Androgenetic Alopecia: Therapy Update

Gas-propelled anti-hair follicle aging microneedle patch for the treatment of androgenetic alopecia

Existing treatments for androgenetic alopecia (AGA) are unsatisfactory, owing to the two major reasons: (1) Oxidative stress and vascularization deficiency in the perifollicular microenvironment provoke the premature senescence of hair follicles, limiting the transformation of hair growth cycle from the telogen to the anagen phase; (2) The amount of drug delivered to the perifollicular region located in the deep dermis is very limited for passive drug delivery systems. Herein, we developed a gas-propelled microneedle patch integrated with ferrum-chelated puerarin/quercetin nanoparticles (PQFN) to increase drug accumulation in hair follicles and reshape the perifollicular microenvironment for improved hair-regenerating effects. PQFN can rejuvenate testosterone (Tes)-induced senescence of dermal papilla cells by scavenging ROS, restoring mitochondrial function, regulating signaling pathways related to hair regeneration, and upregulating hair growth-promoting genes. PQFN more efficiently promoted endothelial cell proliferation, migration, and tube formation than ferrum-chelated quercetin nanoparticles (QFN) because of puerarin's proangiogenic effects. Compared with passive MNs, gas-propelled MNs promoted drug diffusion and permeation into deeper skin layers, resulting in significantly higher drug accumulation in hair follicles. Pharmacodynamic studies on an AGA mouse model further showed that PQFN-loaded active MNs achieved higher hair coverage by alleviating oxidative stress, promoting angiogenesis, and rejuvenating senescent cells. Therefore, this study presents a novel "anti-hair follicle aging" treatment strategy for AGA.

Natural phenylethanoid glycoside forsythoside A alleviates androgenetic alopecia by selectively inhibiting TRPV3 channels in mice

Dihydrotestosterone (DHT), an androgen derivate, is known to be a key factor involved in androgenetic alopecia. DHT suppresses the growth of outer root sheath cells and induces apoptosis of hair keratinocytes, thereby causing hair follicle miniaturization and hair regrowth inhibition. Forsythoside A, a natural substance derived from Forsythia suspensa, has been shown to reduce DHT-induced apoptosis in human hair cells and suppress hair regrowth inhibition induced by DHT in mice. However, the molecular mechanism underlying the action of forsythoside A remains unclear. Here, we report that the alleviation of androgenetic alopecia by natural phenylethanoid glycoside forsythiaside A involves the selective inhibition of warmth-sensitive Ca2+-permeable transient receptor potential vanilloid-3 (TRPV3) channels. TRPV3 mRNA and protein expressions are upregulated in the skin of a mouse model of androgenetic alopecia induced by DHT. Ablation of the Trpv3 gene or subcutaneous injection of forsythoside A alleviates DHT-induced hair regrowth inhibition. In whole-cell patch clamp recordings, forsythoside A selectively inhibits macroscopic TRPV3 currents in a concentration-dependent manner with an IC50 value of 40.1 ± 4.8 μM. At the single-channel level, forsythoside A also reduces the channel open probability and open frequency without significantly altering the channel unitary conductance. Molecular docking combined with site-directed mutagenesis reveals two residues T636 and T665 critical for forsythoside A-mediated inhibition of TRPV3. Taken together, our findings demonstrate that TRPV3 inhibition is an important a mechanism by which natural forsythoside A ameliorates DHT-induced hair regrowth. Topical TRPV3 inhibitors may hold promise as a new therapeutic approach for treating androgenetic alopecia.

Innovative strategies for the discovery of new drugs against androgenetic alopecia

INTRODUCTION

Androgenetic alopecia (AGA) is the most common cause of hair loss worldwide. The significant psychological and social impact of AGA continues to drive demand for more effective treatments beyond the limited options currently available.

AREAS COVERED

The authors review the key components of AGA pathogenesis, as well as current treatments and therapeutic techniques under development. Innovative strategies for AGA drug discovery are still needed given the significant unmet medical needs and the limited efficacy of both current and emerging treatments. They also outline relevant preclinical models, such as hair follicle cell cultures, 3D spheroids and organoids, follicle explants, and animal models, highlighting their advantages and limitations in AGA research. Finally, the authors summarize the primary objectives in AGA treatment development, including direct hair growth promotion, interference with androgen signaling, and HF rejuvenation, identifying key pathogenesis intervention points for treatment development.

EXPERT OPINION

Developing better in vitro models, possibly using induced pluripotent stem cell (iPSC) systems, could greatly accelerate drug discovery. Similarly, a superior in vivo model could significantly expedite drug discovery. Near future development research should focus on drug delivery improvements. Longer term, treatments targeting AGA's underlying pathophysiology and promoting HF rejuvenation or true regeneration would provide the most benefit to prospective patients.

Efficacy and safety of oral minoxidil versus topical solution in androgenetic alopecia: a meta-analysis of randomized clinical trials

The benefits and potential risks of oral minoxidil therapy versus topical minoxidil therapy in patients with androgenetic alopecia (AGA) are controversial. We systematically searched PubMed, Embase, and Cochrane for randomized clinical trials (RCTs) comparing the use of oral minoxidil and minoxidil topical solution in patients with AGA. Statistical analyses were performed using R Studio 4.3.2. Standard mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CI) were pooled across trials. This meta-analysis included four RCTs reporting data on 279 patients. Follow-up ranged from 24 to 39 weeks. There were no differences in hair density (SMD 0.02; 95% CI -0.25 to 0.29; P = 0.88; I2 = 0%) or hair diameter (SMD -0.25; 95% CI -0.75 to 0.26; P = 0.34; I2 = 36%). The incidence of hypertrichosis was statistically significantly higher in the oral minoxidil group when compared to the topical minoxidil group (RR 2.01; 95% CI 1.18-3.41; P = 0.01; I2 = 0%). There was no statistically significant difference between groups for the incidence of hypotension (RR 2.42; 95% CI 0.26-22.46; P = 0.44; I2 = 0%). In patients with AGA, oral minoxidil and minoxidil topical solution have similar efficacy and safety, with equivalent improvements in hair density, hair diameter, and incidence of adverse events, such as hypotension.

Epidemiological landscape of androgenetic alopecia in the US: An All of Us cross-sectional study

BACKGROUND

Androgenetic alopecia (AGA) is extremely prevalent with a multifactorial etiology.

MATERIALS

We conducted a cross-sectional study using the All of US (AoU) dataset Sept 2024 to better understand the epidemiology, social determinants and management of AGA.

RESULTS

Most males were 20-39 years old and females 60-69 years old. Men typically have an earlier onset of AGA than females. Male AGA is generally managed with finasteride; oral minoxidil is prescribed in younger males. Females are prescribed spironolactone and oral minoxidil with finasteride in post-menopausal females. There was very little dutasteride prescribed. Topical minoxidil is available over the counter and was not evaluated. Early in 2011 there were reports of the Post-Finasteride Syndrome (PFS); subsequently, the finasteride prescription rate fell to about 10-20% of the pre-PFS prescription rate. There was increased reporting for AGA in those who drink, have an annual household income ≥$75,000, and those with a higher level of education. There was also higher reporting of female AGA in those with anxiety and depression. Patients with higher income and education may have less pressing medical concerns enabling them to bring their AGA to the physician's attention. Females in whom the AGA affects their anxiety and depression may seek help for the AGA as a way to address their underlying disorder.

CONCLUSIONS

This study provides a snapshot of the epidemiology and management of AGA in the USA. AGA is linked to the social determinants of health; addressing the AGA may help better manage the underlying mental and physical state.

Black phosphorus nanosheets encapsulated microneedle for multifunctional therapy for androgenic alopecia

BACKGROUND

Androgenetic alopecia (AGA), a chronic and progressive disease, significantly impacts the patients' social, emotional, and mental well-being. Current treatment for AGA are mainly limited by drug side effects and the stratum corneum (SC) barrier of scalp.

RESULTS

To address these issues, we developed a microneedle (MN) system loaded with black phosphorus nanosheets (BP) encapsulating baicalin (BA), a natural ingredient, for effective treatment of AGA. We first fabricated BP-BA based on the BP properties of high drug loading capacity and excellent photothermal conversion efficiency. Upon 635 nm laser irradiation, BP-BA demonstrated efficient photothermal conversion to mild thermal of ~ 42 °C. This mild thermal effect controlled BA's stimuli-responsive release, enhanced cellular uptake, and effectively modulated gene expression in dihydrotestosterone-treated human dermal papilla cells, downregulating negative regulators such as SRD5A2, AR, DKK1, and TGFB1, while upregulating positive regulators like CTNNBIP1 and VEGFA. Furthermore, we encapsulated BP-BA to MN fabricating BP-BA@MNs to overcome the SC barrier. Compared with BP-BA@MNs without laser irradiation, BP-BA@MNs with laser irradiation significantly enhanced drug penetration into the subcutaneous area and accumulation at the follicular site. Importantly, BP-BA@MNs demonstrated synergistic efficacy against testosterone-induced AGA in vivo through combining BA chemotherapy, BP-mediated mild photothermal therapy, and MN delivery, as well as good biocompatibility and biosafety, and the underlying synergistic mechanism was elucidated in terms of follicular microenvironment reconstruction.

