated by trichoscan parameters. Among the PRP application methods, dermapen-mediated application was found to be superior to the point-by-point technique in terms of anagen, telogen, and average hair length parameters.