Miniaturization Of Hair Follicles Research Articles

Efficacy and safety of spironolactone versus bicalutamide in female pattern hair loss: A retrospective comparative study.

Female-pattern hair loss (FPHL) is characterized by decreased scalp hair density, thinning of hair shafts, and progressive miniaturization of hair follicles. To compare the safety and efficacy of spironolactone versus bicalutamide in female pattern hair loss [FPHL]. The study design was retrospective, and all eligible females aged between 18 years and 50 years with FPHL were included. We identified 120 patients from our database who fulfilled the inclusion and exclusion criteria, and patients were then categorized into two groups, Group A comprising patients who were taking 100 mg of spironolactone once daily and Group B comprising patients who were taking 50 mg of bicalutamide once daily along with topical minoxidil 2% in both groups. Patient were analysed at approximately at 24 weeks from the commencement of the treatment. Mean reduction in hair loss severity score on Sinclair scale was 19.51% in spironolactone group compared to 28.20% in bicalutamide group at 24 weeks, which was statistically significant. On global photographic assessment, marked improvement was seen in bicalutamide group compared to spironolactone group (p = 0.139). Our study, though limited by its retrospective design and small sample size, showed that bicalutamide has greater efficacy and better safety profile in comparison to spironolactone in the treatment of FPHL.

The Hormonal Background of Hair Loss in Non-Scarring Alopecias.

Hair loss is a common clinical condition connected with serious psychological distress and reduced quality of life. Hormones play an essential role in the regulation of the hair growth cycle. This review focuses on the hormonal background of hair loss, including pathophysiology, underlying endocrine disorders, and possible treatment options for alopecia. In particular, the role of androgens, including dihydrotestosterone (DHT), testosterone (T), androstenedione (A4), dehydroepiandrosterone (DHEA), and its sulfate (DHEAS), has been studied in the context of androgenetic alopecia. Androgen excess may cause miniaturization of hair follicles (HFs) in the scalp. Moreover, hair loss may occur in the case of estrogen deficiency, appearing naturally during menopause. Also, thyroid hormones and thyroid dysfunctions are linked with the most common types of alopecia, including telogen effluvium (TE), alopecia areata (AA), and androgenetic alopecia. Particular emphasis is placed on the role of the hypothalamic-pituitary-adrenal axis hormones (corticotropin-releasing hormone, adrenocorticotropic hormone (ACTH), cortisol) in stress-induced alopecia. This article also briefly discusses hormonal therapies, including 5-alpha-reductase inhibitors (finasteride, dutasteride), spironolactone, bicalutamide, estrogens, and others.

Divergent progression pathways in male androgenetic alopecia and female pattern hair loss: Trichoscopic perspectives.

Despite similarities in progressive miniaturization of hair follicles and transition of terminal hairs to vellus hairs, insufficient trichoscopic comparisons between male androgenetic alopecia (MAGA) and female pattern hair loss (FPHL) hinder our ability to select effective treatments. Our study aimed to explore gender-specific trichoscopic characteristics of MAGA and FPHL, while formulating hypotheses regarding the progression of these conditions across clinical stages. We classified 126 male MAGA subjects using Hamilton-Norwood Classification and 57 FPHL subjects using adopted Sinclair Scale. Subsequently, we analyzed nine trichoscopic factors divided into three categories: hair-diameter related, hair-number per follicular unit related, and hair density related factors. Of the nine quantitative trichoscopic factors, hair-diameter and hair-number per follicular unit showed strong correlations with clinical stages in both genders. Hair density, a common trichoscopic factor for hair loss evaluation, weakly correlated with clinical stages in FPHL, but not at all in MAGA. In addition, MAGA was characterized by a progressive reduction in hair-diameter, followed by a reduction in hair-number per follicular unit. FPHL, on the contrary, showed the opposite progression. Trichoscopic factors vary with disease severity in a gender-specific manner. Our research highlights that MAGA and FPHL involve two distinct streams: hair-diameter decreasing by hair follicle miniaturization (Stream 1), and hair-number per follicular unit decreasing by hair follicle tri-lineage niche dysfunction (Stream 2). MAGA typically starts from Stream 1 to Stream 2, while FPHL starts from Stream 2. These diverse progression pathways underscore the importance of personalized treatment approaches.