CONCLUSIONS

This combining BP mild photothermal and MN system is a promising approach for follicular targeted drug delivery, providing a multifunctional strategy for addressing the clinical needs of anti-AGA.

New tool in our arsenal: efficacy of injectable platelet-rich fibrin (i-PRF) in androgenetic alopecia treatment

OBJECTIVE

This study assesses the short-term therapeutic efficacy and safety of injectable platelet-rich fibrin (i-PRF) in managing androgenetic alopecia (AGA). AGA, a common genetic condition leading to hair loss, significantly affects the quality of life. Given the limited efficacy of existing treatments, there is an urgent need for novel therapeutic strategies. This study investigates the potential of i-PRF, a biotherapeutic agent enriched with growth factors and cell proliferation promoters, to enhance hair regeneration and ameliorate the microenvironment of hair follicles.

METHODS

A prospective, single-center study enrolled 30 AGA patients with inadequate responses to conventional treatments. Participants received six monthly i-PRF injections. Assessments included hair scoring (hair density, vellus hair percentage, and hair shaft diameter), treatment efficacy, physician's visual subjective scoring, scalp inflammation scoring (folliculitis, greasiness, dandruff, and itching), Dermatology Quality of Life Index (DLQI) scores, patient satisfaction scoring, and monitoring for adverse reactions post-injection.

RESULTS

At the 6-month mark, an 80% response rate was achieved, with significant improvements in hair loss and scalp symptoms as per hair scoring, physician's visual subjective scoring, scalp inflammation scoring, DLQI scoring, and patient satisfaction scoring compared to baseline.

CONCLUSION

i-PRF effectively enhances hair density and alleviates scalp symptoms in AGA patients, demonstrating notable therapeutic effects with minimal adverse reactions, offering a promising new avenue for AGA treatment.

Assessing Causality Between Androgenetic Alopecia with Depression: A Bidirectional Mendelian Randomization Study

Background

Androgenetic alopecia (AGA) is the most common form of alopecia globally, which exerts a negative impact on patients' self-esteem and overall quality of life. Previous observational studies have found a significant increase in the prevalence of depression in AGA patients, but the causal relationship remains to be elucidated.

Methods

In this study, we conducted a bidirectional Mendelian randomization (MR) using genome-wide association studies (GWAS) datasets. The available GWAS dataset of AGA was obtained from the Neale Lab consortium (n=154988). The dataset for depression was obtained from the ebi-a-GCST90038650 (n=484598). The main analysis method for determining the causal link between AGA and depression was inverse variance weighted (IVW). Subsequently, pleiotropy and heterogeneity tests were performed to determine the reliability of the results.

Results

Utilizing the IVW method, depression does not significantly contribute to the incidence of AGA (IVW odds ratio [OR] = 1.101, 95% confidence interval [CI] =0.890-1.362, P = 0.374). Conversely, the data suggested a statistically significant association where AGA may precipitate the development of depression, with a notable increase in risk (IVW OR = 1.015, 95% CI = 1.002-1.029, P = 0.020).

Conclusion

We are the first to use MR analysis to explore the causal relationship between AGA and depression, revealing an increased risk of depression in individuals with AGA.

Application of platelet-rich plasma lysate combined with hyaluronic acid microneedles for the treatment of alopecia

Androgenetic alopecia (AGA) continues to pose a significant challenge due to the paucity of effective therapeutic options. Upon lysis, platelet-rich plasma (PRP) releases numerous growth factors (GFs), which facilitate tissue reconstruction and hair regeneration. However, concerns such as infection, bleeding, local erythema, and patient anxiety associated with injections have substantially diminished patient acceptance. To address these issues, we developed a microneedle (MN) system loaded with PRP lysate (PL), termed PL-MN, designed to deliver GFs transdermal to sites of hair loss without inducing significant discomfort. The PL-MN not only exhibits a well-defined needle structure but also demonstrates excellent in vivo penetration and external transdermal efficacy. Upon skin penetration, the needle matrix rapidly dissolves, releasing GFs directly to the target site. In animal tests, the PL-MN shows synergistic effects by orchestrating an upregulation in the expression of Ki67 and CD31, which collectively foster cell proliferation and migration, thereby facilitating the expedited progression of hair follicles (HFs) into the anagen phase and promoting peripheral angiogenesis. Compared with minoxidil, the first-line clinical drug for treating AGA (administered once per day, 20 times in total), the PL-loaded MN could induce hair regeneration in mice with a lower frequency of administration (once every 3 days, 5 times in total). Consequently, such a safe and GFs-releasing MNs patch shows great potential for clinical AGA treatment.

Modulating metal-organic frameworks by surface engineering of stearic acid modification for follicular drug delivery and enhanced hair growth promotion

Cyclodextrin metal-organic frameworks (CD-MOF) as delivery carriers have gained great attention in the biomedical field. However, limited by challenges of moisture-sensitive nature, the design and application of CD-MOF-based hair follicle delivery for androgenic alopecia (AGA) has rarely been explored. We developed the metal-organic frameworks as hair follicle-targeted delivery system (SA-MOF), stearic acid (SA) was used to modify metal-organic frameworks to form a protective hydrophobic layer on the surface and provide the additional hair growth-promoting effect. Cardamonin (CAR), a newly discovered biosafety natural product, was encapsulated in SA-MOF (CAR@SA-MOF) to promote the therapeutic efficacy on AGA. CD-MOF surface-engineered nanoparticles modified by SA avoided the rapid hydration and disintegration of CD-MOF in water, which improved the drug release and follicular deposition of drug. Assisted by the delivery of SA-modified CD-MOF carriers, the drug significantly promoted cell proliferation and migration, achieving the promoting effect on hair follicle differentiation and hair regeneration in testosterone-challenged C57BL/6 mice. Simultaneously, SA modification provided additional promoting effects on human dermal papilla cell proliferation, regulating effect on keratinocyte growth factor, and activating effect of key signaling pathways. The surface engineering design of CD-MOF hair follicle drug delivery based on SA modification exhibits significant potential for the treatment of hair follicle and sebaceous gland-related diseases.

Assessing the safety of topical minoxidil through disproportionality analysis of FAERS reports

BACKGROUND

Topical minoxidil, approved by the FDA in the 1980s, has been widely used to manage androgenetic alopecia. While effective, several adverse events (AEs) related to its use, especially those not well-documented on product labels, remain a concern.

OBJECTIVE

This study aimed to evaluate the safety of topical minoxidil by analyzing AEs reported in the FDA Adverse Event Reporting System (FAERS) from 2004 to 2024, focusing on identifying potential risk signals not highlighted on current product labels.

METHODS

Adverse event reports (AERs) from FAERS, where topical minoxidil was identified as the primary suspect, were analyzed. Disproportionality analysis methods, Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-Item Gamma Poisson Shrinker (MGPS), were used to assess the relationship between minoxidil and reported AEs.

RESULTS

Among 45,130 reports, most were from males (50.88%) and showed a significant increase in incidents since 2015. Newly identified AEs, such as application site acne and cysts, were observed. These AEs are not well represented on product labels.

CONCLUSION

The study identified previously unreported AEs linked to topical minoxidil, underscoring the need for updated patient information and regulatory reassessment to enhance safety and inform clinical practices.

Unhealthy diet and lifestyle factors linked to female androgenetic alopecia: a community-based study from Jidong study, China

BACKGROUND

To explore unhealthy diet and lifestyle factors associated with female androgenetic alopecia (FAGA) in a community-based study.

METHODS

A total of 3,008 participants were recruited from the Jidong community (Tangshan, Hebei, China). FAGA was assessed by the Savin scale. Data collection was conducted through structured questionnaires. Univariate and multivariate logistic regression analyses were employed to identify potential factors. Multivariable models were built by selecting covariates with P < 0.05 in univariable analyses and removing collinear variables identified by a variance inflation factor > 5. The predictive performance was evaluated using the receiver operating characteristic curve.

RESULTS

The prevalence of FAGA in this study was 6.85% (206/3008). Sleep snoring (adjusted odds ratio [AOR] = 1.398, 95% confidence interval [CI] 1.032-1.894, P = 0.031), frequent consumption of bacon and preserved meat (AOR = 2.205, 95% CI 1.181-4.118, P = 0.013), frequently drinking unboiled water (AOR = 1.984, 95% CI 1.156-3.406, P = 0.013), age (AOR = 1.063, 95% CI 1.050-1.076, P < 0.001) and suboptimal health status score (AOR = 1.033, 95% CI 1.020-1.047, P < 0.001) were identified as independent factors associated with FAGA.

