Terminal Hair Regrowth Research Articles

Hair regrowth in alopecia areata and re-pigmentation in vitiligo in response to treatment: Commonalities and differences.

Both alopecia areata (AA) and vitiligo share common pathogenesis involving, interferon-γ (IFN-γ) and interleukin-15 (IL-15) signalling pathways that activate cytotoxic CD8+ T lymphocytes. These shared mechanisms may explain why both diseases respond to currently available treatments (e.g. topical/systemic corticosteroid) and emerging treatment modalities. As compared with the speed of re-pigmentation in vitiligo lesions, the regeneration of pigmented terminal hair follicles in AA lesions appears fast in response to treatments targeting the inhibition of the Janus kinases (JAKs) and other kinases. We summarize the commonalities and differences between AA and vitiligo focusing on the treatment modalities, followed by recent findings associated with hair follicle stem cells (HFSC) in hair bulge (HBg) and melanocyte stem cells (McSC) in HBg and hair germ (HGm). We then discuss how HFSC and HGm-McSC are involved in the initiation of anagen phase, followed by pigmented terminal hair regrowth in the recovering AA lesions in association with immunology. We also discuss how HBg-McSC contribute to the migration of fully dendritic mature melanocytes into interfollicular epidermis and the equal distribution of melanin in recovering vitiligo lesions. Finally, we present four hypotheses to elucidate the delayed distribution of melanin by mature melanocytes in depigmented vitiligo lesions from the aspects of stem cell biology, as compared with quick hair recovery in AA: (1) McSC are less abundant than HFSC. (2) McSC require a long travel, whereas HFSC reside close to hair regeneration trigger point. (3) Keratinocyte scaffold to accept melanin is not well preserved, whereas scaffold for hair regrowth is well preserved. (4) Inhibitors targeting JAKs and other kinases have less direct effects on melanocyte proliferation and differentiation in vitiligo than hair regrowth in AA. Our review provides an overview of treatment modalities and bridges the gap between scientific advancement and clinical practice in AA and vitiligo management.

Clinical and Pathological Evaluation of Hemp Seeds Oil Effectiveness in the Treatment of Alopecia Areata

Background: Alopecia areata is an inflammatory, autoimmune, non-scarring, common patchy, hair-loss condition. Many treatment lines are used to treat alopecia areata, but all are palliative. Alternative medicine, like aromatherapy is expected to promote hair growth, but they are still lacking the scientific basis. Hemp oil is one of the aromatherapies that comprises polyunsaturated fat in approximately 76% involving “essential fatty acids” mainly omega-6 fatty acids” and lesser amount of “omega-3 fatty acids.” Objective: The aim of this study was to evaluate hemp seed oil effect in the treatment of patients with alopecia areata. Materials and Methods: This was a clinical trial planned to evaluate the efficacy of hemp seed oil in 20 patients with localized alopecia areata for 2 months. Plant material is hemp oil extract, applied at night daily for 2 months. Regrowth of terminal hair was evaluated by clinically and by trichoscope examination to evaluate the pathologic changes response. The assessment was done at 0, 4, and 8 weeks of the treatment. Results: After 8 weeks of the treatment, the response was marked in five (25%) patients, moderate in eight (40%) patients, and mild in two (10%) patients. Five (25%) patients revealed no response. There was a significant increase in the response of patients who were under the marked improvement group between 4 and 8 weeks of treatment (P < 0.05). Conclusion: Hemp seed oil can be considered as a promising therapeutic agent for localized alopecia areata. Additional clinical trials are advised to adjust the dose and determine the period of time, which is required to obtain a better result.

Sex differences in clinical trials of ALRV5XR treatment of androgenetic alopecia and telogen effluvium.

