Terminal Hair Research Articles

Guselkumab effectiveness, and posology in patients with moderate to severe hidradenitis suppurativa: A retrospective bicentric experience.

Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recalcitrant skin disease of the terminal hair follicle. Therapeutic alternatives in HS are limited nowadays. Adalimumab, is the only approved biological treatment for patients with moderate to severe HS, and some patients do not reach an optimal response, or experience a progressive response loss, needing therapeutic alternatives. IL-23 pathway is also involved in HS pathogenesis, so its blockade could contribute to reach disease control. Guselkumab is a monoclonal antibody targeting the p19 subunit of extracellular IL-23, currently approved for psoriasis in adults, and recently some authors have reported its effectiveness in patients with moderate to severe HS refractory to other systemic treatments, becoming a hope for some patients. However adequate dosing and intervals have not been determined yet, so in most published series, doses approved for psoriasis are commonly used. On this topic a retrospective bicentric study including HS patients treated with guselkumab in the dermatologic departments of university hospitals Puerta de Hierro of Majadahonda (Madrid, Spain) and Doctor Peset of Valencia (Valencia, Spain) was conducted. We reported effectiveness, dosage and frequency of administration in the cohort, in order to establish the most effective dosage regimen and to clarify the potential role of guselkumab for this disease.

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

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

Electrosurgical epilation using acupuncture needles for unwanted white hairs after surgery

Transplantation of terminal hairs to a non–hair-bearing recipient area can occur when a full-thickness skin graft or flap is harvested from hairy areas. Traditionally, unwanted hairs are removed using intense pulsed light or lasers; however, the disadvantage of this is the high cost and low effectiveness on nonpigmented hair.

Phenytoin-induced hypertrichosis and gingival hyperplasia

Increased hair growth may be due to hirsutism or hypertrichosis. Hirsutism is the growth of excessive terminal hair in androgen-dependent areas in females, whereas, hypertrichosis is excessive hair growth anywhere in the body in both males and females. Both these entities, although similar in presentation, have varied etiologies and required a distinct diagnostic approach. Gingival or gum hyperplasia can be a presentation of various conditions including drug induced. We would like to report the case of a young boy on phenytoin who had presented to our outpatient services with increased hair growth and gingival hyperplasia.

Trichogenic effect of low level laser therapy combined with platelet-rich plasma for the management of androgenetic alopecia

Background: (AGA) is a very common hair disorder in men, Topical minoxidil and more recently low-level light therapy and Platelet-rich plasma therapy have been used in the management of (AGA). Objectives: To assess the Trichogenic effect of LLLT combined with PRP in the management of AGA. Patients and methods: Forty seven patients with AGAwere subjected to PRP therapy plus LLLT, affected area of all patients were treated for three months and then follow up for another three months. Efficacy was evaluated using global photography, folliscopic pictures analysis, answers for standardized hair growth questions and score of patient Gratification. Results: There was statistically significant improvement in diameter, vellus hair, terminal hair and density after treatment for three months although these improvements were decreased at three month after stoppage of treatment but still better than the baseline. Conclusion combination of LLLT with PRP could be a good treatment modality of AGA.

Comparison of efficacy of diode laser in patients of facial hirsutism with normal dehydroepiandrosterone sulfate and dihydrotestosterone versus deranged dehydroepiandrosterone sulfate and dihydrotestosterone level-A longitudinal study.

Hirsutism is defined as an excessive terminal hair growth in female over male pattern distribution areas. Traditional methods of hair removal have been replaced by lasers. The aim of the study was to observe the effect of diode laser in hirsutism patient with normal and deranged dehydroepiandrosterone sulfate (DHEAS) and dihydrotestosterone (DHT) level. Fifty patients of facial hirsutism with skin type IV and V were enrolled. Eighteen patients with deranged DHEAS and DHT level were allocated in group A whereas 16 patients with normal level were allocated in group B. Three sittings of diode laser was done in all subjects with varying session within a period of 6 months. At first follow-up visit, the percentage of hair reduction was fair in 62.5% of patients in group B and 16.7% of patients in group A, whereas at second follow-up visit, it was good in 56.3% of patients in group B and 11.1% of patients in group A. Increase in vellus hair and reduction in percentage of terminal hair were more significant in group B. Hair free interval and satisfaction level was significantly higher in group B. Diode laser is effective mode of treatment in hirsutism patient irrespective of hormone level. But, the effect is observed to be more efficacious in patients with normal DHEAS and DHT level.

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.

Idiopathic unilateral facial hirsutism

Hirsutism is the growth of terminal hair in a female in a male-like distribution. Idiopathic hirsutism (IH) is when there is no increase in circulating androgens or ovarian hormones. IH usually involves multiple sites with variable densities. Localized and unilateral dermatomal hirsutism has been rarely described. We report a forty-year-old female with a history of terminal hair growth on the left side of the chin. There was no associated biochemical or ultrasonic evidence of hyperandrogenism suggesting it to be idiopathic.