CONCLUSIONS

In conclusion, our data suggest that females who snore during sleep, frequently consume bacon and preserved meats, and regularly drink unboiled water are more susceptible to androgenetic alopecia. Additionally, our analysis revealed that age and suboptimal health status score are significantly correlated with FAGA.

Caffeine as an Active Ingredient in Cosmetic Preparations Against Hair Loss: A Systematic Review of Available Clinical Evidence

Background/Objectives: Hair loss (alopecia or effluvium) can significantly affect the self-esteem and psychosocial well-being of patients, resulting in a reduced quality of life. It may herald a systemic disease, nutritional deficiency, or side effects of pharmacotherapy. Current therapeutic options for hair loss are not always satisfactory and may be associated with considerable side effects; therefore, new solutions are still sought. Caffeine seems to be an effective agent against hair loss thanks to its stimulating effects on cell growth and good penetration into the hair follicle. The aim of this study was to systematically review published clinical trials of topical caffeine preparations against hair loss. Methods: We searched PubMed, Scopus, and Web of Science for clinical trials investigating the efficacy of topical caffeine products in hair loss, published until 29 November 2024. The quality of evidence was assessed using the GRADE classification. Results: The query returned 1121 articles, of which 9 ultimately met the inclusion criteria. In total, 684 people with androgenetic alopecia, excessive hair loss, or hair thinning were included in these trials. In all studies, conclusions were in favor of topical caffeine treatment; however, the level of scientific evidence was medium in 3 studies, low in 1, and very low in the remaining 5. Their major flaws included the lack of randomization and placebo and control groups, as well as the lack of information on the caffeine concentration in the topical products. Conclusions: Results from studies published to date suggest that topical caffeine preparations are safe and effective against hair loss. Nevertheless, better-designed clinical trials of well-defined caffeine products are required for an ultimate statement. Commercial hair products with caffeine offered on the market nowadays may be worth a try, but due to incomplete scientific data and product information, satisfactory outcomes are not guaranteed.

Dahuang-Gancao decoction ameliorates testosterone-induced androgenetic alopecia in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Dahuang-Gancao decoction (DGD) is a traditional Chinese medicinal formula that is recorded in the Synopsis of the Golden Chamber, and is widely used to treat damp-heat in the body. Since the pathological factors of androgenetic alopecia (AGA) also reflect damp-heat blockage, DGD has great potential for the treatment of AGA and has been used effectively in clinical practice.

AIM OF THE STUDY

The aim of the study was to investigate whether external application of DGD could promote the activation and proliferation of hair follicle stem cells (HFSCs) and improve AGA through the Wnt/β-catenin pathway.

MATERIALS AND METHODS

The main chemical components of DGD-contained serum were identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and database search. Cell Counting Kit-8 (CCK8) was used to investigate the appropriate concentration. Hair regeneration was assessed by hair growth score and histopathological staining. The proliferation of HFSCs and the activation of Wnt/β-catenin pathway were detected by Western blot, immunofluorescence staining, real-time reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). The AGA mouse model was induced by external application of testosterone (T). Immunofluorescence staining was performed to localize HFSCs by CK15, followed by staining with Ki67, β-catenin, and Cyclin D1, respectively.

RESULTS

The results illustrated that the 10% DGD group and the 10% DGD + HLY78 group could significantly promote the expression of Wnt10b and β-catenin and the proliferation of HFSCs in vitro, while the 10% DGD + IWR-1 group could reverse the promotion effect of DGD. Animal experiments showed that compared with the model group (T group), DGD promoted hair follicles to enter the anagen phase, as evidenced by an increase in hair growth score, an increase in the number of hair follicles in hematoxylin and eosin (HE) staining, and a significant increase in the ratio of the number of anagen follicles to the total number of hair follicles (AF/AF + TF). In addition, DGD upregulated the expression of Wnt/β-catenin signaling pathway proteins in the skin tissues of AGA mice. It also promoted the proliferation of HFSCs and the expression of β-catenin and Cyclin D1 cytokines in the region of HFSCs.

CONCLUSION

Both oral and external application of DGD can promote the proliferation of HFSCs by activating the Wnt/β-catenin signalling pathway. External application of DGD can promote the hair follicles to enter the anagen phase, which can ameliorate the symptoms of alopecia in AGA mice. Therefore, compared to oral DGD, external application of DGD is an effective and safer way of administration for the treatment of AGA.

Efficacy, safety and tolerability of drugs for alopecia: a comprehensive review

INTRODUCTION

Alopecia, encompassing non-scarring and scarring types, presents therapeutic challenges requiring individualized approaches based on pathophysiology and treatment responses. A comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science (2015-2024) focused on randomized controlled trials, meta-analyses, and observational studies.

AREAS COVERED

This review evaluates pharmacological strategies for androgenetic alopecia (AGA), alopecia areata (AA), and scarring alopecias, emphasizing efficacy and safety. Treatments for non-scarring alopecia include finasteride, minoxidil, JAK inhibitors, and antiandrogens like spironolactone. JAK inhibitors, such as baricitinib, show promise for AA but require monitoring due to immune suppression risks. Scarring alopecias, including lichen planopilaris and discoid lupus erythematosus, are managed with systemic agents like hydroxychloroquine and corticosteroids, alongside adjunctive topical and laser therapies.

EXPERT OPINION

The future of alopecia treatment is poised for transformation, particularly for AA and AGA. Emerging targeted therapies, such as JAK inhibitors for AA, represent significant advancements. Additionally, innovations in regenerative medicine and delivery systems for AGA treatments, alongside nanotechnology and 3D bioprinting, promise enhanced efficacy and personalization. This shift toward mechanism-targeted and individualized therapy is expected to improve outcomes for various alopecia subtypes.

Autolougous platelet concentrates in esthetic medicine

This narrative review summarizes current knowledge on the use of autologous platelet concentrates (APCs) in esthetic medicine, with the goal of providing clinicians with reliable information for clinical practice. APCs contain platelets that release various growth factors with potential applications in facial and dermatologic treatments. This review examines several facial esthetic applications of APCs, including acne scarring, skin rejuvenation, melasma, vitiligo, stretchmarks, peri-orbital rejuvenation, peri-oral rejuvenation, hair regeneration and the volumizing effects of APC gels. A systematic review of literature databases (PubMed/MEDLINE) was conducted up to October 2023 to identify randomized controlled trials (RCTs) in the English language on APCs for facial rejuvenation and dermatology. A total of 96 articles were selected including those on platelet rich plasma (PRP), plasma-rich in growth factors (PRGF), and platelet-rich fibrin (PRF). Clinical recommendations gained from the reviews are provided. In summary, the use of APCs in facial esthetics is a promising yet relatively recent treatment approach. Overall, the majority of studies have focused on the use of PRP with positive outcomes. Only few studies have compared PRP versus PRF with all demonstrating superior outcomes using PRF. The existing studies have limitations including small sample sizes and lack of standardized assessment criteria. Future research should utilize well-designed RCTs, incorporating appropriate controls, such as split-face comparisons, and standardized protocols for APC usage, including optimal number of sessions, interval between sessions, and objective improvement scores. Nevertheless, the most recent formulations of platelet concentrates offer clinicians an ability to improve various clinical parameters and esthetic concerns.

Exosome-derived long non-coding RNA AC010789.1 modified by FTO and hnRNPA2B1 accelerates growth of hair follicle stem cells against androgen alopecia by activating S100A8/Wnt/β-catenin signalling

BACKGROUND

The increased incidence of androgenic alopecia (AGA) causes adverse physiological and psychological effects on people of all genders. The hair follicle stem cells (HFSCs) have displayed clinical improvements on AGA. However, the molecular mechanism of HFSCs against AGA remains elusive.

METHODS

The expression and prognosis of lncRNA AC010789.1 in AGA hair follicle tissues were assessed by qRT-PCR analysis. CCK-8, EdU and Transwell analysis were utilized to assess cell growth. The specific binding between AC010789.1 and FTO mediated m6A modification or the effect of AC010789.1 on hnRNPA2B1, S100A8 and Wnt/β-catenin signaling expression was confirmed by bioinformatic analysis, RIP, RNA pull-down and Western blot assay. The effects of Exosome-loaded AC010789.1 prompted HFSCs proliferation and hair follicle regeneration were confirmed in hairless mice.

RESULTS

We herein found that the mRNA levels of lncRNA AC010789.1 were decreased in AGA tissue samples but increased in HFSCs of surrounding normal tissue samples. Overexpression (OE) of AC010789.1 promoted HFSC proliferation, DNA synthesis and migration as well as K6HF and Lgr5 upregulation, whereas knockdown of AC010789.1 showed the opposite effects. The total or AC010789.1 m6A levels were reduced and FTO demethylase was upregulated in AGA tissue samples, but these indicated the reverse results in HFSCs of surrounding normal tissue samples. FTO OE decreased AC010789.1 m6A levels and its mRNA levels in HFSCs and abolished AC010789.1-induced HFSCs proliferation. In addition, AC010789.1 was identified to bind to m6A reader hnRNPA2B1, which was downregulated in AGA but upregulated in HFSCs of surrounding normal tissue samples. hnRNPA2B1 OE attenuated AC010789.1 knockdown-induced inhibition of HFSCs proliferation. Moreover, AC010789.1 could bind to and enhance downstream S100A8 protein expression, which mediated Wnt/β-catenin signaling to accelerate HFSCs proliferation. Exosome-loaded AC010789.1 prompted HFSCs proliferation and hair follicle regeneration in mice.