Signaling pathways in hair aging.

Hair follicle (HF) homeostasis is regulated by various signaling pathways. Disruption of such homeostasis leads to HF disorders, such as alopecia, pigment loss, and hair aging, which is causing severe health problems and aesthetic concerns. Among these disorders, hair aging is characterized by hair graying, hair loss, hair follicle miniaturization (HFM), and structural changes to the hair shaft. Hair aging occurs under physiological conditions, while premature hair aging is often associated with certain pathological conditions. Numerous investigations have been made to determine the mechanisms and explore treatments to prevent hair aging. The most well-known hypotheses about hair aging include oxidative stress, hormonal disorders, inflammation, as well as DNA damage and repair defects. Ultimately, these factors pose threats to HF cells, especially stem cells such as hair follicle stem cells, melanocyte stem cells, and mesenchymal stem cells, which hamper hair regeneration and pigmentation. Here, we summarize previous studies investigating the above mechanisms and the existing therapeutic methods for hair aging. We also provide insights into hair aging research and discuss the limitations and outlook.

Non-invasive assessment of hair regeneration in androgenetic alopecia mice in vivo using two-photon and second harmonic generation imaging.

The identification of crucial targets for hair regrowth in androgenetic alopecia (AGA) involves determining important characteristics and different stages during the process of hair follicle regeneration. Traditional methods for assessing key features and different stages of hair follicle primarily involve taking skin tissue samples and determining them through various staining or other methods. However, non-invasive assessment methods have been long sought. Therefore, in this study, endogenous fluorescence signals from skin keratin and second harmonic signals from skin collagen fibers were utilized as probes, two-photon excited fluorescence (TPEF) and second harmonic generation (SHG) imaging techniques were employed to non-invasively assess hair shafts and collagen fibers in AGA mice in vivo. The TPEF imaging technique revealed that the alternation of new and old hair shafts and the different stages of the growth period in AGA mice were delayed. In addition, SHG imaging found testosterone reduced hair follicle area and miniaturized hair follicles. The non-invasive TPEF and SHG imaging techniques provided important methodologies for determining significant characteristics and different stages of the growth cycle in AGA mice, which will facilitate future non-invasive assessments on human scalps in vivo and reduce the use of animal testing.

Co-delivery of minoxidil and tocopherol acetate ethosomes to reshape the hair Follicular Microenvironment and promote hair regeneration in androgenetic alopecia

The most prevalent kind of hair loss is androgenic alopecia (AGA), which is characterized by hair follicle miniaturization and microenvironment dysfunction. Although topical Minoxidil (MXD) was considered to be a safe and effective treatment for AGA, excess reactive oxygen species (ROS) and lower sulfotransferase activity in the hair follicular microenvironment led to an unsatisfactory treatment of AGA. Here, we developed the ethosome (MTE) load of minoxidil and tocopherol acetate to improve the therapeutic effect of MXD on androgenic alopecia. It could regulate the microenvironment around hair follicles, promote the telogen-to-anagen transition of hair follicles, and boost hair regeneration, thus achieving a synergistic effect of 1 + 1 > 2. The results proved that MTE showed excellent stability, biosafety, and good dermal and follicular permeability in vitro. The hair regeneration ability of AGA model mice showed that the co-delivery ethosome might regulate the microenvironment around the hair follicles and improve hair regeneration in comparison to the commercial minoxidil tincture alone. As a result, the strategy provided a promising new strategy for the treatment of AGA.