IntroductionALRV5XR treatment of androgenetic alopecia (AGA) and telogen effluvium (TE) has early evidence of regenerating a normal scalp hair phenotype in both sexes.DesignWe performed two 24-week double-blinded placebo-controlled comparison trials, one in each sex, on the ALRV5XR treatment effect on hair regeneration, in AGA and TE, in 92 AGA subjects (24 also had TE). Forty-six women (age 24–64 years) and 46 men (age 22–63 years) were randomized 1:1 to either ALRV5XR or placebo regimens (one b.i.d. oral capsule and daily administration of shampoo, conditioner, and follicle serum).EvaluationPrimary outcomes: Absolute and relative changes in terminal hair (TH) density. Secondary outcomes: Response rate, changes in vellus hair (VH) density, TH/VH ratio, hair diameter, growth, and shedding rate.ResultsForty-one women (20 ALRV5XR, 21 placebo) and 36 men (17 ALRV5XR, 19 placebo) completed the trials. TH outcome was evaluable for 18 and 21 women and 11 and 11 men (ALRV5XR, placebo, respectively). Efficacy in women: 30.1 THs/cm2 (p = 0.0002) and 19.7% (p = 0.0016). Efficacy in men: 21.0 THs/cm2 (p = 0.0014) and 16.4% (p = 0.0012). 66.7% of women and 100% of men responded to ALRV5XR. TH/VH ratio for men increased 33.0% (p = 0.0033). Growth rate in women increased by 30.7 μm/24 h (p < 0.0001) and 10.0% (p < 0.0001). There were no adverse events reported.Conclusion and relevanceALRV5XR induced significant regrowth of TH. Accelerating regrowth by reactivation of dormant telogen follicles were the dominant effects in women. Thickening of miniaturized hair and regrowth of dormant telogen follicles contributed equally to the increased TH seen in men (see Graphical ).

Risk factors of long-term alopecia after pulsed-dye laser treatment for infantile scalp hemangiomas: A retrospective study.

Pulsed-dye laser (PDL), as an effective and frequently-used treatment modality for infantile hemangiomas (IH), could render patients at risk of developing long-term alopecia. Data on alopecia caused by PDL treatment remain scant and the contributing factors are not clear. Our objective was to identify the risk factors associated with long-term alopecia resulting from PDL treatment for scalp IH. We conducted a retrospective study incorporating patients with IH diagnosis and PDL intervention via thoroughly reviewing the clinical database of the dermatology department. Scalp IH patients were further screened and their medical records were collected. Long-term alopecia was defined as no signs of terminal hair regrowth for at least 2years in this study. Of the 1293 IH patients, 47 (14 boys and 33 girls) with a mean age of 4.5months (standard deviation, 3.2) were diagnosed as scalp IH and had subsequently undergone PDL treatments. Hair growth in the treatment area of 18 patients (38.3%) nearly returned to normal, 22 patients (46.8%) had varying degrees of hair loss, and seven patients (14.9%) had no hair regrowth (long-term alopecia). Compared with the older patients receiving treatment, IH patients younger than 3months who started PDL treatment had a higher risk of developing long-term alopecia (odds ratio, 30.833; 95% confidence interval, 4.079-232.025; p=0.01). The total number of PDL sessions, post-treatment blisters, and location of IH were not shown to be significantly associated with the development of long-term alopecia. Collectively, our study provides an important insight into curating treatments for IH in infants younger than 3months. PDL treatments for scalp IH may perhaps be avoided or delayed to prevent the development of treatment-associated long-term alopecia.

Safety and efficacy of ALRV5XR in men with androgenetic alopecia: A randomised, double-blinded, placebo-controlled clinical trial.