CONCLUSIONS

Our findings demonstrated that exosome-derived lncRNA AC010789.1 modified by FTO and hnRNPA2B1 facilitated the proliferation of human HFSCs against AGA by activating S100A8/Wnt/β-catenin signaling.

KEY POINTS

Long non-coding RNA (lncRNA) AC010789.1 was downregulated in hair follicle tissues from androgenic alopecia (AGA) and upregulated in hair follicle stem cells (HFSCs). LncRNA AC010789.1 promoted the proliferation and migration of HFSCs. FTO/hnRNPA2B1-mediated m6A modification of lncRNA AC010789.1 promoted HFSCs growth by activating S100A8/Wnt/β-catenin signalling. Exosome-derived AC010789.1 accelerated HFSCs proliferation.

Causal relationship between gut microbiota and androgenetic alopecia: A Mendelian randomization study

Recent studies have found a strong correlation between gut microbiota and the risk of skin diseases and proposed a "gut-skin axis." Androgenetic alopecia (AGA) is the most common type of alopecia, and androgen plays an important role in its pathogenesis. It has been found that the gut microbiome is closely related to androgens; however, whether this relationship is causal or merely coincidental remains uncertain. To address this issue, Mendelian randomization (MR) analysis was performed to explore the association between gut microbiota and AGA. Genome-wide association studies (GWAS) have compiled summary statistics of the gut microbiota, including 211 taxa (131 genera, 35 families, 20 orders, 16 classes, and 9 phyla), with data from MiBioGen's comprehensive study. We collected genetic associations with AGA from the IEU OpenGWAS project. We performed MR Analyses to assess the causal relationship between the genetically predicted gut microbiota and AGA. In order to verify the reliability of the findings, we systematically performed sensitivity analyses and heterogeneity tests and performed a heterogeneity test. MR Analysis provides important evidence for the causal relationship between genetically predicted gut microbiota and AGA. Lachnospiraceae UCG008 (OR = 0.939, 95%CI 0.175-0.775, P < .01), Oxalobacte (OR = 0.932, 95%CI 0.896-0.969, P < .01) would reduce the risk of AGA. Eubacterium rectale group (OR = 1.102, 95%CI 1.025-1.186, P < .01), Roseburia (OR = 1.183, 95%CI 1.048-1.336, P < .01) would increase the risk of AGA. Further sensitivity and heterogeneity analyses confirmed the robustness of these results. The results of this study indicate that there is a potential genetic susceptibility between gut microbiota and AGA, and screen out protective and risk factors. These results provide a theoretical basis for the prevention and treatment of AGA by regulating gut microbiota.

Discovery of a Novel Non-invasive AR PROTAC Degrader for the Topical Treatment of Androgenetic Alopecia

Elevated expression levels and enhanced activity of androgen receptor (AR) proteins are key factors in the development of androgenetic alopecia (AGA). AR proteolysis-targeting chimera (PROTAC) degraders have shown therapeutic potential, but their poor skin permeability requires invasive delivery methods. In this study, we conducted a structure feature analysis to investigate the effects of different linkers and E3 ligands of AR PROTACs on skin retention properties and degradation potency. Among these, compound C6 was discovered with excellent skin retention properties and nanomolar level AR degradation. By degrading AR, C6 regulated the expression levels of downstream paracrine factors associated with AGA. Additionally, after non-invasive topical application, C6 demonstrated excellent skin accumulation and achieved hair regeneration in an AGA mouse model. Overall, the development of non-invasive C6 offers a promising new strategy for AGA treatment and highlights the potential for using PROTACs in treating other skin diseases.

Effects of photobiomodulation on human hair dermal papilla cells with various light modes and light parameters

Androgenetic alopecia (AGA) is a prevalent hair loss disorder and influenced by genetic, hormonal, and environmental factors. Minoxidil and finasteride have been widely used for treating AGA. However, the side effects associated with these drugs often lead to poor patient compliance. In contrast, photobiomodulation (PBM), due to its safety and non-invasiveness, holds promising prospects for use. Although the promoting effects of PBM on AGA have been reported, the mechanisms by which PBM affects dermal papilla cells (DPCs) remain largely unknown. Hence, this study explored the impacts of both continuous wave (CW) and pulsed wave (PW) PBM on DPCs, and revealed the underlying actions of light parameters in PBM. Orthogonal experiments were conducted to evaluate the effects of CW PBM on DPCs at varying irradiances and doses, indicating that irradiance was the crucial parameter, as well as cell viability and proliferation were maximized at 8 mW/cm2 and 8 J/cm2. For PW PBM, response surface methodology was employed to determine the influences of duty cycles, frequencies, and doses. The findings highlighted frequency as a primary factor, with the optimum cell viability observed at peak irradiance 10 mW/cm2, duty cycle 80 %, 500 Hz, and 8.8 J/cm2. Notably, PBM could enhance cell viability, proliferation, and migration in DPCs by activating the Wnt/β-Catenin signaling and suppressing Transforming Growth Factor signaling, particularly when applied in pulsed mode. Overall, this study determined the key light parameters that influence PBM effectiveness, further identified the optimal light conditions, and preliminary revealed into the mechanisms of PBM in DPCs, highlighting that PW PBM may be a competitive therapeutic option for alleviating AGA in the future.

A finasteride patch for the treatment of androgenetic alopecia: A study of promoting permeability strategy using synthetic novel O-acylmenthols combined with ion-pair

Currently, finasteride (FIN) is approved to treat androgenetic alopecia only orally, and the application of FIN in transdermal drug delivery system (TDDS) has introduced a new approach for treating the disease. This study was aimed to develop a FIN transdermal patch for the treatment of androgenetic alopecia（AGA） by combing ion-pair and O-acylmenthols (AM) as chemical permeation enhancers (CPEs). The formulation of patch was optimized though single-factor investigation and Box-Behnken design. The pharmacokinetics and androgenetic alopecia pharmacodynamics of the patch were evaluated. Additionally, the permeability enhancement mechanisms of ion-pair and AMs were explored at both the patch and skin levels. The effects of ion-pair and AMs on the patch were characterized by rheology study, FTIR, and molecular docking, and the effects on the skin were assessed through ATR-FTIR, Raman study, DSC, CLSM and molecular dynamics. The finalized formulation of FIN patches was consisted of 5 % (w/w) synthetic FIN-CA (Citric Acid), 6 % MT-C6 as CPEs, 25-AAOH as a pressure-sensitive adhesive (PSA), with a patch thickness of 80 ± 5 μm. The final Q24 h is 78.22 ± 5.18 μg/cm2. Based on the high FIN permeability, the pharmacokinetic analysis revealed that the FIN patch group exhibited a slower absorption rate (tmax = 7.3 ± 2.7 h), lower peak plasma concentration and slower metabolic rate (t1/2 = 6.2 ± 0.8 h, MRT0-t = 26.0 ± 7.8 h) compared to the oral group. Moreover, the FIN patch also demonstrated the same effect as the oral group in promoting hair growth in AGA mice. The results indicated that both FIN-CA and AMs could enhance the fluidity of the PSA and weaken the interaction between FIN-CA and PSA, thereby promoting the release of the FIN from the patch. The interaction sites on the skin for ion-pair and the four AMs were found in the stratum corneum (SC) of the skin, disrupting the tight arrangement of stratum corneum lipids. This study serves as a reference for the multi-pathway administration of FIN and the combination of ion-pair with AMs to enhance drug permeation.

Novel natural lipids based NLC containing finasteride improved androgenetic alopecia treatment in rats

Androgenetic alopecia (AGA) is the most common hair loss disorder, affecting millions of men and women worldwide. Current formulations used to treat this condition often lead to a wide variety of side effects, ranging from allergies to sexual disfunction, especially when those drugs are administered orally. In this study, we developed and tested unique formulations containing nanostructured lipid carriers (NLC) composed of lipids extracted from fruit seeds, carrying finasteride to enhance efficacy of AGA treatment. By stabilizing the hydrophobic compounds in the solid matrix, three formulations of NLC were engineered and successfully prepared. Further an in vivo model of AGA was induced in rats by the administration of testosterone, as a platform to evaluate the efficiency of the formulations. The chosen formulation exhibited high bioavailability, medium size of 124.5 nm and PdI of 0.143, without systemic absorption. In addition, it promoted efficient and significant follicle restoration in AGA induced rats by increasing number of active bulbs and showed to be a safe formulation for topical application. The results of this research indicate that the presented formulation has significant potential to yield improved outcomes in AGA treatment.