Evaluation of the Efficacy of Nanofat Injection in Treatment of Androgenic Alopecia

Abstract Background Androgenic alopecia is the most common hair loss disorder in both males and females. The importance of this disease comes from the immense emotional distress that it leaves on the patient caused by the hair loss. The terminal hair follicles over the frontal and vertex regions are replaced by miniaturized hair follicles which leads progressively to a visible reduction in hair density. Aim of the Work To evaluate the efficacy of Nanofat injected into the scalp for management of androgenic alopecia. Patients and Methods This prospective clinical pilot study included 20 patients with androgenic alopecia, 10 males and 10 females, attending Dermatology outpatient clinic of Ain Shams University Hospitals from December 2020 to July 2021. Results Our results showed clinically significant improvement by comparing patients’ photographs in most of the treated patients and high mean patients’ satisfaction with minor encountered side effects. Moreover, dermoscope revealed significant increased median terminal hair density in all patients 6 months after nanofat session. Conclusion Although the exact mechanism of action is still unclear, nanofat injection can be considered an effective treatment modality for androgenic alopecia. Yet, further studies are needed with a bigger number of cases to minimize statistical errors and to detect the most accurate nanofat isolation method yielding best results.

A clinical trial of treating androgenic alopecia with mesenchymal stem cell suspension derived from autologous hair follicle.

Androgenic alopecia (AGA) is characterized by progressive hair follicle miniaturization, and novel treatments are needed to intervene in the miniaturization process. We aimed to evaluate the efficacy, safety, effectiveness, and effective population of autologous hair follicle mesenchymal stem cell therapy for the treatment of advanced AGA in Chinese people. 50 patients ranging from 25 to 45 years old, with an average age of 32 ± 1.24 years were included. None of them had ever used minoxidil, finasteride, or other drugs to promote hair growth. Healthy hair follicles were extracted from the occipital area and treated to obtain hair follicle mesenchymal stem cells suspensions. The recipient sites were divided into two groups. Nine points were injected in a 1 cm 2 area, and 100 µl of solution containing either 1 × 10 5 cells or normal saline was injected at each point. The follow-up duration was 9 months. Observers were blinded to patient groupings and measurements. An increased proportion of terminal hair and hair shaft diameter was observed in the experimental group at 1 month; the effect lasted until 3 months. The hair thickening effect of advanced miniaturized hair follicles with hair shaft diameter less than 60 µm was more notable than that above 60 µm. None of the patients experienced any obvious side effects. Hair follicle mesenchymal stem cells were effective in the treatment of Chinese advanced AGA, and a hair shaft diameter of 60µm can be used as a key index to predict the effectiveness of the therapy.

Correlation between sebum level and severity of male androgenetic alopecia

Background: Androgenetic alopecia is the main concern hair problem in the male which is characterized by progressive miniaturization of hair follicles. One factor which contributed in androgenetic alopecia progression is sebum level. This study determined the correlation between sebum level and the severity of AGA in men. Patients and methods: This study was an observational analytic study with a cross sectional method involving 50 male androgenetic alopecia (AGA) patients based on inclusion and exclusion criteria. Recorded age, education, occupation, family history and duration of illness. AGA severity was determined by the Hamilton- Norwood classification I–VII. Sebum levels were measured using Sebumeter® SM 815. The correlation between sebum level and severity of AGA was analyzed using the Gamma correlation test and significant if p-value<0.05. Results: Most AGA patients were found in the 36–45 age group, had a diploma/bachelor education level, worked in business services and salespeople, had a family history of their father suffering from AGA, and had suffered from AGA for >20 years. Most AGA patients were found in Hamilton-Norwood III (50%) with the most sebum levels were found to be normal (60%). The results of this study showed a positive correlation (p<0.01) with a very strong strength between sebum level and severity of AGA (r=0.94). Conclusion: There is a very strong correlation between sebum level and severity of AGA.

Evidence Based Treatments of Alopecia Areata

Androgenetic Alopecia (AGA) is considered as major non-cicatricial alopecia which causes progressive hair follicle miniaturization. To a large extent, a person's genetic makeup and hormonal environment determine whether or not their terminal scalp hairs will be transformed into vellus hairs. AGA becomes more common and commoner as people get older. AGA is a progressive disorder characterized by a shortening of the anagen phase and maintenance of the telogen phase. Females with AGA tend to see more diffuse hair loss over the head, while males with AGA tend to experience thinning near the vertex. The gold standard treatments for AGA are minoxidil (used topically) and finasteride (an oral 5α-reductase inhibitor type II inhibitor) and they are the only medications accepted by the Food and Drug Administration (FDA) to date. The success of existing therapy for AGA is frequently questioned, making the discovery of new therapeutics for this illness of critical importance. In an effort to slow the disease's course and boost its outcomes, this article will examine the causes and diagnostic tools used to identify AGA.