BackgroundAndrogenetic alopecia (AGA) is the most common hair loss disorder seen in men. It can have an early onset but has also been associated with ageing and senescence. It often induces pronounced psychological impact. ALRV5XR, a new hair loss treatment herein evaluated, was designed to target multiple molecular pathways involved in hair growth and hair follicle stem cell biology. The main objectives of the study were the assessment of safety and efficacy profiles of ALRV5XR in men.MethodsThis 24-week, parallel randomised, placebo-controlled, double-blinded clinical trial was performed in a USA community clinic. Healthy men (age 22–65) with AGA and belonging to the Hamilton-Norwood (HN) classification I–VII and Fitzpatrick skin type (FST) I–VI, were randomly allocated in a 1:1 ratio into ALRV5XR or placebo treatment groups. Dermatologist assessment, phototrichograms, and blood samples were obtained in a blinded fashion at baseline, 12 and 24 weeks. Subjects were given a masked treatment consisting of oral capsules, shampoo, conditioner, and follicle serum, which was intended for daily use. Efficacy was assessed via absolute and per cent changes in terminal hair (TH) density, and response rates. The trial was registered with clinicaltrials.gov (NCT04450589) and is completed.FindingsForty-six subjects were enroled in the study, 23 allocated to the ALRV5XR treatment and 23 to the placebo group. Enrolment occurred from April 11 to October 23, 2018. Thirty-six subjects completed the trial (17 ALRV5XR, 19 placebo) and 11 subjects in each group were evaluable for TH outcomes. At 24 weeks, the absolute change in TH density improved by 21·0 THs/cm2 (95% CI: 9·2–32·8; p = 0·0014), and the relative density increased by 16·4% (95% CI: 7·4%–25·5%; p = 0·0012). The odds ratio for being a responder (≥ 0 change) was 87·4. TH density increased linearly and was not affected by HN, FST, ethnicity, age, or body mass index. All subjects in the ALRV5XR group responded to treatment while 81·8% of the placebo group decreased TH density. ALRV5XR induced statistically significant changes in both decrease in vellus hair (VH) density as well as in concomitant increase of the TH/VH ratio when compared to placebo. ALRV5XR was well tolerated, and no adverse events were observed.InterpretationALRV5XR treatment resulted in clinically significant TH regrowth in men with AGA. Furthermore, it appeared to reverse the characteristic hair miniaturisation seen in this condition. When compared to results of published trials of standard therapy, ALRV5XR showed a multi-fold increase both in efficacy and in response rates. In addition, the continuance of TH regrowth from 12 to 24 weeks suggests that the normal structure and function of non-productive telogen follicles is restored and that a normal hair phenotype may be attained by extended ALRV5XR treatment.FundingArbor Life Labs.

Safety and efficacy of ALRV5XR in women with androgenetic alopecia or telogen effluvium: A randomised, double-blinded, placebo-controlled clinical trial.

BackgroundScalp hair loss (alopecia) in women is a common ageing and senescing condition. It usually presents as androgenetic alopecia (AGA) or telogen effluvium (TE) and often has pronounced psychological consequences. ALRV5XR is a novel treatment aiming to regenerate a normal hair phenotype by targeting multiple molecular pathways linked to hair growth promotion and hair follicle stem cell activation. The primary objectives of this 24-week trial were to evaluate the safety and efficacy of ALRV5XR in terminal hair (TH) regrowth in women with AGA or TE.MethodsThis randomised, double-blind, placebo-controlled trial was performed in a USA community clinic. Healthy women 18-65 years of age with AGA or TE of Ludwig classification I-II and Fitzpatrick skin type I-VI were enrolled. They were allocated in a 1:1 ratio into ALRV5XR or placebo treatment groups using a random number table. Masked dermatologist assessments, phototrichograms and blood samples were obtained at baseline, 12 and 24 weeks. Subjects were given a masked treatment regimen of oral capsules, shampoo, conditioner and follicle serum for daily administration. Main outcomes were absolute and per cent changes in TH density and response rates. The trial was registered with clinicaltrials.gov (NCT04450602) and is completed.Findings46 subjects (23 ALRV5XR, 23 placebo) were enrolled between April 3 and October 20, 2018. Five subjects dropped out and two were non-compliant. Thirty-nine subjects completed the trial (18 ALRV5XR, 21 placebo). At 24 weeks, the absolute change in TH density improved by 30·1THs/cm2 (95% CI: 15·1–45·1; p=0·0002), and the relative density increased by 19·7% (95% CI: 8·0%–31·4%; p=0·0016). The odds ratio for being a responder (≥0 change) was 2·7. Efficacy increased 133% from week 12 to 24. Efficacy outcomes were similar in AGA and TE subjects. 66·7% of the ALRV5XR group responded by regrowing 40THs/cm2 or more hair. No adverse events were reported.InterpretationIn women with AGA or TE, ALRV5XR treatment significantly increased hair regrowth without adverse events. ALRV5XR displayed a multi-fold improved efficacy and response rate when compared to published trials of standard therapy. Progressive acceleration of TH regrowth suggests regeneration of the structure and function of non-productive telogen follicles and prolonged treatment may restore a normal hair phenotype.