Efficacy and safety of compound glycyrrhizin combined with topical minoxidil for alopecia areata: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Alopecia areata (AA) is a common autoimmune skin disease. Our study aimed to systematically evaluate the efficacy and safety of compound glycyrrhizin (CG) combined with topical minoxidil therapy in treating AA.

METHODS

We searched the PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases. Randomized controlled trials (RCTs) on CG combined with topical minoxidil therapy compared with topical minoxidil therapy alone for AA were included. The Cochrane Collaborative Network Tool was used to assess the risk of bias. Statistical analysis was completed using RevMan5.3 software and Stata 15.0 software. The GRADE system was used to evaluate the quality of evidence for outcomes.

RESULT

11 RCTs and 1189 patients were included. Compared with topical minoxidil therapy alone, CG combined with topical minoxidil therapy was more effective at improving the clinical efficacy (RR = 1.36, 95% CI [1.27, 1.45], p < 0.00001). The SALT score (MD = -10.09, 95% CI [-12.89, -7.30], p < 0.00001), serum TNF-α levels (MD = -0.99, 95% CI [-1.19, -0.39], p < 0.00001), serum IL-12 levels (MD = -8.84, 95% CI [-11.20, -6.47], p < 0.00001) and serum IFN-γ levels (MD = -7.44, 95% CI [-11.51, -3.37], p = 0.0003) were reduced, and the serum TGF-β1 levels (MD = 2.40, 95% CI [1.24, 3.57], p < 0.0001) were increased. There were no significant differences in reported adverse events, including irritant contact dermatitis (RR = 0.51, 95% CI [0.25, 1.01], p = 0.05),' gastrointestinal reactions (RR = 2.47, 95% CI [0.49, 12.55], p = 0.28), lower limb edema (RR = 2.60, 95% CI [0.61, 11.06], p = 0.20), facial edema (RR = 2.33, 95% CI [0.61, 8.93], p = 0.22), or localized itching (RR = 0.56, 95% CI [0.18, 1.75], p = 0.32), between the two groups.

CONCLUSION

The current evidence indicates that CG combined with topical minoxidil therapy is effective and safe for AA. However, owing to the suboptimal quality of the included studies, more high-quality and large-scale RCTs are needed for comprehensive analysis and further validation.

An Overview of Commonly Used Natural Alternatives for the Treatment of Androgenetic Alopecia, with Special Emphasis on Rosemary Oil

Androgenetic alopecia is a chronic dermatological condition in which genetically predisposed individuals undergo progressive hair loss secondary to the effects of circulating androgens. It has been well documented that dihydrotestosterone binds to the androgenic receptors prevalent in the scalp, thus inducing miniaturization of the hair follicle. To date, the only FDA approved medications for the treatment of androgenetic alopecia are finasteride and minoxidil. A plethora of studies have been conducted testing the efficacy of various herbal compounds, but additional research is needed to further establish the concrete efficacy of such natural remedies in treating androgenetic alopecia. Of late, rosemary oil has gained mass popularity as a promising natural alternative. This review article will not only provide a detailed background on this ancient herbal component but will additionally overview all other major herbal alternatives including peppermint oil, tea tree oil, green tea, pumpkin seed oil, saw palmetto, and lavender oil and will summarize the latest clinical studies, which have tested their efficacy for the management of androgenetic alopecia.

Meta-Analysis of Efficacy of Platelet-Rich Plasma Combined with Minoxidil for Androgenetic Alopecia

BACKGROUND

Androgenetic alopecia (AGA) is a prevalent type of hair loss that impacts individuals of both genders. Platelet-rich plasma (PRP) and minoxidil have been employed as therapeutic interventions for AGA, yet the efficacy of their concurrent use remains ambiguous.

OBJECTIVE

To perform a comprehensive review and meta-analysis aimed at evaluating the effectiveness of platelet-rich plasma (PRP) in combination with minoxidil for the treatment of androgenetic alopecia (AGA).

METHODS

We conducted a comprehensive search of the databases PubMed, Embase, Web of Science, and Cochrane Library, encompassing their complete records up until December 2023. Eligible studies were randomized controlled trials that compared the combination of PRP and minoxidil with minoxidil or PRP alone in patients with AGA. The primary outcome measure was the change in hair growth as assessed by the hair density or hair thickness. Secondary outcome measures included patient satisfaction, and global photographic assessment.

RESULTS

A total of 6 studies involving 343 participants were included in this meta-analysis. The results showed that PRP combined with minoxidil significantly improved hair growth compared to minoxidil or PRP alone. The pooled analysis demonstrated a significant increase in hair density (weighted mean difference [WMD] = 9.14; 95% confidence interval [CI]: 6.57-11.70) and hair diameter (WMD = 4.72; 95% CI 3.21-6.23) in the PRP combined with minoxidil group. Moreover, patients receiving PRP combined with minoxidil reported higher satisfaction rates compared to those using minoxidil or PRP alone.

CONCLUSIONS

This meta-analysis suggests that PRP combined with minoxidil is an effective treatment for AGA, providing significant improvement in hair growth and patient satisfaction.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness of Exosome Treatment in Androgenetic Alopecia: Outcomes of a Prospective Study

OBJECTIVE

Harnessing the regenerative capabilities of stem cell-derived exosomes holds great promise for developing novel hair growth therapies, offering hope for individuals experiencing hair loss or alopecia. This aimed to elucidate the effect of "foreskin-derived mesenchymal stromal cells derived exosome" injection into the scalp on hair density in patients with androgenetic alopecia and the contribution of this treatment on patient satisfaction.

METHOD

This prospective study included 30 male patients, aged between 22 and 65, with hair type III-VI according to the Norwood-Hamilton scale. Characterization of the stem cell exosomes was performed with the nanoparticle tracking analysis (NTA), hair densities were calculated via digital imaging analysis, and patient satisfaction was questioned with a modified survey.

RESULTS

NTA results showed a characteristic distribution of peaks for exosomes 139.7 ± 2.3 nm in diameter. A statistically significant increase in hair density was observed in the 4th and 12th weeks after treatment (p < 0.05). Patient-reported satisfaction revealed a statistically significant difference in the answers given in the 12th week compared to the 4th week (p < 0.05). No side effects or complications were observed after exosome injection.

CONCLUSION

Foreskin-derived mesenchymal stromal cells derived exosome injection increased hair density, with sustained patient satisfaction throughout the study. The exosome application resulted in no side effects.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Progress of clinical research on fractional laser treatment of androgenetic alopecia: A review article

BACKGROUND

Androgenetic alopecia (AGA) is a prevalent form of hair loss that affects both men and women, severely impacting patients' quality of life. Traditional treatments include oral medications, topical medications, and hair transplantation, but these methods have certain side effects and limitations. How to safely effectively and maximally promote hair growth has been a key issue in the treatment of AGA. In recent years, fractionated laser therapy, as a noninvasive method, has gradually gained attention due to its minimally invasive and highly effective nature.

AIMS

In this paper, we summarized the studies related to fractional laser treatment of AGA in the past 15 years, and discussed its therapeutic mechanism, clinical effect, future development direction, and advantages and disadvantages compared with traditional treatment methods in the treatment of AGA.

METHODS

An extensive literature search was conducted using PubMed, Google, Google Scholar, Embase, and Scopus. All available articles studying fractional laser treatment of AGA were compiled in March 2024. Titles and abstracts were then screened for relevance and thoroughly examined for patient clinical outcomes. Prospective clinical trials, retrospective chart reviews, case series, and individual case reports were included in the literature review.

CONCLUSIONS

Fractional laser treatment of AGA showed remarkable efficacy and high safety. Compared with traditional treatments, fractional laser has the advantages of minimally invasive, quick recovery, fewer side effects, and a wide range of population applicability, providing an effective treatment option for AGA patients. Further large-scale clinical studies will help optimize the laser parameters and treatment settings to improve the therapeutic effect.

Comparative proteomic analysis of male and female androgenetic alopecia: elucidating gender-specific molecular patterns

This study presents a comprehensive comparative proteomic analysis aimed at elucidating the molecular mechanisms underlying male androgenetic alopecia (AGA) and female AGA. Scalp samples from both male AGA and female AGA patients, along with their respective normal controls, were subjected to proteomic analysis, followed by bioinformatics investigations. Our findings revealed distinct proteomic profiles between male AGA and female AGA, with a total of 68 differentially expressed proteins identified in male AGA and 84 in female AGA. Among these, specific proteins were altered in male AGA and female AGA, highlighting the sex-specific molecular pathways involved in the pathogenesis of pattern hair loss. Protein-protein interaction network analyses further delineated the most impacted biological processes, including cytoskeleton organization, stress response, and metabolic pathways, with particular emphasis on the differing altered stress responses and metabolic states associated with hair loss between sexes. Our study not only uncovered the complex molecular landscape of male AGA and female AGA but also identified potential biomarkers and therapeutic targets, offering new insights into the sex-specific pathogenesis of pattern hair loss.