Guava (Psidium guajava L.) Leaf Extract as Bioactive Substances for Anti-Androgen and Antioxidant Activities.

Leaves of guava (Psidium guajava L.) have been used in Thai folk medicine without any supporting evidence as a traditional herbal remedy for hair loss. Androgenetic alopecia (AGA) is chronic hair loss caused by effects of androgens in those with a genetic predisposition, resulting in hair follicle miniaturization. Our objectives were to provide the mechanistic assessment of guava leaf extract on gene expressions related to the androgen pathway in well-known in vitro models, hair follicle dermal papilla cells (HFDPC), and human prostate cancer cells (DU-145), and to determine its bioactive constituents and antioxidant activities. LC-MS analysis demonstrated that the main components of the ethanolic extract of guava leaves are phenolic substances, specifically catechin, gallic acid, and quercetin, which contribute to its scavenging and metal chelating abilities. The guava leaf extract substantially downregulated SRD5A1, SRD5A2, and SRD5A3 genes in the DU-145 model, suggesting that the extract could minimize hair loss by inhibiting the synthesis of a potent androgen (dihydrotestosterone). SRD5A suppression by gallic acid and quercetin was verified. Our study reveals new perspectives on guava leaf extract's anti-androgen properties. This extract could be developed as alternative products or therapeutic adjuvants for the treatment of AGA and other androgen-related disorders.

Outcome of Dutasteride 0.5mg in Androgenic Alopecia

Introduction: Androgenetic alopecia (AGA) is an androgen-mediated condition that is characterized by a progressive decline in visible scalp hair density. Genetically predisposed hair follicles are the target of dihydrotestosterone (DHT), which leads to the progressive miniaturization of hair follicles and hair thinning. Dutasteride inhibits conversion of testosterone to dihydrotestosterone, which significantly improves hair growth. Objective: To assess the outcome of dutasteride in androgenic alopecia. Methods: This study was carried out at Dermatology and Venereology Department, Enam Medical College Hospital, Savar, Dhaka, Bangladesh from January2022 to July 2022. From the outpatient clinic fifty (50) patients were recruited who fulfilled the inclusion and exclusion criteria. Dermatologist observe every patients hair changes before, during &after treatment with dutasteride for 24 week. Results: Out Of the 50 patients, 60% patients were female. 40% patients noticed hair loss first at the age of 16-25 years of their lifetime. 44% patients had this disease from 1 to 6 months duration. After 6 months of therapy with dutasteride 0.5mg 20% patients were improved markedly, followed by 24% improved moderately, 16% improved mild. Besides that, six months after dutasteride treatment, there was significant improvement in both hair density and thickness. And during treatment libido decreased in 24% cases and ejaculatory disorder seen in 14% cases. After 6 months therapy in patients where 20% improved markedly, followed by 24% improved moderately, 16% improved mild. Conclusion: It is concluded that dutasteride at a dosage of 0.5 mg/d clinically improve hair growth after six months of therapy in patients with AGA but there was a higher prevalence of sexual dysfunction. Large number of studies are required to recommend dutasteride 0.5 mg/d as the alternative therapeutic option for AGA.

Dendrobium officinale Polysaccharide (DOP) Promotes Hair Regrowth in Testosterone-Induced Bald Mice.