Linear lupus panniculitis of scalp: a case report from north-east India

&lt;p class="abstract"&gt;Lupus panniculitis of scalp is an uncommon manifestation of lupus erythematosus, which presents as non-scarring linear, arched, or annular alopecia along the lines of Blaschko. A 7 year old child presented with localised linear non-scarring alopecia on scalp. Examination revealed a single linear alopecic patch on the left parietal scalp. There were no associated systemic complaints. Skin biopsy showed atrophic lining epithelium, diffuse and nodular lymphocytic and plasma cells infiltrates in the superficial and deep dermis, lobular inflammatory infiltration of lymphocytes, histiocytes and plasma cells, with minimal involvement of septa in the subcutaneous tissue. Antinuclear Antibody (ANA) and anti-ds DNA tests were negative. Patient responded well with regrowth of terminal hair within 3 weeks to a combination treatment of hydroxychloroquine, topical and intralesional steroids, and topical calcineurin inhibitor. Linear lupus panniculitis of scalp should be considered in cases of patterned, non-scarring alopecia. Regular follow-up is also essential due to the possibility of recurrence and development of systemic lupus erythematosus.&lt;/p&gt;

Superficial Cryotherapy, Does It Work In Alopecia Areata?

Abstract:Alopecia areata is a common cause of nonscarring alopecia, with patchy, confluent or diffuse patterns, involving mainly the scalp and other hairy areas of the body. It's considered a therapeutic challenge due to prognosis, unpredictable course and variable efficacy of available therapies. Several studies have evaluated the efficacy of cryotherapy in the treatment of alopecia areata with varying success rates.Superficial cryotherapy using liquid nitrogen mainly was used in several studies for treating alopecia areata with various subtypes including mild, moderate and recalcitrant alopecia areata, and alopecia totalis with variable rates of therapeutically accepted terminal hair regrowth. Its main mechanisms of efficacy in alopecia areata are vascular changes and immunomodulation. Superficial cryotherapy was effective and safe in treating alopecia areata of the eyebrows. It was nearly as effective as topical steroids and topical PUVA therapy, and was combined with topical immunotherapy and topical steroid with increased efficacy. It's well-tolerated, convenient and simple office-based procedure, especially in children who are susceptible to side effects of other conventional therapeutic options.The reported side effects of superficial cryotherapy included vesiculation, erosion, crust formation, transient pigmentary alteration and partial leukotrichia, however they were transient. Key words: alopecia, cryotherapy, liquid nitrogen

Alopecia areata treated with dimethyl fumarate: A case series.

Alopecia areata is an autoimmune condition leading to non-scarring hair loss. Clinically, several presentations ranging from single or few small patches to complete hair loss are documented. The management of alopecia areata is challenging and all available treatments do not ensure a long-term remission to assess the safety and efficacy of systemic dimethyl fumarate in alopecia areata patients not responding to other systemic treatments. After obtaining informed consent, we administered off-label dimethyl fumarate to 10 adult patients with alopecia areata, for a period ranging from 4 to 37 weeks. Medical information for each patient and the severity of alopecia tool (SALT) score before and after dimethyl fumarate administration were recorded. During the treatment, 50% of patients (5 patients out of 10) had a slight improvement of hair regrowth; it was mainly as partial hair regrowth (ranging from 8% to 32%) and only one patient (10%) achieved > 50% terminal hair regrowth. Authors conclude that dimethyl fumarate is not advisable as a treatment of alopecia areata, also considering the risk of fumaric acid esters toxicity.

