Terminal Hair Research Articles

Efficacy of autologous platelet-rich plasma combined with a non-cross-linked hyaluronic acid compound in the treatment of female androgenetic alopecia: A retrospective, case-series study.

Female androgenetic alopecia (FAGA) is a condition that affects women and involves the gradual loss of terminal hair in specific areas of the scalp. The limited treatment options for FAGA necessitate the development of new strategies. This study aimed to evaluate the potential benefit of using a combination therapy composed of autologous platelet-rich plasma (PRP) and a non-cross-linked hyaluronic acid (HA) compound in the treatment of FAGA. This was a retrospective, case-series study, which enrolled nine female patients with FAGA between September 2021 and December 2022. The non-cross-linked HA compound (Hearty®, Imeik Technology Development Co., Ltd.) and PRP were implanted into the areas of hair loss over four treatment sessions separated by 4-week intervals. Patients were monitored for overall improvement in their hair loss, hair count, treatment satisfaction, and adverse events at 1, 3, and 6 months follow-up. The improvement rates, subjectively evaluated by the study physician, were 88.89% at the 1-month and 100% at the 3-month follow-up, relative to baseline. Moreover, the quantitative evaluation results showed that the FAGA patients' hair density increased by 54.51% at the 1-month and by 77.25% at the 3-month follow-up. The combination of PRP and non-cross-linked HA compound appeared to be a certain positive effective procedure for FAGA without serious adverse event. We envisage that this work will contribute to the development of new treatment options for women suffering from this condition.

Male pattern hair loss: Can developmental origins explain the pattern?

Male pattern hair loss (MPHL), also referred to as male androgenetic alopecia (AGA) is the most common type of non-scarring progressive hair loss, with 80% of men suffering from this condition in their lifetime. In MPHL, the hair line recedes to a specific part of the scalp which cannot be accurately predicted. Hair is lost from the front, vertex, and the crown, yet temporal and occipital follicles remain. The visual effect of hair loss is due to hair follicle miniaturisation, where terminal hair follicles become dimensionally smaller. Miniaturisation is also characterised by a shortening of the growth phase of the hair cycle (anagen), and a prolongation of the dormant phase (kenogen). Together, these changes result in the production of thinner and shorter hair fibres, referred to as miniaturised or vellus hairs. It remains unclear why miniaturisation occurs in this specific pattern, with frontal follicles being susceptible while occipital follicles remain in a terminal state. One main factor we believe to be at play, which will be discussed in this viewpoint, is the developmental origin of the skin and hair follicle dermis on different regions of the scalp.

Evaluation of platelet-rich plasma plus basic fibroblast growth factor combined with minoxidil in the treatment of androgenetic alopecia: A randomized controlled trial.

Platelet-rich plasma plus basic fibroblast growth factor (PRPF) has been confirmed to be a safe and valuable therapy for androgenetic alopecia (AGA). However, the efficacy of PRPF combined with minoxidil treatment remains unknown. To assess the efficacy of combined PRPF and minoxidil treatment for AGA. In this prospective, randomized controlled trial, 75 patients with AGA were randomly divided into three groups and were administered the following treatments: Group 1, direct intradermal PRPF injection; Group 2, topical minoxidil 5% twice daily; and Group 3, PRPF injection combined with minoxidil. The PRPF injection was performed three times, 1 month apart. Hair growth parameters were evaluated using a trichoscope until the sixth month of the study. Patient satisfaction and side effects were recorded during the follow-up. All patients showed improvements (p < 0.05) in hair count, terminal hair, and decrease in telogen hair ratio after treatment. The efficacy of PRPF complex therapy revealed significant improvements (p < 0.05) in hair count, terminal hair and growth rate, compared with monotherapy. Small sample size, short follow-up time and lack of quantification of GFs in PRPF. The effect of complex therapy exceed both the effects of PRPF monotherapy and minoxidil treatment, which can be a beneficial AGA treatment strategy.

SERUM VITAMIN D LEVELS IN PREMATURE ANDROGENETIC ALOPECIA- A CASE -CONTROL STUDY.