Correlating Physician versus Adolescent Self-Rating Using Modified Ferriman-Gallwey (mFG) Hirsutism Scoring to Androgen Levels

Background: Hirsutism affects 5-15% of reproductive-age women and is characterized by excessive terminal hair growth in a male pattern distribution. The gold standard screening tool for quantifying hirsutism is the mFG score. In the absence of specific hormonal markers and preexisting depilation confounding the physical exam for hirsutism, we are the first to study if adolescent vs physician rated hirsutism using mFG correlates to androgen levels.

What's Race Got to Do With It? CRP Levels in Immune Mediated Skin Diseases: Considerations for Hidradenitis Suppurativa.

Currently, there is a lack of racial/ethnic heterogeneity in research databases, exposing a systematic issue in studies exploring inflammation-mediated diseases, such as hidradenitis suppurativa (HS). HS is a chronic inflammatory skin condition that disrupts normal structure and functioning of terminal hair follicles, resulting in the formation of recurrent abscesses, nodules, and sinus tracts within intertriginous regions. Studies have described higher serum levels of inflammation-mediated C-reactive protein (CRP) in patients with HS, a disease that predominantly affects skin of color (SOC) populations. Herein, we explore the role of CRP levels in the context of HS disease presentation, management, and psychosocial implications in SOC patients to determine existing disparities in research studies.

Treatment of Androgenetic Alopecia Using PRP to Target Dysregulated Mechanisms and Pathways.

Androgenetic alopecia (“AGA”) is the most prevalent type of progressive hair loss, causing tremendous psychological and social stress in patients. However, AGA treatment remains limited in scope. The pathogenesis of androgenetic alopecia is not completely understood but is known to involve a hair follicle miniaturization process in which terminal hair is transformed into thinner, softer vellus-like hair. This process is related to the dysregulation of the Wnt/β-catenin signaling pathway, which causes premature termination of the anagen growth phase in hair follicles. Historically used for wound healing, platelet rich plasma (“PRP”) has recently been at the forefront of potential AGA treatment. PRP is an autologous preparation of plasma that contains a high number of platelets and their associated growth factors such as EGF, IGF-1, and VEGF. These factors are known to individually play important roles in regulating hair follicle growth. However, the clinical effectiveness of PRP is often difficult to characterize and summarize as there are wide variabilities in the PRP preparation and administration protocols with no consensus on which protocol provides the best results. This study follows the previous review from our group in 2018 by Cervantes et al. to analyze and discuss recent clinical trials using PRP for the treatment of AGA. In contrast to our previous publication, we include recent clinical trials that assessed PRP in combination or in direct comparison with standard of care procedures for AGA such as topical minoxidil and/or oral finasteride. Overall, this study aims to provide an in-depth analysis of PRP in the treatment of AGA based on the evaluation of 17 recent clinical trials published between 2018 and October 2021. By closely examining the methodologies of each clinical trial included in our study, we additionally aim to provide an overall consensus on how PRP can be best utilized for the treatment of AGA.

A new crinipelloid species (Marasmiaceae, Agaricales) from Pakistan

Moniliophthora pakistanica sp. nov. is described from Punjab, Pakistan, based on micro- and morphological characteristics and phylogenetic analysis. The taxon is characterized by a creamy to brownish basidiomes, a depressed or subumbonate and tomentose pileus with distinct orange to brown zones, a hairy stipe, oblong to ellipsoid basidiospores (4.7–8.5 × 4–6 μm), frequent clavate to flexuous cheilo- and pleurocystidia with apical projections, common long setiform terminal hairs in both pileipellis and stipitipellis, rhizomophs, and growth on fallen plant debris. A detailed description of macro- and microscopic characters and field photographs of collections are given. Based on our phylogenetic analysis, M. iopus is found to be a close relative of the new species. Two phylograms inferred from the datasets of nrITS and nrLSU sequences, and a comparison with phylogenetically closely related species are provided.

The Evolution of the Promise of Hair Cloning: How Hair Cell Cloning Will Fit Into Your Practice

Successful work in mice in the 1980s using cultured dermal papilla cells to form brand-new hair follicles led to the hope that a human version could be developed to treat androgenic alopecia. This could potentially provide a system to create unlimited amounts of cosmetically useful hair follicles in bald areas of scalp. However, clinical studies by biotech companies Intercytex and subsequently Aderans Research showed that although new hairs could be produced, the cosmetic effect was not sufficient. It was discovered that actively miniaturising follicles appeared to be rejuvenated and returned to the dimensions of terminal hairs. This led to a potentially new, long-term treatment plan for patients based on mapping the scalp to determine DHT-resistant areas and DHT-sensitive areas. Once areas of future miniaturisation are determined, a small number of hair follicles from DHT-resistant areas could be excised, transported to a tissue bank, and cryopreserved. These could then be utilised, when needed, to produce cultured dermal papilla cells to rejuvenate and rebuild miniaturising follicles as the wave of miniaturisation proceeded, thus resulting in the maintenance of hair throughout life.