Superficial cryotherapy versus topical psoralen and ultraviolet A in the treatment of alopecia areata: a randomized, controlled trial

Background Alopecia areata (AA) is a prevalent autoimmune skin disease with no definitive cure or standard therapeutic options. Topical psoralen and ultraviolet A (PUVA) proved to be effective in the treatment of AA, while superficial cryotherapy has been described in the literature as one of the emerging unconventional therapies for AA with varying degrees of success. Objective To clarify and compare the therapeutic efficacy and safety of superficial cryospray versus topical PUVA in the treatment of mild-to-moderate AA. Patients and methods Fifty-two patients with mild-to-moderate AA were recruited and assigned into two groups. Group 1 included 27 patients who were treated with superficial liquid nitrogen cryospray every 2 weeks for 12 weeks and group 2 included 25 patients treated with topical PUVA twice weekly for 6 weeks. Patients showing more than 25% terminal hair regrowth are considered responders. Results An excellent response was obtained in 33% (9/27) of the patients in group 1 treated with cryospray compared with 28% (7/25) in group 2 treated with topical PUVA. However, a satisfactory response was achieved in 29.6% (8/27) of the patients in group 1 compared with 52% (13/25) in group 2 with statistically insignificant difference. Both therapeutic modalities were well tolerated with minimal side effects. Conclusion Superficial liquid nitrogen cryospray is a comparable therapeutic option to topical PUVA in mild-to-moderate AA. Moreover, it has the advantage of being a simple, convenient, short-term, and office-based technique.

The comparison of therapeutic effect of Clobetasol propionate lotion and squill extract in alopecia areata: a randomized, double-blind clinical trial.

Alopecia areata is a chronic inflammatory disease that characterized by round or oval patches of non-scarring hair loss. From the past, Urginea maritima (white squill) was used for the treatment of hair loss in Iranian traditional medicine. We aimed the comparison of Clobetasol lotion and squill extract efficacy in treatment of alopecia areata in a randomized, double-blind clinical trial. The 42 patients were randomized into two groups. Both groups received topical squill and clobetasol lotion twice daily lotion for 12 weeks. Clinical evaluation included size of patches (using 1×1 cm2 schablone), total number of grown hair and number of terminal hair was performed every 2 weeks. Re-growth of terminal coarse hairs was evaluated using a semi-quantitative regrowth score (RGS) (0: no regrowth, 1: growth of <25%, 2: growth of 25-50%, 3: growth of 51-75%, 4: growth of >75%). There were significant differences between RGS4 in two groups after 2- and 3-month treatment (P<0.05). At the end of follow-up period, the mean hair growth rates increased significantly from 6.5 to 11.3 in squill group (P=0.031) and it improved significantly from 10.3 to 17.9 in clobetasol group (P=0.001). There were no significant differences between mean hair growth rates in two groups after 3-month treatment (P=0.969). The lotion 2% of U. maritima bulbs extract showed good effect in 45% patients with patchy alopecia areata and showed moderate effect on re-growth of terminal hairs.

Topical Immunomodulation with Diphenlycyclopropenone for Alopecia Areata

Introduction: Topical immunotherapy with diphenylcyclopropenone is a treatment option for patients with refractory or extensive alopecia areata. The aim of this study was to evaluate the clinical efficacy and tolerability of diphenylcyclopropenone therapy, in patients with alopecia areata, and identify possible prognostic factors that predict response to treatment.&#x0D; Methods: We conducted a retrospective study that included all patients diagnosed with alopecia areata and treated with diphenylcyclopropenone at our Department.&#x0D; Results: Twenty one patients were included for analysis (15 females and 6 males). Overall, nine patients (42.9%) had some hair regrowth with diphenylcyclopropenone therapy. Of these, five (55.6%) achieved pigmented terminal hair regrowth but with persistent patches of alopecia. Only one patient achieved &gt; 90% of hair regrowth. Older age at onset, broader extent of alopecia at baseline and presence of nail dystrophy were all negative prognostic factors (p &lt; 0.05). Atopy and thyroid dysfunction were not statistically significant as predictors of poor treatment outcome. Adverse effects were documented in 15 patients, most of them were mild and did not lead to treatment interruption.&#x0D; Conclusion: Diphenylcyclopropenone therapy is a viable treatment option in patients with extensive alopecia areata, although the response is partial in the majority of the cases. Limitations of this study include its retrospective nature and the limited number of patients.