Background: Androgenetic alopecia is a hereditary, androgen-dependent disorder characterized by a gradual conversion of terminal hair into miniaturized hair and causes progressive hair loss. Studies have showed lowered vitamin D levels in patients with androgenetic alopecia, which also correlated to their severity. The purpose of this study is to determine the association and correlation of Serum vitamin D levels in premature onset of androgenetic alopecia Methods and methodology: A total of fty males clinically diagnosed with androgenetic alopecia and fty age matched healthy controls were recruited. Serum Vitamin D levels of the cases and controls obtained were assessed. The data was analysed statistically. Results: In this study the mean levels of serum vitamin D were signicantly decreased in cases, compared to controls (13.90 vs. 28.4 nmol/L; P ≤ 0.001). Eighty seven percent of the cases had deciency of vitamin D (&lt;25 nmol/L), while 13% had insufcient vitamin D levels (25-75 nmol/L). However, there was no correlation between severity of androgenetic alopecia and serum vitamin D levels. (P value =1.65). Conclusion: This study shows that majority of cases with early onset androgenetic alopecia had deciency of vitamin D levels. However, there was no correlation between severity of androgenetic alopecia and serum vitamin D levels

A STUDY TO COMPARE THE CLINICAL EFFICACY OF PLATELET-RICH PLASMA (PRP) AND PLATELET RICH PLASMA (PRP) WITH MINOXIDIL IN PATIENTS WITH ANDROGENETIC ALOPECIA (AGA)

Pattern or androgenetic alopecia is a genetically dened condition caused by an overreaction to androgens that affects up to 50% of boys and girls. It is distinguished by gradual loss of terminal hair on the scalp at any point after puberty, with a distinct pattern in both men and girls. Hair loss is most noticeable in the vertex and frontotemporal areas of men, although the frontal hairline is usually spared in women, with diffuse apical hair loss seen as a broader anterior section of 1,2 the hair. With age, the extent of hair loss becomes obvious.

Prospective Efficacy and Safety Study of an Innovative Kerascalp Hair Growth Serum in Mild-to-Moderate Alopecia in India: Regrowth Study.

Male and female pattern baldness, commonly known as androgenetic alopecia is the most common type of alopecia, often predetermined genetically, which generally affects the scalp and is characterized by progressive terminal hair loss, known as miniaturization. This study aimed to assess the safety and efficacy of Kerascalp hair serum, a unique combination of esculin, ximenynic acid, and lauric acid, extracted from natural sources in subjects with mild to moderate androgenetic alopecia. An open-label, single-arm clinical study was conducted on healthy males and females aged 18-60 years. Each subject applied the hair serum once daily for 90 days. The efficacy of hair serum was evaluated in terms of the following outcome variables: anagen and telogen ratio (A:T ratio), hair thickness, hair density, hair fall, and hair strength assessment. Subjects were assessed on day 0, day 30, day 60, day 90, and on follow-up day 120. Thirty subjects completed all assessment visits. After using the hair serum for 90 days, statistically significant (p<0.0001) improvement was observed in A:T ratio, hair density, hair thickness, and hair strength; a statistically significant reduction (p<0.0001) in hair fall was also observed. Moreover, improvement in general appearance of hair (in terms of hair volume and density) and scalp (in terms of itchiness, redness, roughness, and dryness) was recorded through dermatological assessment at each treatment visit and at follow-up visit compared to baseline. No adverse event was recorded during the study period, and on follow-up. The results of this clinical study suggest that a 90 days treatment with a phyto-ingredient-based Kerascalp hair serum is safe and effective in significantly improving A:T ratio, hair density, hair thickness, and hair strength, while reducing hair shedding. The improvement in the test parameters persists, even 30 days after stopping the usage of the serum.

Platelet-Rich Plasma in Androgenetic Alopecia: Is It Really Worth the Hype?

Androgenetic alopecia (AGA) is defined as progressive, patterned hair loss that occurs as a result of androgen-mediated conversion of terminal hairs to vellus hairs. By the age of 60 years, 45% of men and 35% of women develop AGA. The Hamilton-Norwood scale is used to assess the extent and severity of AGA and classify the stages of male pattern hair loss in men, whereas the Ludwig scale is preferred for women. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment. A number of studies on PRP have shown promising results, leading to increased hair density and thickness with minimal or no side effects. We aim to study the safety, efficacy, and side effects of PRP therapy in patients of AGA and to study demographic data in the form of age, sex, age of onset of hair loss, and grade of AGA in patients. Fifty patients, 38 males and 12 females, with AGA were enrolled in the study. PRP was prepared using a double-spin method. Upon activation, PRP was injected in the involved areas of scalp once every 2 weeks for 6 months. Follow-up photos were taken every 3 months. At 6 months, majority of the patients (45%) were unsatisfied and showed no change in hair growth after PRP therapy and few patients were lost in follow-up. Adverse effects were minimal and no long-term serious adverse effects were noted. We conclude from the results in our study that PRP therapy is not significantly effective in treatment of AGA. There is a need to develop standard protocols with regard to total length of PRP therapy and spacing between the two sessions of PRP for AGA.