Effectiveness of Platelet-Rich Plasma Therapy in Androgenic Alopecia-A Meta-Analysis.

Platelet-rich plasma (PRP) represents a novel therapy tested and is used more and more frequently in dermatology and cosmetic surgery for a variety of conditions, including androgenic alopecia (AGA), a common condition with a complex pathogenesis involving genetic factors, hormonal status and inflammation. We performed an extensive literature search which retrieved 15 clinical trials concerning the use in AGA of PRP therapy, alone or in combination, in male, female or mixed patient groups. A quantitative statistical meta-analysis of n = 17 trial groups proved significant increases in hair density from 141.9 ± 108.2 to 177.5 ± 129.7 hairs/cm2 (mean ± SD) following PRP (p = 0.0004). To the best of our knowledge, this is the first meta-analysis that proved a statistically significant correlation between the number of PRP treatments per month and the percentage change in hair density (r = 0.5, p = 0.03), as well as a negative correlation between the mean age of treatment group and the percentage change in hair density (r = −0.56, p = 0.016). Other factors considered for analysis were the PRP preparation method, amount used per treatment, hair diameter, terminal hairs and pull test. We conclude that PRP represents a valuable and effective therapy for AGA in both males and females if patients are rigorously selected.

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

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

HOME-BASED LASER DEVICES. EFFICACY AND SAFETY

BACKGROUND Home-based light and laser devices are effective for the treatment of various dermatological problems OBJECTIVES To systematically review and evaluate the efcacy and safety of commercially available home-based laser devices for various dermatological applications METHOD A comprehensive literature search was performed on Google Scholar and PubMed. Prospective clinical trials were included, while animal studies, non-English articles, and studies that did not focus on home use or dermatological indication were excluded. A total of 675 articles were identied regarding home use devices. After screening the articles for inclusion and exclusion criteria, 44 studies involving 1,951 participants were selected, including 21 randomized control trials, 5 non-randomized controlled trials, and 18 case series. RESULTS There was signicantly more evidence for the safety or efcacy of Intense pulse light, but this study focused on using home-based laser devices. Most studies evaluated short-term hair reduction up to 3 and 6 months. Devices were found to be effective for short-term hair removal, with side effects ranging from erythema and edema to blisters. The use of laser for skin rejuvenation is based on the fact that laser-treated areas can have islands of healthy skin left behind, which accelerate recovery. Patients who underwent treatment in a recent prospective, split-face study were evaluated by a blinded dermatologist and showed at least a 1-point improvement in wrinkles, dyschromia, and diffuse redness in 75% of participants Low-level laser therapy stimulates hair growth. Patients who used the device for 15 minutes per week for 26 weeks demonstrated signicant improvement in mean terminal hair density and overall hair growth compared to the control group. CONCLUSION Available information from current clinical trials indicates that home-based laser devices are adequate for the short treatment of hair removal, skin rejuvenation, and hair removal. Additional controlled trials are recommended to better quantify the safety and efcacy of available devices.

A study to assess the efficacy of fractional carbon dioxide laser with topical platelet-rich plasma in the treatment of androgenetic alopecia.

Owing to the inadequate response to and limitations of the approved medications for androgenetic alopecia, novel therapies are warranted to enhance outcomes. The objective of this paper is to ascertain the effectiveness of fractional carbon dioxide laser followed by platelet-rich plasma application on hair regrowth and to compare the two laser settings. Seven participants were enrolled in this half-head pilot study based on different laser pulse energy and density values (12 mJ, 800 spots/cm2 and 22 mJ, 400 spots/cm2). Ten treatment sessions were performed every 2 weeks with 12-week follow-up. The evaluation methods were based on hair density from standardized phototrichograms, global photographic assessment, and patient satisfaction. Significantly increased total and terminal hair densities were observed during treatment in both groups as compared with baselines. The mean total hair density has weekly increased significantly with high pulse energy (1.42 hair/cm2) as compared to low pulse energy (1.04 hair/cm2) throughout the study period (p = 0.023; 4.89 hair/cm2). Global photographs and patient satisfaction scores demonstrated improvement, but only the latter showed statistical significance (p = 0.029). The average pain intensity scores were not different between the groups (p = 0.760) all over the procedure. The adverse events were minor and well tolerated. This synergistic treatment remarkably leads to hair restoration and high patient satisfaction. The parameters of 22-mJ beam energy with 400 spots/cm2 density are appropriate and superior to 12-mJ beam energy with 800 spots/cm2. Albeit higher energy, no more pain is indicated in the high pulse energy group. Trial registration number (TRN): TCTR20180619004, Thai Clinical Trials Registry (TCTR) since 2018-05-15 13:39:48.