Efficacy and safety of anthralin in combination with diphenylcyclopropenone in the treatment of alopecia areata: a retrospective case series.

Contact immunotherapy with diphenylcyclopropenone (DPCP) and anthralin is considered the treatment option for extensive alopecia areata (AA) unresponsive to DPCP immunotherapy alone. Only one study has described the efficacy of combination therapy; therefore, we investigated whether topical DPCP and anthralin can promote hair regrowth in DPCP-non responders. In this retrospective case-series we analyzed the efficacy and side effects of DPCP with anthralin in AA patients who did not respond to several months of treatment with DPCP alone. Thirty-two DPCP-nonresponsive AA patients were treated with DPCP and anthralin for the average of 8.3 ± 3.8 (3-17)months. During the treatment, 40.62% of patients (13 patients out of 32) had terminal hair regrowth. The mean of hair regrowth rate was 41%; it was mainly as partial hair regrowth (˂ 50%) and 27.27% of cases achieved > 50% terminal hair regrowth. Treatment response strongly related to the duration of combination therapy (p value ˂ 0.001), but we did not find any relation with other demographic characteristics. The first signs of response to treatment were noticed 2-12months (5.5 ± 3.4) after initiation of combination therapy while there was a positive correlation among the duration of treatment and percentage of hair regrowth (p < 0.001). The most common complication was bullae (25%), and the least frequent side effect was generalized pruritus (3.1%). The combination therapy with DPCP and anthralin could be effective to treat DPCP non-responder AA patients. Additionally, the higher treatment response could be achieved by longer treatment duration.

Chronological clinicopathological characterization of rapidly progressive alopecia areata resistant to multiple i.v. corticosteroid pulse therapies: An implication for improving the efficacy.

Intravenous corticosteroid pulse therapy (pulse therapy) has been reported to be effective for rapidly progressive alopecia areata (RP-AA). Mostly, a single 3-day administration of corticosteroid (methylprednisolone 500 mg/day) has been performed in Japan; however, to what extent additional administrations improve the outcome has not been fully elucidated. To assess the advantage of repeating the pulse therapy to RP-AA cases refractory to the initial intervention, retrospective clinicopathological analysis was performed. Detailed chronological analysis was conducted in eight cases (one man and seven women; average age, 38.3 ± 10.4 years) demonstrating total scalp hair loss 3 months after the first pulse therapy and treated with additional rounds of the pulse therapy. All cases manifested total hair loss, scalp edema, itch or pain on the scalp after the initial intervention. Histopathological analyses of affected lesions prior to additional pulse therapies revealed persisting dense perifollicular lymphocytic inflammation in all cases. Interestingly, such inflammatory change tended to be severer when compared with previously reported pulse therapy good responders. Extra pulse therapy resulted in partial regrowth of terminal hairs in three out of eight cases, but all of them experienced relapse in the long run. The literature review also suggested limited efficacy of repeating pulse therapy to severe AA cases. These findings suggested that the efficacy of currently conducted repetitive pulse therapy is limited in RP-AA cases with extensive perifollicular inflammation and resistant to the initial pulse therapy. Modulation of the dose and the interval of intervention, in combination with alternative approaches, may be required to achieve a successful outcome.