The Efficacy and Safety of Dr. SKS Hair Booster Serum (a Cocktail of Micronutrients and Multivitamins) in Adult Males and Females With Androgenetic Alopecia: An Open-Label, Non-randomized, Prospective Study.

Background Androgenetic alopecia (AGA) is frequently encountered in dermatological practice; however, there is a lack of approved treatment. At present, only three therapies have been approved for on-label use in androgenetic alopecia: minoxidil, finasteride, and lower-level laser therapy. Micronutrients are primary elements in the normal hair follicle cycle, and their role in androgenetic alopecia is a growing matter of research nowadays. This study aims to investigate the clinical efficacy and safety of Dr. SKS Hair Booster Serum, a cocktail of micronutrients and multivitamins (copper, niacinamide, hyaluronic acid, thiamine, riboflavin, and biotin), in male and female patients with androgenetic alopecia. Methods We did an open-label, non-randomized, multicenter, prospective study across five hair clinic chains in India (Mumbai, Hyderabad, Jabalpur, Balaghat, and Nagpur). Eligible participants were patients with a confirmed diagnosis of androgenetic alopecia based on clinical examination and trichoscopic findings, age of 18 years or older, and any gender. Each patient received Dr. SKS Hair Booster Serum, 1 ml in volume, once a month by mesotherapy or derma roller/derma pen for up to six months. All patients were subjected to a 60-second hair counttest (comb test), hair pulltest, global photographic assessment (GPA), trichoscopy assessment, patient self-assessment questionnaire, and safety assessment at baseline and six months after the treatment. Results One thousand patients (500 males and females each) with androgenetic alopecia were analyzed. There was a significant reduction in hair fall with bulb (<0.0001) and without bulb (<0.0001) six months after the treatment versus baseline. There was a significant improvement in the number of hairs removed per pull (<0.0001), global photographic assessment score (<0.0001), hair growth rate (<0.0001), follicular hair density (<0.0001), vellus hair density (<0.0001), and terminal hair density (<0.0001) six months after the treatment versus baseline. The majority of patients (95%) were satisfied with six-monthtreatment of Dr. SKS Hair Booster Serum. No major adverse events were reported during the study. Conclusion Dr. SKS Hair Booster Serum was found to be a safe and effective treatment for androgenetic alopecia, with 95% patient self-assessment score.

Comparative histopathological analyses of non-scarring alopecia in systemic lupus erythematosus patients in Lagos Nigeria.

Systemic lupus erythematosus (SLE) is known to cause non-scarring alopecia. However, histopathological evaluation is uncommon. The objective of this study was to document the histopathology of non-scarring alopecia and to compare histopathology of alopecic and normal appearing scalp areas in SLE hair loss patients. A cross-sectional comparative evaluation of scalp biopsies from 23 SLE patients; 12 with hair loss and 11 without was conducted over a 7-month period in 2020. A total of 58 scalp biopsies stained with H and E (23 vertical and 35 cross-sectional) were evaluated. Mucin deposit evaluation was done using Alcian blue (pH 2.5). There were no significant differences in the sociodemographic data between the patients. The SLE hair loss patients demonstrated mucin deposition (91.7%), reduced size/number of sebaceous glands (58.3%), epidermal atrophy (50.0%), naked arrector pili muscles (50.0%), lymphocytic infiltration (33.3%), pigment incontinence (16.7%), fibrous stellae (16.7%), increased telogen percentage, and increased terminal versus vellus hair ratios. On comparing the histopathology of those who had hair loss to those without hair loss, the only significant difference was in the number and size of sebaceous gland. There were no significant differences between scalp areas with and without hair loss in the SLE hair loss patients. There are differences in size and number of sebaceous glands on histopathology between SLE patients who have hair loss and those who do not. Also, there are no histopathological differences between alopecic and non-alopecic scalp areas of SLE patient.

Comparative Efficacy of Topical Finasteride (0.25%) in Combination with Minoxidil (5%) Against 5% Minoxidil or 0.25% Finasteride Alone in Male Androgenetic Alopecia: A Pilot, Randomized Open-Label Study.