Small molecule agents against alopecia: Potential targets and related pathways

Alopecia has emerged as a global concern, extending beyond the middle-aged and elderly population and increasingly affecting younger individuals. Despite its growing prevalence, the treatment options and effective drugs for alopecia remain limited due to the incomplete understanding of its underlying mechanisms. Therefore, it is urgent to explore the pathogenesis of alopecia and discover novel and safer therapeutic agents. This review provided an overview of the prevailing clinical disorders of alopecia, and the key pathways and targets involved in hair growth process. Additionally, it discusses FDA-approved drugs and clinical candidates for the treatment of alopecia, and explores small molecule compounds with anti-alopecia potential in the drug discovery phase. These endeavors are expected to provide researchers with valuable scientific insights and practical information for anti-alopecia drug discovery.

Improvement of androgenic alopecia by extracellular vesicles secreted from hyaluronic acid-stimulated induced mesenchymal stem cells

BACKGROUND

Androgenetic alopecia (AGA) is a common form of hair loss. Androgens, such as testosterone and dihydrotestosterone, are the main causes of AGA. Extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) can reduce AGA. However, preparing therapeutic doses of MSCs for clinical use is challenging. Induced pluripotent stem cell-derived MSCs (iMSCs) are homogenous and easily expandable, enabling scalable production of EVs. Hyaluronic acid (HA) can exert various functions including free radical scavenging, immune regulation, and cell migration. Herein, we examined whether hyaluronic acid (HA) stimulation of iMSCs could produce EVs with enhanced therapeutic outcomes for AGA.

METHODS

EVs were collected from iMSCs primed with HA (HA-iMSC-EVs) or without HA (iMSC-EVs). The characteristics of EVs were examined using dynamic light scattering, cryo-transmission electron microscopy, immunoblotting, flow cytometry, and proteomic analysis. In vitro, we compared the potential of EVs in stimulating the survival of hair follicle dermal papilla cells undergoing testosterone-mediated AGA. Additionally, the expression of androgen receptor (AR) and relevant growth factors as well as key proteins of Wnt/β-catenin signaling pathway (β-catenin and phosphorylated GSK3β) was analyzed. Subsequently, AGA was induced in male C57/BL6 mice by testosterone administration, followed by repeated injections of iMSC-EVs, HA-iMSC-EVs, finasteride, or vehicle. Several parameters including hair growth, anagen phase ratio, reactivation of Wnt/β-catenin pathway, and AR expression was examined using qPCR, immunoblotting, and immunofluorescence analysis.

RESULTS

Both types of EVs showed typical characteristics for EVs, such as size distribution, markers, and surface protein expression. In hair follicle dermal papilla cells, the mRNA levels of AR, TGF-β, and IL-6 increased by testosterone was blocked by HA-iMSC-EVs, which also contributed to the augmented expression of trophic genes related to hair regrowth. However, no notable changes were observed in the iMSC-EVs. Re-activation of Wnt/β-catenin was observed in HA-iMSC-EVs but not in iMSC-EVs, as shown by β-catenin stabilization and an increase in phosphorylated GSK3β. Restoration of hair growth was more significant in HA-iMSC-EVs than in iMSC-EVs, and was comparable to that in mice treated with finasteride. Consistently, the decreased anagen ratio induced by testosterone was reversed by HA-iMSC-EVs, but not by iMSC-EVs. An increased expression of hair follicular β-catenin protein, as well as the reduction of AR was observed in the skin tissue of AGA mice receiving HA-iMSC-EVs, but not in those treated with iMSC-EVs.

CONCLUSIONS

Our results suggest that HA-iMSC-EVs have potential to improve AGA by regulating growth factors/cytokines and stimulating AR-related Wnt/β-catenin signaling.

Delivery of minoxidil encapsulated in cyclodextrins with photoacoustic waves enhances hair growth

The current pharmacological management of androgenetic alopecia is inconvenient and requires a discipline that patients find difficult to follow. This reduces compliance with treatment and satisfaction with results. It is important to propose treatment regimens that increase patient compliance and reduce adverse effects. This work describes transdermal delivery of minoxidil partially encapsulated in β-cyclodextrin and assisted by photoacoustic waves. Photoacoustic waves transiently increase the permeability of the skin and allow for the delivery of encapsulated minoxidil. A minoxidil gel formulation was developed and the transdermal delivery was studied in vitro in the presence and absence of photoacoustic waves. A 5-min stimulus with photoacoustic waves generated by light-to-pressure transducers increases minoxidil transdermal delivery flux by approximately 3-fold. The flux of a 1% minoxidil formulation promoted by photoacoustic waves is similar to the passive flux of a 2% minoxidil commercial formulation. Release of minoxidil from β-cyclodextrin increases dermal exposure without increasing peak systemic exposure. This promotes hair growth with fewer treatments and reduced adverse effects. In vivo studies using encapsulated minoxidil and photoacoustic waves yielded 86% hair coat recovery (vs. 29% in the control group) and no changes in the blood pressure.

Risk factors and lipid metabolism characteristics of early-onset male androgenetic alopecia: A pilot study

BACKGROUND

Male androgenetic alopecia (MAA) is a multifactorial disease, with patients presenting at a younger age, which is a risk factor for many metabolic diseases.

AIMS

To explore the risk factors associated with early-onset of MAA and its metabolic characteristics.

METHODS

Forty patients with MAA and 45 healthy controls were collected. The serum levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total testosterone (TT), uric acid (UA), and 25-hydroxyvitamin D (25(OH)D) were measured. Meanwhile, lipid metabolites were detected by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS).

RESULTS

37.50% MAA patients had metabolic syndrome, compared to 17.78% in control group (p < 0.05). The levels of HDL-C, UA, and 25(OH)D were decreased in patients with MAA compared to healthy controls (p < 0.05). However, there was no significant difference in the level of TT between the two groups. Additionally, there were no significant differences in the levels of HDL-C, UA, 25(OH)D, and TT among different grades of hair loss (p > 0.05). The lipid profile of early-onset MAA differed significantly from healthy controls. In early-onset MAA, the levels of ceramide (Cer) and sphingomyelin (SM) were significantly lower. Cer(d38:5) and TG(15:0/18:1/18:1) may be the biomarkers.

CONCLUSION

Low HDL-C, UA, and 25(OH)D may be the independent risk factors for early-onset MAA. Abnormal lipid metabolism was observed in early-onset MAA, wherein Cer and SM may serve as protective factors.

Randomized Clinical Trial to Evaluate the Effect of Probiotic Intake on Androgenic Alopecia

This study aimed to assess the impact of a combination of probiotic strains of Lactiplantibacillus on the treatment of androgenic alopecia (AGA). To this end, 136 individuals with AGA (62 men and 74 women) aged 18-65 years were enrolled in a double-blind, parallel-group clinical trial. A total of 115 individuals (57 in the probiotic group and 58 in the placebo group) completed this study within a 16-week intervention period. Capillary density, thickness, and length of hair were analyzed before and after the intervention using FotoFinder Trichoscale Pro. In addition, the gut microbiota was assessed by paired-end sequencing on the Illumina MiSeq platform (2 × 300 bp). At the conclusion of the treatment period, a notable decline (p < 0.05) in the number of telogen hairs was evident in the probiotic group while hair thickness decreased in the placebo group (p < 0.05). However, the remaining variables did not exhibit any statistically significant changes. In the probiotic-treated group, individuals aged less than 37.5 years exhibited a reduction in the number and density of telogen hair (p = 0.0693 and p = 0.0669, respectively) and an increase in hair length (p = 0.0871). Furthermore, a notable decline in the number and density of vellus hair (p < 0.05) was observed, and this was accompanied by no change in the hair thickness. The probiotic-treated group exhibited a significantly higher abundance of Lactobacillus (p-adjusted < 0.05, DEseq2 test) and demonstrated a notable reduction in the number and density of telogen hair, and this was accompanied by an increase in the percentage of anagen hair. The probiotic mixture was well tolerated by the participants, with a treatment adherence rate of 90%. In light of this study's limitations, it can be concluded that a mixture of three strains of Lactiplantibacillus promotes the presence of terminal follicles, preventing their gradual miniaturization, which is a characteristic of AGA.

Rational Design of Human Hair Keratin-Driven Proteins for Hair Growth Promotion

Keratins, the most abundant proteins in human hair, are excellent hair nutrients for growth. However, the complex components of keratin extract hinder their mechanism investigation, and the pure recombinant keratin with poor solubility limited its hair growth promotion efficiency. Here, the water-soluble recombinant keratins (RKs) of K31 and K81 are rationally designed through QTY Code methodology, which are then used to fabricate the microneedles to study the effect of keratin on hair growth. Interestingly, it is discovered that more than 40% of the hair follicles (HFs) in the RK81QTY group entered the anagen on day 12 and the diameter of new hair is 15.10 ± 2.45 µm, which significantly promoted growth and development of HFs and improved new hair quality compared to RK31QTY. Water-soluble RKs significantly enhanced HFs activity and de novo regeneration of robust hairs compared to extract and minoxidil by upregulating the PI3K/AKT/Nf-κB signaling axis. These findings highlight the potential of designing solubilized recombinant keratins with distinct properties to improve therapeutical effects and open new avenues to designing keratin-based proteins.