Best dilution of the best corticosteroid for intralesional injection in the treatment of localized alopecia areata in adults

Purpose: To evaluate and compare the clinical efficacy, dermoscopic results and safety of triamcinolone acetonide (TA) and betamethasone dipropionate (BD) injections at different concentrations in localized scalp and beard alopecia.Methods: Intralesional injection of BD or TA in three different dilutions; 1/4, 1/8, 1/12 (BD1, BD2, BD3, TA1, TA2, TA3) and Saline (control) was randomly applied to a total of 231 alopecia patches in 83 patients every four weeks in a maximum of six sessions until a hair regrowth score of 4 was achieved. The number of required sessions, sixth-month hair regrowth scores, treatment success rates and dermoscopic data were investigated.Results: The mean number of required sessions were similar and significantly lower in BD1 and TA1 being 4.21 ± 1.12 and 3.74 ± 0.99, respectively. Dermoscopic examinations revealed similar terminal hair growth rations in Saline (30.3%), BD1 (44.4%) and TA1 (42.9%). However, sixth-month hair regrowth scores, overall treatment success rates and percentage of terminal hair regrowth were similar in BD1 and TA1. However, adverse effects were more common in TA groups (24.3%) than in BD groups (10.6%) at the sixth month.Conclusions: BD ¼ dilution (1.25 mg/dL) seems best corticosteroid for intralesional injection in the treatment of localized alopecia areata in adults.

Efficacy and Safety of Methotrexate Combined with Low- to Moderate-Dose Corticosteroids for Severe Alopecia Areata

Background: In severe alopecia areata (AA), spontaneous recovery is unlikely, and treatment is not standardized. Objective: To evaluate the efficacy and safety of methotrexate (MTX) used alone or combined with low- to moderate-dose oral corticosteroids (OC) for treating severe AA (totalis, universalis and severe multifocal). Methods: Retrospective monocentric study of all consecutive patients receiving this treatment between 2006 and 2012. Efficacy was defined as achieving a total regrowth of terminal hair. Results: 26 patients were included (17 with AA universalis or totalis and 9 with severe multifocal AA). Total regrowth was noted in 15/26 patients. After 3 months of treatment, hair regrowth >80% was associated with further complete regrowth, and hair regrowth <30% was associated with later treatment failure (p = 0.0014). When treatment was tapered, 11/15 patients with initial complete efficacy experienced AA relapse. Conclusion: MTX combined with low- to moderate-dose OC may be an efficient and well-tolerated treatment for severe AA. However, long-term maintenance treatment is usually required.

A Comparative Study of Oral Cyclosporine and Betamethasone Minipulse Therapy in the Treatment of Alopecia Areata.

BackgroundVarious systemic agents have been assessed for the treatment of alopecia areata (AA); however, there is a paucity of comparative studies.ObjectiveTo assess and compare cyclosporine and betamethasone minipulse therapy as treatments for AA with regard to effectiveness and safety.MethodsData were collected from 88 patients who received at least 3 months of oral cyclosporine (n=51) or betamethasone minipulse therapy (n=37) for AA. Patients with ≥50% of terminal hair regrowth in the alopecic area were considered responders.ResultsThe responder of the cyclosporine group was 54.9% and that of the betamethasone minipulse group was 37.8%. In the cyclosporine group, patients with mild AA were found to respond better to the treatment. Based on the patient self-assessments, 70.6% of patients in the cyclosporine group and 43.2% of patients in the betamethasone minipulse group rated their hair regrowth as excellent or good. Side effects were less frequent in the cyclosporine group.ConclusionOral cyclosporine appeared to be superior to betamethasone minipulse therapy in terms of treatment effectiveness and safety.