Different platelet-rich plasma preparation protocols in Female pattern hair loss: Does it affect the outcome? A pilot study.

Platelet-rich plasma (PRP) injection is a promising modality for hair regeneration in female pattern hair loss (FPHL). A standard protocol on best methods for PRP preparation has not been established. To optimize standard PRP preparation protocols and evaluate its clinical efficacy in FPHL. Comparative study enrolled 40 female patients with FPHL divided randomly into 4 equal groups. Each group received 3 sessions of monthly intradermal injection of PRP prepared by different methods regarding number of spins, centrifugation speeds, type of the centrifuge, and the size of PRP tube. Patients were evaluated by trichoscan before and 1month after the 3rd session for number of terminal, vellus hair, and average hair width. A statistically significant increase in platelet count in PRP prepared by combination of digital centrifuge, large-sized sodium citrate tube, and low centrifugation speed (900rpm). All patients showed statistically significant increase in percentage of terminal hair and average width of hair after treatment as assessed by trichoscan, without statistically significant difference between studied groups. Digital centrifuge, large-sized sodium citrate tubes, and a single spin with low centrifugation speed (900rpm) were ideal for PRP preparation. PRP is an effective and safe modality in FPHL therapy.

Efficacy of a new combination of a microemulsion and oral supplementation for androgenetic alopecia: an interventional multicentric study.

The aim of this study was to study new therapeutic options for the treatment of female and male androgenetic alopecia (AGA) and to assess the efficacy of a possible new coadjuvant oral and topical therapy, containing a complex of natural substances. Sixty individuals affected by mild-to-moderate female and male AGA were enrolled in the study and underwent the oral and topical treatment with a microemulsion formulation for 6 months. At baseline and at 3- and 6-month follow-up, global photographs were taken and three expert operators evaluated photographs using the 7-point scale. On a subgroup of our sample, non-invasive phototrichograms with TrichoScan® HD at baseline and follow-ups were performed to collect the trichological parameters of total number of hairs, hair density/cm2, vellus hair density/cm2, terminal hair density/cm2 and hair thickness. One-way ANOVA and Unpaired Student t-test were performed to analyze the data. Using the 7-point scale, a clinically visible improvement of hair loss was observed after three and six months of treatment. A statistically significant increase of all TrichoScan® trichological parameters was observed at both 3- and 6 month-follow-up. The complex of natural and active substances tested in this work showed good efficacy in improving both male and female hair loss. These new products could represent a valid alternative or coadjuvant therapy of AGA, increasing the efficacy of conventional treatments such as minoxidil or finasteride.

Hair Shedding Evaluation for Alopecia: A Refined Wash Test.

PurposeThe aim of this study is to establish a refined wash test (RWT) and explore the characteristics of daily shedding hair parameters in normal individuals and patients with androgenetic alopecia (AGA) or telogen effluvium (TE).Materials and MethodsChinese subjects diagnosed as normal, AGA or TE were enrolled. For the RWT procedure, the subjects were asked to pre-wash their hair 24 hours before the first collection, then to wash and rinse their hair with flowing water above a sink covered with a piece of filtering cloth. All hairs entrapped in the filtering cloth were air dried and collected. This “wash-and-collect” process was repeated for 3 consecutive days with a 24 ± 2 hour interval. Collected hairs were counted manually, and hair diameter was measured by videodermoscope. Number and diameter of daily shedding hairs and percentage of vellus and terminal hairs were analyzed.ResultsA total of 176 subjects participated in and completed the study. Shedding hair number during daily shampooing was 27.9 ± 12.2, 52.2 ± 28.5 and 125.5 ± 62.7 hairs in normal, AGA and TE participants, respectively, and the differences between each two of the three groups were all statistically significant. Diameter of shedding hairs was 76.9 ± 9.0 μm, 60.0 ± 9.5 μm and 82.7 ± 9.2 μm in normal, AGA and TE, respectively. Along with advancement of AGA severity, shedding hair number was generally increased, while hair diameter decreased. The percentage of vellus hairs in AGA was significantly higher than in the normal and TE groups (8.3 ± 6.6% vs 1.0 ± 1.6% and 1.0 ± 1.0%). The combination of shedding hair number and percentage of vellus hairs had a high diagnostic confidence (AUC = 0.957) to diagnose AGA from normal. Shedding hair number alone showed high confidence to diagnose TE from normal (AUC = 0.999).ConclusionThe non-invasive, easy-to-use RWT established in this study is a valuable tool to evaluate daily shedding hairs, which may be useful in diagnosis, dynamic monitoring of disease progression and treatment efficacy.