Androgenetic alopecia (AGA) is the most common cause of hair loss in males which remains a therapeutic challenge. To compare the efficacy of topical 5% minoxidil and 0.25% finasteride combination (MNF) over 5% minoxidil (MNX) or 0.25% finasteride (FNS) alone by assessing hair count, physician assessment score (PAS), and patient satisfaction score (PSS). Pilot randomized open-label study where 60 male patients with AGA ≥ III grade were randomized into three treatment groups and evaluated over 24 weeks. Improvement in hair count was assessed manually using dermoscopy. Global photographs were used to assess PAS. Side effects were evaluated using relevant laboratory investigations. At the 12th and 24th week, all three groups showed significant improvement in total hair density as compared to baseline (P < 0.001). None of the groups was superior to the other (P > 0.05) at the 12th week but at 24th week, MNF was comparatively superior (P < 0.02). At the 12th week and 24th week, all three groups showed significant improvement in terminal hair density as compared to baseline (P < 0.001). In the 12th week, MNF was comparatively superior (P = 0.028) and at the 24th week, MNF was comparatively superior (P < 0.02). PAS and PSS were significantly better with MNF and MNX compared to FNS (P < 0.004). Side effects such as scaling and itching were reported with MNF and MNX. Topical minoxidil 5% and finasteride 0.25% had an overall better efficacy compared to monotherapy without significant side effects.

The Association of Depression, Loneliness, and Internet Addiction Levels in Male Bachelor of Medicine, Bachelor of Surgery (MBBS) Students With Androgenetic Alopecia Male Pattern Baldness in a Medical College in Kolar, India.

Introduction The genetically determined progressive process that causes a gradual conversion of terminal hair into vellus hair is known as androgenetic alopecia (AGA). AGA male pattern baldness is very common among male medical students whose self-image is severely deteriorated by AGA and this affects the quality of their professional career. Hence, the assessment of the association of depression, loneliness, and internet addiction levels of male Bachelor of Medicine, Bachelor of Surgery (MBBS) students with AGA male pattern baldness is essential to improving academic and professional performance. Aims and objectives The aim of this study is to evaluate the effects of AGA male pattern baldness and its severity on depression, loneliness, and internet addiction levels of male medical students in Kolar. Materials and methods This questionnaire-based cross-sectional study was conducted among 100 male MBBS students from Sri Devaraj Urs Medical College in Kolar with AGA male pattern baldness of varying grades. The participants were selected through simple random sampling from July 2022 to November 2022 with their prior informed consent. Students' AGA severity was evaluated clinically using the Norwood-Hamilton Classification. Their levels of depression, loneliness, and internet addiction were assessed using the standardized Beck Depression Inventory (BDI) scale, University of Carolina Los Angeles - Loneliness Scale (UCLA-LS), and Young Internet Addiction Test - Short Form (YIAT-SF), respectively, and one-way analysis of variance (ANOVA) was used to ascertain the statistical significance between the means of BDI, UCLA-LS, and YIAT-SF with the severity of AGA. Chi-square/Fisher Exact test was used to find the significance of study parameters on a categorical scale between two or more groups. Significance was assessed at a 5% level of significance. Results The mean of BDI (17.38, 25.11, 34.62, 41.25, 51.00), UCLA-LS (18.72,27.51,36.69,43.5,49.00), and YIAT-SF (20.51, 31.77, 50.31, 60.25, 72.00) scores in each of the AGA grades from Grade I to Grade V in our study showed that these scores increase along with an increase in the severity of AGA and are statistically significant. The frequency distribution of male medical students with varied degrees of AGA and the level of depression, loneliness, and internet addiction levels assessed by the BDI, UCLA-LS, and YIAT-SF showed a robust and statistically significant association between the severity of AGA and the severity of depression, loneliness, and internet addiction levels. Conclusion The current study showed that there is a statistically significant association of depression, loneliness, and internet addiction levels in male MBBS students with AGA male pattern baldness.

Three-dimensional correlative light and focused ion beam scanning electron microscopy reveals the distribution and ultrastructure of lanceolate nerve endings surrounding terminal hair follicles in human scalp skin.