Hair Regrowth Following Topical HairUpTM Treatment in Subjects with Alopecia Totalis (AT) and Alopecia Universalis (AU): A Retrospective Analysis of Efficacy and Cosmetic Acceptability

Objective: Alopecia areata is a common disorder 5-30% of cases representing alopecia totalis (AT) or alopecia universalis (AU), the most severe forms of the disorder. In the absence of any FDA-approved treatments, topical Hair UpTM has shown promising results but has not been subject to formal study. The following study reports the initial use of a customized natural topical treatment-Hair UpTM in an unselected population of AT and AU patients. It includes a cohort of patients with an intention to treat and aims to serve as a pilot study to a prospective study. Methods: A retrospective analysis of AT/AU patients treated with topical Hair UpTM was conducted. The study assessed type of hair growth and the percentage hair regrowth using the severity alopecia tool (SALT) scoring system with a subjective determination of the cosmetic acceptability of response over a 2 year follow-up period. Results: Of 109 subjects, 53 with available data were eligible for analysis including 26 minors <18 years of age (mean age 10.8+4.7 years) and 27 adults (mean age 39.1+12.2 years). There were 34 subjects with AU and 19 with AT. Treatment appeared to bevery safe with minimal contact reactivity. Almost all subjects achieved vellus hair growth (96%; 51/53) with 43% (23/53) developing full abundant hair and 81% (43/53) showing a return to quality vellus hair as early as 3 months after commencement of treatment. SALT scores exceeded 75% in 75% (21/28) of cases. Overall, 94% (17/18) of minors ultimately achieved a subjective cosmetically acceptable result compared with 58% (11/19) of adults (p=0.02). Conclusion: Topical Hair UpTM treatment of subjects with Alopecia totalis (AT) and Alopecia universalis (AU) is effective and safe with a high rate of terminal hair regrowth and cosmetic acceptability, particularly in minors.

Clinical Efficacy of Diphenylcyclopropenone in Alopecia Areata: Retrospective Data Analysis of 50 Patients.

Diphenylcyclopropenone (DPCP) is widely considered the most effective topical immunotherapy for refractory or extensive alopecia areata (AA), but questions regarding how long to try DPCP therapy before terminating and what factors are prognostic of therapeutic success still remain unanswered. In this retrospective study of 50 AA patients, we evaluated DPCP efficacy and identified patient factors predictive of therapeutic success/failure. The median duration of DPCP treatment was 3 years, with 47% patients experiencing their first regrowth in the first 6 months of DPCP therapy, 20% between 6 months-1 year, and 8% between 1-2 years. In our study, treatment success, defined as ⩾50% terminal hair regrowth, was reached in 71% of alopecia totalis patients and in 56% of alopecia universalis patients. Three factors were statistically significant predictors of poor treatment outcome-extent of hair loss before DPCP treatment, history of thyroid disease, and extent of body hair involvement. Relapse was observed in 44% of patients and significantly associated with history of thyroid disease. Common side effects were itching, rash, and local lymphadenopathy. The results of this study support our belief that DPCP therapy is a viable treatment option, can be successfully accomplished at home, and should not be terminated before 2 years.

Comparative Evaluation of Intralesional Triamcinolone Acetonide Injection, Narrow Band Ultraviolet B, and their Combination in Alopecia Areata.

Context:Alopecia areata (AA), an autoimmune disorder, can affect any hair-bearing area. No treatment so far has produced a consistent response. Narrow band ultraviolet B (NBUVB) has not been studied in its management.Aims:Comparative evaluation of intralesional triamcinolone acetonide injection, NBUVB, and their combination in AA.Materials and Methods:Forty patients (28 males and 12 females) with at least three patches of hair loss were enrolled after obtaining written informed consent. Patches were subdivided as follows: Patch 1 was injected with triamcinolone acetonide 2.5 mg/ml (total of three injections) at 3 weeks interval. Patch 2 - NBUVB was given twice a week for a total of 12 weeks. Patch 3 - combination of injection and NBUVB. Therapeutic response was recorded as regrowth of terminal hair (G0 to G4).Statistical Analysis Used:Chi-square test. P < 5% was considered significant.Results:At the end of treatment and follow-up, that is, at week 12, more than 50% of hair regrowth was evident in 27 (67.5%) patients with intralesional steroid; 7 (17.5%) with NBUVB; and 25 (62.5%) patients with their combination. This difference in the clinical response was statistically significant.Conclusions:Intralesional steroid is more effective than NBUVB and their combination is not synergistic in terms of the clinical response in AA.