Ellagic acid inhibits dihydrotestosterone-induced ferroptosis and promotes hair regeneration by activating the wnt/β-catenin signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Androgenic alopecia (AGA) is the most prevalent form of hair loss in clinical practice and affects the physical and psychological well-being of adolescents. Paeonia lactiflora Pallas (PL), which is widely used in traditional Chinese medicine, enhances blood function and promotes hair growth, and ellagic acid (EA), a polyphenol in PL extract, shows strong antioxidant, anti-aging, and anti-inflammatory properties and also plays a role in the treatment of various skin conditions. However, its role and mechanism of action in AGA remain unclear.

AIM OF THE STUDY

To determine whether EA can rescue slow hair regeneration by regulating dihydrotestosterone (DHT)-induced ferroptosis in AGA mice and clarify the effect of EA on DHT-induced ferroptosis in dermal papilla cells (DPCs).

MATERIALS AND METHODS

Male C57BL/6 mice were used to establish a DHT-induced AGA mouse model, whereas DPCs were used to establish a DHT-induced cellular model. Thereafter, we investigated the therapeutic mechanism of action of EA via immunofluorescence, western blot analysis, immunohistochemistry, electron microscopy, and molecular docking.

RESULTS

EA stimulated hair regeneration in mice and reversed DHT-induced increases in iron content, lipid peroxidation, and DHT-induced mitochondrial dysfunction by activating the Wnt/β-catenin signaling pathway. Further, β-catenin knockdown suppressed the inhibitory effect of EA on DHT-induced ferroptosis in DPCs.

CONCLUSION

EA inhibits DHT-induced ferroptosis and promotes hair regrowth in mice by activating the Wnt/β-catenin signaling pathway. Thus, it has potential for use as a treatment option for AGA.

Effects of RF Electric Currents on Hair Follicle Growth and Differentiation: A Possible Treatment for Alopecia

Androgenic alopecia (AGA) is the most common type of alopecia and its treatments involve drugs that have various adverse effects and are not completely effective. Radiofrequency-based therapies (RF) are an alternative for AGA treatment. Although there is increasing clinical evidence of the effectiveness of RF for alopecia, its effects at the tissue and cellular level have not been studied in detail. The objective of this study was to analyze ex vivo the potential effect of RF currents used in capacitive resistive electrical transfer (CRET) therapy on AGA. Hair follicles (HFs) were donated by patients with AGA and treated with CRET. AGA-HFs were exposed in vitro to intermittent 448 kHz electric current in subthermal conditions. Cell proliferation (Ki67), apoptosis (TUNEL assay), differentiation (β-catenin), integrity (collagen and MMP9), thickness of the epidermis surrounding HF, proportion of bulge cells and melanoblasts in AGA-HF were analyzed by immunohistochemistry. CRET increased proliferation and decreased death of different populations of AGA-HF cells. In addition, the melanoblasts increased in bulge and the epidermis surrounding the hair follicle thickened. These results support the effectiveness of RF-based therapies for the treatment of alopecia. However, clinical trials are necessary to know the true effectiveness of CRET therapy and other RF therapies for AGA treatment.

Delivery Strategies of siRNA Therapeutics for Hair Loss Therapy

Therapeutic needs for hair loss are intended to find small interfering ribonucleic acid (siRNA) therapeutics for breakthrough. Since naked siRNA is restricted to meet a druggable target in clinic,, delivery systems are indispensable to overcome intrinsic and pathophysiological barriers, enhancing targetability and persistency to ensure safety, efficacy, and effectiveness. Diverse carriers repurposed from small molecules to siRNA can be systematically or locally employed in hair loss therapy, followed by the adoption of new compositions associated with structural and environmental modification. The siRNA delivery systems have been extensively studied via conjugation or nanoparticle formulation to improve their fate in vitro and in vivo. In this review, we introduce clinically tunable siRNA delivery systems for hair loss based on design principles, after analyzing clinical trials in hair loss and currently approved siRNA therapeutics. We further discuss a strategic research framework for optimized siRNA delivery in hair loss from the scientific perspective of clinical translation.

An Academic Dermatology Center's Structured Platelet-rich Plasma Approach to Patients with Androgenetic Alopecia

Androgenetic alopecia (AGA) is a prevalent cause of hair loss with complex pathophysiologic mechanisms that pose challenges for effective treatment. Despite various therapeutic approaches yielding only partial results, regenerative treatments, such as platelet-rich plasma (PRP), have gained popularity. However, the lack of standardized PRP practices, encompassing product preparation and application, has been a significant concern. This article aims to contribute to fill this gap by presenting a comprehensive overview of PRP practices at a large academic center. Through detailing our protocols, this work not only contributes to the understanding of AGA treatment but also emphasizes the crucial aspect of treatment standardization in the context of PRP therapy. By providing a practical representation of our institutional PRP practices, we aim to contribute to the ongoing discourse on refining and implementing standardized protocols, fostering reproducibility, and improving clinical outcomes in the management of AGA.

Thyroid receptor β: A promising target for developing novel anti-androgenetic alopecia drugs

Androgenetic alopecia (AGA) significantly impacts the self-confidence and mental well-being of people. Recent research has revealed that thyroid receptor β (TRβ) agonists can activate hair follicles and effectively stimulate hair growth. This review aims to comprehensively elucidate the specific mechanism of action of TRβ in treating AGA from various perspectives, highlighting its potential as a drug target for combating AGA. Moreover, this review provides a thorough summary of the research advances in TRβ agonist candidates with anti-AGA efficacy and outlines the structure-activity relationships (SARs) of TRβ agonists. We hope that this review will provide practical information for the development of effective anti-alopecia drugs.

Intradermal Injection in Balding Region Versus Intramuscular Injection in Surrounding Muscles: A Split-Scalp, Randomized Trial on BoNT for Androgenetic Alopecia

INTRODUCTION

Recent advancements in androgenetic alopecia (AGA) treatment have highlighted the efficacy of botulinum toxin (BoNT). However, inconsistencies in injection sites and depths warrant attention. It remains unclear which injection strategy is most beneficial for patients.

METHODS

This split-scalp randomized controlled trial divided each enrolled participant's scalp along the midline: one side was randomized to receive intramuscular BoNT injections in the surrounding muscles, while the other side received intradermal BoNT injections directly into the balding areas. This study evaluated the impact of treatment on hair density and diameter through trichoscopic examinations conducted at baseline and 12 weeks post treatment. Additionally, assessments of pain and overall safety were integrated into the study protocol.

RESULTS

Twenty-nine patients completed the study, with significant improvements in hair density observed in the intramuscular injection group compared to the intradermal group (p < 0.001). Both groups exhibited increases in hair diameter, but no significant difference was found between the two methods (p = 0.433). Pain evaluation revealed that intradermal injections in balding areas were more painful than intramuscular injections (p = 0.036), with no severe adverse reactions reported except for a single case of alopecia areata following injection.

CONCLUSION

Our research revealed that both BoNT injection strategies enhanced hair diameter 12 weeks post-treatment, with intramuscular injections significantly improving hair density more effectively. Despite the promising outcomes, the variability in patient responses underscores the necessity for personalized approaches and further research to refine injection protocols for optimized efficacy and safety.

TRIAL REGISTRATION NUMBER

ChiCTR2400080190.

Autophagy Dysfunction: The Kernel of Hair Loss?

Autophagy is recognized as a crucial regulatory process, instrumental in the removal of senescent, dysfunctional, and damaged cells. Within the autophagic process, lysosomal digestion plays a critical role in the elimination of impaired organelles, thus preserving fundamental cellular metabolic functions and various biological processes. Mitophagy, a targeted autophagic process that specifically focuses on mitochondria, is essential for sustaining cellular health and energy balance. Therefore, a deep comprehension of the operational mechanisms and implications of autophagy and mitophagy is vital for disease prevention and treatment. In this context, we examine the role of autophagy and mitophagy during hair follicle cycles, closely scrutinizing their potential association with hair loss. We also conduct a thorough review of the regulatory mechanisms behind autophagy and mitophagy, highlighting their interaction with hair follicle stem cells and dermal papilla cells. In conclusion, we investigate the potential of manipulating autophagy and mitophagy pathways to develop innovative therapeutic strategies for hair loss.