Lanceolate nerve endings (LNEs) surrounding hair follicles (HFs) play an important role in detecting hair deflection. Complexes of the LNEs form a palisade-like structure along the longitudinal axis of hair roots in which axons are sandwiched between two processes of terminal Schwann cells (tSCs) at the isthmus of HFs. The structure and molecular mechanism of LNEs in animal sinus hair, pelage, and human vellus hairs have been investigated. Despite the high density of HFs in human scalp skin, the LNEs in human terminal HFs have not been investigated. In this study, we aimed to reveal the distribution and ultrastructure of LNEs in terminal HFs of human scalp skin. Using light-sheet microscopy and immunostaining, the LNEs were observed at one terminal HF but not at the other terminal HFs in the same follicular unit. The ultrastructure of the LNEs of terminal HFs in human scalp skin was characterized using correlated light and electron microscopy (CLEM). Confocal laser microscopy and transmission electron microscopy of serial transverse sections of HFs revealed that LNEs were aligned adjacent to the basal lamina outside the outer root sheath (ORS), at the isthmus of terminal HFs, and adjacent to CD200-positive ORS cells in the upper bulge region. Moreover, axons with abundant mitochondria were sandwiched between tSCs. Three-dimensional CLEM, specifically confocal laser microscopy and focused ion beam scanning electron microscopy, of stained serial transverse sections revealed that LNEs were wrapped with type I and type II tSCs, with the processes protruding from the space between the Schwann cells. Moreover, the ultrastructures of LNEs at miniaturized HFs were similar to those of LNEs at terminal HFs. Preembedding immunoelectron microscopy revealed that Piezo-type mechanosensitive ion channel component 2 (Piezo2), a gated ion channel, was in axons and tSCs and adjacent to the cell membrane of axons and tSCs, suggesting that LNEs function as mechanosensors. The number of LNEs increased as the diameter of the ORS decreased, suggesting that LNEs dynamically adapt to the HF environment as terminal HFs miniaturize into vellus-like hair. These findings will provide insights for investigations of mechanosensory organs, aging, and re-innervation during wound healing.

Histopathological Diagnosis of Alopecia Clinically Relevant to Alopecia Areata

Objective: To study the histopathological diagnosis of alopecia clinically relevant to AA and to compare the histopathology between acute and chronic AA divided by time to onset at three and six months. Materials &amp; Methods: We conducted a cross-sectional study of 113 patients with typical manifestation of AA. Two scalp biopsies were done horizontally and vertically to confirm diagnosis. Histological findings of AA in the acute group were subsequently compared with the chronic group. Results: Of the 113 eligible patients, 109 (96.5%) were pathologically diagnosed with AA. Other diagnoses included lichen planopilaris, lupus panniculitis, and unspecified scarring alopecia. The percentage of terminal telogen hairs in the acute group was significantly higher than the chronic group (mean % anagen: % telogen ratio = 21.2%:78.8% vs. 36.0%:64.0%; p = 0.016), while the chronic group had a significantly higher number of follicular streamers (mean ± SD; 2.5 ± 2.2 vs. 3.7 ± 2.6; p = 0.023). The number of vellus hairs significantly increased in the acute group at the six-month onset (p = 0.006). The number of nanogen hairs also increased significantly in the chronic group at both the three- and six-month onset (p = 0.020 and p = 0.007). Conclusion: Typical manifestations of AA are not always diagnosed as AA. Acute AA has more terminal telogens and vellus hairs, while chronic AA has more follicular streamers and nanogen hairs.

EVALUATION AND PROGNOSTICATION OF TRICHOSCOPIC FINDINGS IN PATIENTS WITH ALOPECIA AREATA (AA) BEFORE AND AFTER APPLICATION OF DIPHENYLCYCLOPROPENONE (DPCP).

Background: Alopecia areata (AA) is a chronic inammatory disease of hair follicles, causing non-scarring alopecia. Trichoscopy is a noninvasive and inexpensive diagnostic procedure used increasingly in dermatology and hence can be used to evaluate ndings in alopecia areata. Aims And Objectives: Ÿ To evaluate the clinical and trichoscopic ndings of patients with AA. Ÿ To identify prognostic factors in diphenylcyclopropenone (DPCP) response rate. Materials And Methods: Sixteen patients with AA were included, and baseline hair loss was calculated based on the severity of alopecia tool (SALT) score. Trichoscopic ndings of AA were evaluated at baseline before DPCP and at the end of 12 th week after DPCP application. Results: Men (M: F=4.3:1) with a mean age of 33.6 years were commonly affected with a mean duration of 9.9 months in this study. Most of the patients had localized type with three patches over the scalp and a SALT subclass of S1. The mean regrowth was 82.56 %. Trichoscopic ndings like black dots, depigmented vellus hairs, broken hairs, depigmented terminal hair, and exclamation mark hairs decreased whereas pigmented vellus hairs increased after the 12th week. Insufcient sample size Black dots, depigment Limitations: Conclusion: ed vellus hairs, broken hairs, and exclamatory mark hairs are considered to be bad prognostic factors and were found to be reduced with DPCP in our study whereas the signicant increase of pigmented vellus hairs which is a good prognostic factor was noted after DPCP when compared to baseline. This study concludes that trichoscopy is an invaluable tool in diagnosing AA and assessing the treatment response to DPCP.