Androgenetic alopecia can affect up to 70% of males and 40% of females; however, certain therapeutic medications offer partial and transitory improvement but with major side effects. Dendrobium officinale polysaccharide (DOP) has been reported to improve androgen-related hair loss in mice, but the molecular mechanism remains unclear. To explore the effects of DOP on androgenetic alopecia. In this study, testosterone was subcutaneously administered to shave dorsa skin of mice to establish androgenetic alopecia; the effects of DOP in androgenetic alopecia were explored by DOP administration. Testosterone treatment extended the time of skin growing dark and hair growing, decreased the mean numbers of follicles in skin tissues, decreased β-catenin and cyclin D1 levels, and elevated testosterone, DHT (dihydrotestosterone), and 5α-reductase levels. In contrast, DOP administration shortened skin growing dark and hair growing times, promoted follicle cell proliferation, increased follicle numbers, increased β-catenin and cyclin D1 levels, and decreased testosterone, DHT, and 5α-reductase levels. DOP application significantly improved testosterone-induced hair follicle miniaturization and hair loss, possibly through affecting the Wnt signaling and hair follicle stem cell functions. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Predictive Value of Midscalp Hair Density and Terminal Hair Percentage in the Severity Evaluation of FPHL Assessed by Trichoscan in a Sample of Chinese Population.

Female pattern hair loss (FPHL) is the most common hair loss disorder in women, which may impair patient's self-identity. It presents as a diffuse reduction in hair density at the mid and frontal regions of the scalp with preservation of the frontal hairline. TrichoScan can be used as a diagnostic tool and for monitoring patients in male pattern hair loss, but little is known in FPHL with Chinese population. To explore the predictive value of various TrichoScan characteristics at different areas of the scalp in the diagnosis and evaluation of FPHL. A total of 261 FPHL subjects were divided into three groups according to Ludwig classification. Together with 108 healthy controls, they were evaluated by computer-assisted TrichoScan. Various hair parameters were analyzed in the frontal, midscalp, vertex, parietal, and occipital areas of the scalp. Declining hair densities, terminal hair percentage, hair follicular unit density, mean hair diameter, and average hair/unit combined with increased intermediate hair percentage, and vellus hair percentage were observed across all areas of the scalp for FPHL subjects. Hair density and terminal hair percentage in the midscalp area were the factors most affecting Ludwig classification. The two parameters combined achieved 85.12% correct classification rate and an area under the ROC curve of 0.88 in the diagnosis of FPHL. Additionally, we reported a unique type of FPHL which mostly affected the parietal area, occurring with or without traditional midline changes. FPHL in a Chinese population presented characteristics of reduced hair density and miniaturization of hair follicles in the midline scalp and to a lesser extent in the parietal area. Hair density and terminal hair percentage in the midscalp exhibited the greatest predictive value of Ludwig classification. Our results may further provide the basis for quantitative classification of FPHL.

Pharmacotherapy of androgenetic alopecia – a literature review

INTRODUCTION: Androgenetic alopecia, also known as male pattern baldness, is a common dermatological problem. It manifests as hair thinning and miniaturization of hair follicles. In recent years, knowledge of the risk factors and pathomechanisms of this disease has increased, making treatment more effective. Serious consequences of this condition include reduced quality of life and patient self-esteem.
 PURPOSE OF THE WORK: The purpose of this paper is to review and discuss selected studies involving agents used in the pharmacotherapy of androgenetic alopecia and to evaluate their safety and efficacy.
 DESCRIPTION OF THE STATE OF KNOWLEDGE: There are two drugs approved by the Food and Drug Administration (FDA) for the treatment of androgenetic alopecia - oral finasteride 1 mg and 2% or 5% minoxidil solution for topical use. There are also other preparations for external use, such as 0.1% finasteride solution or ketoconaloze shampoo, and for oral use, dutasteride. They seem to be a promising alternative for the treatment of androgenetic alopecia, but require further research. It is possible to use one drug of choice or to use combination therapy to achieve better therapeutic effects.
 SUMMARY: In order to achieve the best and fastest treatment results, patients should be treated with combination therapy consisting of two or more preparations. To reduce systemic side effects, consider using several topical preparations.