Effectiveness and safety of the ablative fractional 2940-nm Er: YAG laser for the treatment of androgenetic alopecia

Laser sources have established their potential effect in inducing hair regrowth. No large cohort study has evaluated the effect of ablative fractional 2940-nm erbium yttrium aluminum garnet (Er: YAG) laser in the treatment of androgenetic alopecia (AGA). To investigate the efficacy and safety of the ablative fractional 2940-nm Er: YAG laser in combination with medication therapy for the treatment of AGA. We performed a retrospective study between first July 2021 to 30th December 2021. All included patients received oral finasteride and topical minoxidil, or combined with six sessions of Er: YAG laser at 2-week intervals. Patients were divided into medication or combined therapy groups. The efficacy of the two therapies was evaluated by the investigator's Global Assessment (IGA) scores and the patient's Likert satisfaction scale at week 12 and week 24. Changes in total, terminal and villous hair count, total and terminal hair diameter, and AGA grade were also recorded. Adverse events were evaluated at each follow-up. A total of 192 male patients with AGA were included, including 67 receiving combination treatment, and 125 receiving medication treatment. At week 24, the combination treatment afforded superior outcomes in the IGA score, patient's global assessment, total and terminal hair counts, and diameters (all P<0.05). No severe adverse events were reported in both groups. The combined therapy of ablative fractional Er: YAG laser and medication was superior in treating male AGA than single medication therapy without serious adverse effects.

Phloroglucinol Enhances Anagen Signaling and Alleviates H2O2-Induced Oxidative Stress in Human Dermal Papilla Cells

Phloroglucinol (PG) is one of the abundant isomeric benzenetriols in brown algae. Due to its polyphenolic structure, PG exhibits various biological activities. However, the impact of PG on anagen signaling and oxidative stress in human dermal papilla cells (HDPCs) is unknown. In this study, we investigated the therapeutic potential of PG for improving hair loss. A non-cytotoxic concentration of PG increased anagen-inductive genes and transcriptional activities of β-Catenin. Since several anagen-inductive genes are regulated by β-Catenin, further experiments were performed to elucidate the molecular mechanism by which PG upregulates anagen signaling. Various biochemical analyses revealed that PG upregulated β-Catenin signaling without affecting the expression of Wnt. In particular, PG elevated the phosphorylation of protein kinase B (AKT), leading to an increase in the inhibitory phosphorylation of glycogen synthase kinase 3 beta (GSK3β) at serine 9. Treatment with the selective phosphoinositide 3-kinase/AKT inhibitor, LY294002, restored the increased AKT/GSK3β/β-Catenin signaling and anagen-inductive proteins induced by PG. Moreover, conditioned medium from PG-treated HDPCs promoted the proliferation and migration of human epidermal keratinocytes via the AKT signaling pathway. Subsequently, we assessed the antioxidant activities of PG. PG ameliorated the elevated oxidative stress markers and improved the decreased anagen signaling in hydrogen peroxide (H2O2)-induced HDPCs. The senescence-associated β-galactosidase staining assay also demonstrated that the antioxidant abilities of PG effectively mitigated H2O2-induced senescence. Overall, these results indicate that PG potentially enhances anagen signaling and improves oxidative stress-induced cellular damage in HDPCs. Therefore, PG can be employed as a novel therapeutic component to ameliorate hair loss symptoms.

Roles of gut microbiota in androgenetic alopecia: insights from Mendelian randomization analysis

Background

Androgenetic alopecia (AGA) is the most common type of androgen-associated hair loss. Previous studies have indicated an association between the gut microbiota and AGA. To delve deeper, we executed a two-sample Mendelian randomization (MR) analysis to investigate the potential causal relationship between the gut microbiota and AGA.

Methods

A two-sample MR investigation was utilized to delve into the intricate interplay between gut microbiota and AGA. Information regarding 211 gut microbial taxa was sourced from the MiBioGen consortium. The summary statistics of the genome-wide association studies (GWAS) for AGA were obtained from the FinnGen biobank, which included 195 cases and 201,019 controls. Various analytical approaches, including Inverse Variance Weighting (IVW), Weighted Median, MR-Egger, Weighted Mode, and Simple Mode were employed to evaluate the causal impact of gut microbiota on AGA. Sensitivity analyses were subsequently conducted to affirm the robustness of the findings.

Results

A two-sample MR investigation unveiled the genus Olsenella, genus Ruminococcaceae UCG-004, and genus Ruminococcaceae UCG-010 were identified as risk factors associated with AGA. In contrast, the family Acidaminococcaceae and genus Anaerofilum, along with the genus Ruminiclostridium 9, demonstrated a protective effect. The sensitivity analyses provided additional assurance that the findings of the current study were less susceptible to the influence of confounding variables and biases.

Conclusion

The MR study has established a link between specific gut microbiota and AGA, offering evidence for the identification of more precisely targeted probiotics. This discovery has the potential to aid in the prevention, control, and reversal of AGA progression.

Medical Treatment for Androgenetic Alopecia

Androgenetic alopecia is a common type of hair loss, which is generally influenced by genetic factors and systemic androgens resulting in follicular miniaturization.1 It can cause cosmetic problems leading to psychological distress among affected men and women. Effective standard medical treatments available are topical minoxidil 2 to 5%, oral finasteride, oral dutasteride, and hair transplantation.1 However, some patients do not achieve favorable results with standard treatments. For these reasons, other novel treatments have been developed, including new medications, regenerative medicines (autologous platelet-rich plasma, adipose-derived stem cells, micrograft generation, and exosome), and low-level laser therapy.

Utilising SNP Association Analysis as a Prospective Approach for Personalising Androgenetic Alopecia Treatment

INTRODUCTION

Androgenetic alopecia (AGA) is a prevalent, multifactorial form of hair loss involving complex aetiological factors, such as altered androgen regulation and energy metabolism. Existing treatments offer limited success, thus highlighting the need for advanced, personalised therapeutic strategies. This study focuses on correlating the genetic mechanisms of AGA with molecular targets involved in the response to current treatment modalities.

METHODS

An anonymised database including 26,607 patients was subjected to analysis. The dataset included information on patients' genotypes in 26 single nucleotide polymorphisms (SNPs), specifically, and diagnosed AGA grades, representing a broad range of ethnic backgrounds.

RESULTS

In our sample, 64.6% of males and 35.4% of females were diagnosed with female pattern hair loss. This distribution aligns well with prior studies, thus validating the representativeness of our dataset. AGA grading was classified using the Hamilton-Norwood and Ludwig scales, although no association was found to the grade of the disease. SNP association analysis revealed eight SNPs, namely rs13283456 (PTGES2), rs523349 (SRD5A2), rs1800012 (COL1A1), rs4343 (ACE), rs10782665 (PTGFR), rs533116 (PTGDR2), rs12724719 (CRABP2) and rs545659 (PTGDR2), to be statistically significant with a p-value below 0.05.

CONCLUSIONS

The study establishes a preliminary association between eight specific SNPs and AGA. These genetic markers offer insights into the variability of therapeutic responses, thus underlining the importance of personalised treatment approaches. Our findings show the potential for more targeted research to understand these SNPs' and further roles in AGA pathophysiology and in modulating treatment response.

Factors associated with early-onset androgenetic alopecia: A scoping review

BACKGROUND

Early-onset androgenetic alopecia (AGA) has been associated with various chronic conditions, including metabolic syndrome (MetS). Gaining a deep understanding of early-onset AGA may enable earlier intervention in individuals at high risks. This scoping review aims to explore the risk factors and etiology, associated conditions, and adverse effects on wellbeing in early-onset AGA.

METHODS

Electronic literature searches were conducted in MEDLINE, EMBASE and CENTRIAL. Eligible studies included case-control, cohort, cross-sectional, and meta-analysis studies. Selected studies needed to clearly define early-onset AGA cases or include only cases starting before the age of 40 and compare them with appropriate controls. The exclusion criteria comprised editorials, commentaries, case series, and non-systematic reviews, among others. Data extraction involved collecting study characteristics, methodologies, main outcomes, and findings. Descriptive tables were used to summarize key information and relevant variables when necessary.

RESULTS

Among the 65 eligible articles, 67.69% were case-control studies and 78.46% evaluated only male patients. "Early-onset" was defined as cases developing before the age of 30 years in 43.08% of the studies. The Hamilton-Norwood scale was the most frequently used method for evaluating the severity of alopecia in men (69.23%). Reported risk factors for early-onset AGA included a family history of AGA, cigarette smoking, unhealthy dietary habits, and a high body mass index. Early-onset AGA may also be associated with hormonal profiles, 5α-reductase enzyme activity, androgen receptor genes, and some susceptibility loci. Comorbidities investigated included MetS, cardiovascular disease, insulin resistance, dyslipidemia, and Parkinson's disease. Men with early-onset AGA may have reduced treatment efficacy with drug like rosuvastatin, metformin or lisinopril for dyslipidemia, prediabetes, or hypertension. Additionally, young men with AGA tended to suffer from psychological issues such as anxiety and low self-esteem compared to those without hair loss.

CONCLUSION

Early-onset AGA is a complex condition with various risk factors and etiology, associated comorbidities, and potential implications for treatment response and psychological health.