Effect of platelet counts and activator in platelet-rich plasma on the treatment of androgenetic alopecia, split-head comparison: A randomised, double-blind study.

Background Androgenetic alopecia is a common, chronic, non-scarring alopecia. It is characterised by stepwise miniaturisation of the hair follicles, due to alteration in the hair cycle dynamics, leading to the transformation of terminal hair follicles into a vellus ones. Oral finasteride and topical minoxidil are the only approved drugs for treating this condition. Due to a limited number of effective therapies for androgenetic alopecia, platelet-rich plasma may be an effective alternative treatment. Aims To study the effect of activator in platelet-rich plasma and baseline platelet count in platelet-rich plasma on the treatment of androgenetic alopecia. Methods A randomised, double-blind split-head comparative study. The sample size was calculated and randomisation was done. Patients with androgenetic alopecia were allocated into two groups; in the first group, autologous activated platelet-rich plasma was injected in the right half of the affected scalp and autologous non-activated platelet-rich plasma was injected in the left half of the affected scalp and vice versa in the second group. Patients were also categorised on the basis of platelet counts in their platelet-rich plasma in three groups; group A (6-8 lakh/mm3), group B (8.1-10 lakh/mm3) and group C (>10 lakh/mm3). Interventions were done monthly for three months and followed up for the next three months. Effects of interventions were assessed by hair density, hair thickness, patient self-assessment and clinical photography. Results A total of 80 patients were included in the study. Activated platelet-rich plasma produced significant improvement of hair density after four months and hair thickness at 6 months. An increase in platelet count led to a significant increase in hair density and hair thickness after three and four months respectively and a highly significant increase in both parameters at the end of the study. Limitations Long-term follow-up of cases was not done and no measurement of vellus hair count was done. Conclusion There is a significant effect of activator and platelet count of the platelet-rich plasma on hair density as well as hair thickness.

Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

Hirsutism, which is characterized by excessive growth of terminal hair in a male pattern, may result from various causes including polycystic ovary syndrome (PCOS), non-classic congenital adrenal hyperplasia, adrenal or ovarian tumors or it may be idiopathic. Idiopathic hirsutism is currently defined as hirsutism associated with normal ovulatory function, normal serum androgen levels and normal ovarian morphology, however, the pathogenesis of idiopathic hirsutism is not clear. The androgens are the main hormones to stimulate growth of body hair, therefore, there should be any form of increased androgen effect irrespective of normal serum androgen levels in any patient with hirsutism. In accordance to this scientific truth, we have previously shown that, although within normal limits, patients with idiopathic hirsutism have relatively higher serum androgen levels (relative hyperandrogenemia) in comparison to healthy subjects which let as to think that is idiopathic hirsutism really idiopathic? In addition to relative hyperandrogenemia, we have previously shown that, in comparison to healthy subjects, women with idiopathic hirsutism demonstrated higher expression of steroid sulphatase and 17-beta hydroxysteroid dehydrogenase mRNA both in the subumbilical region and arm skin, which contributes to local androgen metabolism. Those results support the idea that, in some patients, although the adrenals or ovaries do not secrete increased amount of androgens leading to hyperandrogenemia, pilocebaceous unit locally produce increased amount of androgens leading to hirsutism without ovulatory dysfunction. Upon the demonstration of relative hyperandrogenemia and possible increase in local androgen synthesis in patients with idiopathic hirsutism, we think that idiopathic hirsutism is not idiopathic and it may be named as "normoandrogenic hirsutism". Furthermore, it may not be a different entity but may be an early stage of hyperandrogenic disorders such as PCOS. Clinically, this can be find out by following-up patients with idiopathic hirsutism prospectively.