Women’s hair loss: pathophysiological, diagnostic and therapeutic aspects

The article presents a review of modern ukrainian and foreign publications on the pathogenesis, clinical manifestations and diagnostics of female pattern hair loss (FPHL), which is a common type of hair loss and its frequency increases with age. The questions of terminology, disease prevalence, and risk factors of hair loss are considered. It is emphasized that FPHL is a clinical problem and that it is advisable to clarify the comorbid profile of female patients and to screen for metabolic disorders. There is still no complete understanding of the pathophysiology of FPHL. There is evidence that hormonal, genetic, and environmental factors are involved in the process of hair loss in women. Current data concerning systemic hormonal disturbances in ovarian and adrenal gland diseases in women as well as the importance of disorders of androgen-dependent mechanisms of regulation of the hair follicle growth cycle are presented.The attention is drawn to genetic abnormalities in the case of FPHL. The role of growth factors, cytokines, microinflammation, iron deficiency, perifollicular fibrosis, oxidative stress in regression of the hair follicle is considered. FPHL is characterized as non-scarring alopecia, which develops due to progressive miniaturization of hair follicles and further hair reduction, especially in the central (frontal and parietal) scalp, gradual replacement of long terminal hair by short pubic (vellus) hair. Three models of female hair loss, modern classification according to the stages of progression used in practice, possible causes of clinical differences in alopecia in men and women are presented. The main directions of diagnostics (history, clinical and laboratory examination, special dermatological tests) are outlined, the possibilities of modern noninvasive diagnostic method of dermoscopy are emphasized. Pharmacotherapy, recommended on the basis of evidence-based medicine, is limited to two drugs – topical minoxidil and systemic finasteride. The necessity of interdisciplinary approach to the management of patients with FPHL has been proved.

A Novel Pathogenic CDH3 Variant underlying Heredity Hypotrichosis Simplex detected by Whole-Exome Sequencing (WES)-A Case Report.

Heredity hypotrichosis simplex (HHS) is a rare nonsyndromic disease form of hypotrichosis simplex (HS) characterized by progressive hair follicle (HF) miniaturization. It is usually inherited in an autosomal dominant manner. The differential diagnosis of HHS and the treatments remain challenging despite recent advancement. In this report, we describe a 19-yr-old female affected with HHS alongside most of her family members. Whole-exome sequencing (WES) was performed for some of the family members to unravel the culprit gene involved in HHS phenotype and ascertain the dermatological examination that was done to classify the phenotypes of the disease. A novel pathogenic variant in the CDH3 gene (p.Ser223GlyfsTer4) was identified as a plausible disease-causing variant for HHS. This is the first report to associate CDH3 variants with a HHS phenotype without macular degeneration using WES. WES is an important tool for genotype–phenotype correlation, precision in diagnosis, and in-depth understanding of the disease mechanisms, leading to possible novel therapeutic targets treatment and better patient outcomes.

279 The use of PRP to target dysregulated pathways in androgenetic alopecia

Androgenetic alopecia (AGA) is the most common type of progressive hair loss; however, its treatment remains limited in scope, thus driving the need for alternative therapies for hair restoration. The pathogenesis of androgenetic alopecia is not completely understood but involves disruption of the Wnt/β-catenin signaling pathway, resulting in premature termination of the anagen growth phase in hair follicles. This manifests clinically as the transformation of terminal hair into thinner vellus-like hair, a process known as hair follicle miniaturization.

708 Aire deficiency induces upregulation of JAK-STAT signaling in keratinocytes and results in alopecia areata-like lesions in mice

Alopecia areata (AA) is an autoimmune hair loss disorder with no cure. We report here that C57BL/6J female mice with germline deficiency in autoimmune regulator (Aire-/-) spontaneously developed AA-like lesions (n=61/98; 62%). Aire-/- lesions exhibited AA hallmarks such as miniaturized hair follicles (HFs), decreased hair width (-29%, p<0.0173) and length (-27%, p=0.0002), and increased lymphocytic infiltrate at the hair bulb (+191% in CD8+ T cells, p=0.0546) relative to body site matched Aire+/+ tissue.

726 The Wnt-inhibitor Dkk4 is required for primary hair follicle induction and patterning

Androgenetic alopecia is a common form of pattern hair loss, characterized by miniaturized hair follicles (HFs) at the front and parietal scalp, while hairs on the occipital scalp are preserved. Moreover, different sites of the human body exhibit distinct types and patterns of HFs. Understanding the molecular basis of this heterogeneity will help to design targeted treatment strategies. The Wnt signalling pathway and its Dickkopf (Dkk) inhibitors have been suggested to regulate HF induction and patterning.