Anterior cervical hypertrichosis: A rare location

We report the case of a twelve-year-old male who presented with isolated anterior cervical hypertrichosis persistent since birth. No notion of trauma or local inflammation or the use of a topical treatment was noted. The patient had no other clinical symptoms and no similar family history. A clinical examination found a tuft of hair, approx. 6 × 3 cm in size, at the level of the mid-neck region, consisting of fine, brown hairs, 3 cm in length (Fig. 1a), with a dermoscopic appearance showing terminal hair and fluffy hair without other associated signs. (Fig. 1b). The rest of the somatic examination was unremarkable. A laser hair removal treatment was offered to the patient with a good response.

Bimatoprost versus Clobetasol Propionate in Scalp Alopecia Areata: A Prospective Non-Randomized Open-Label Clinical Trial.

Alopecia areata (AA) is one of the most common forms of alopecia presenting to the dermatology out patient department (OPD) worldwide as well as in Nepal. It is mostly diagnosed clinically. Treatment depends on the extent, location, and severity of the condition. Various treatment options available are topical, intralesional, and oral medications. Bimatoprost is a relatively newer treatment modality in AA. To compare the efficacy and safety of topical bimatoprost 0.01% solution versus clobetasol propionate 0.05% cream in scalp AA. A total of 50 patients attending the dermatology OPD of a tertiary hospital between March 2018 and February 2019 were included in this prospective non-randomized open-label clinical trial. Patients were divided into two groups i.e., Group A- topical bimatoprost solution 0.01% and Group B- topical clobetasol propionate cream 0.05%, and followed up at weeks 4, 8, and 12. The improvement was analyzed subjectively by hair regrowth and objectively by Severity of Alopecia Tool (SALT) score. Side effects, nature of terminal hair and onset of initial response were also recorded. Out of 50 patients, 27 were males and 23 were females with a mean age of 28.5 ± 9.34 years and mean duration of disease of 18.67 ± 46.1 weeks. Hair regrowth rate and reduction in SALT score from baseline were seen more in clobetasol group compared to bimatoprost (p = 0.282 and P = 0.246, respectively). Side effects were seen more in the clobetasol group compared to bimatoprost group (p = 0.002). Onset of cosmetically acceptable hair regrowth was seen earlier in the bimatoprost group (p = 0.017) and also the nature of regrown hairs was more pigmented in bimatoprost group (p = 0.024). There is no significant difference in hair regrowth between clobetasol and bimatoprost in the treatment of AA on scalp at the end of 12 weeks, although bimatoprost has an advantage of lesser side effects, more rapid response and growth of more pigmented hairs.

A Randomized, Double‐Blind, Placebo‐Controlled Clinical Trial to Assess the Efficacy of a Nutritional Supplement in Female Androgenic Alopecia

Introduction. Androgenetic alopecia (AGA), the most common form of hair loss in women, is characterized by progressive hair thinning and loss of terminal hairs over frontal and parietal regions of the scalp. This study aimed to evaluate the efficacy of the nutritional supplement Pilopeptan® WOMAN 5αR (PPT5α) composed of specific plant extracts, vitamins, and minerals in women with initial to moderate AGA. Methods. This was a prospective, randomized, double‐blind, placebo‐controlled clinical trial study. Forty‐seven women (aged 25–59 years) with AGA grade I/II were randomized to daily receive PPT5α (n = 24) or placebo (n = 23), and the treatment safety, as well as the percentages of terminal hair in frontal and parietal areas from trichoscopic images, was assessed at 0, 3, and 6 months. Secondary outcomes included self‐assessed hair parameters and overall treatment satisfaction. Results. A total of 44 women completed the study. At 6 months, patients who received the nutritional supplement showed high percentages of terminal hair both in the frontal (77.6% vs 69.8%, p = 0.02) and parietal (77% vs 64.3%, p = 0.02) areas compared to the placebo group. Self‐assessed evaluation of hair parameters showed an improvement in the reduction of hair loss and hair thickness both at the 3‐month (p = 0.004 and p = 0.012) and 6‐month (p = 0.009 and p = 0.004) visits. At the 3 month visit, the intervention group also showed higher treatment satisfaction (p = 0.01). No significant adverse events were reported. Conclusion. These results evidence that the nutritional supplement PPT5α may be beneficial in preventing progression or even improving the condition of AGA in the early stages.

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 &lt; 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.