1
|
Pozo-Pérez L, Tornero-Esteban P, López-Bran E. Clinical and preclinical approach in AGA treatment: a review of current and new therapies in the regenerative field. Stem Cell Res Ther 2024; 15:260. [PMID: 39148125 PMCID: PMC11328498 DOI: 10.1186/s13287-024-03801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/11/2024] [Indexed: 08/17/2024] Open
Abstract
Androgenetic alopecia (AGA) is the most prevalent type of hair loss. Its morbility is mainly psychological although an increased incidence in melanoma has also been observed in affected subjects. Current drug based therapies and physical treatments are either unsuccessful in the long term or have relevant side effects that limit their application. Therefore, a new therapeutic approach is needed to promote regenerative enhancement alternatives. These treatment options, focused on the cellular niche restoration, could be the solution to the impact of dihydrotestosterone in the hair follicle microenvironment. In this context emerging regenerative therapies such as Platelet-rich plasma or Platelet-rich fibrine as well as hair follicle stem cells and mesenchymal stem cell based therapies and their derivatives (conditioned medium CM or exoxomes) are highlighting in the evolving landscape of hair restoration. Nanotechnology is also leading the way in AGA treatment through the design of bioinks and nanobiomaterials whose structures are being configuring in a huge range of cases by means of 3D bioprinting. Due to the increasing number and the rapid creation of new advanced therapies alternatives in the AGA field, an extended review of the current state of art is needed. In addition this review provides a general insight in current and emerging AGA therapies which is intented to be a guidance for researchers highlighting the cutting edge treatments which are recently gaining ground.
Collapse
Affiliation(s)
- Lorena Pozo-Pérez
- Dermatology Department, Clínico San Carlos Hospital, Madrid, Spain.
- Institute for Health Research of Clinico San Carlos Hospital (IdISSC), Madrid, Spain.
| | - Pilar Tornero-Esteban
- Cellular GMP Manufacturing Facility, Institute for Health Research of Clinico San Carlos Hospital (IdISSC), Madrid, Spain
| | | |
Collapse
|
2
|
Umar S, Khanna R, Lohlun B, Maldonado JC, Zollinger M, Osei-Tutu A, Gonzales A, Chouhan K, Nusbaum A. Follicular Unit Excision in Patients of African Descent: A Skin-Responsive Technique. Dermatol Surg 2023; 49:949-955. [PMID: 37530735 PMCID: PMC10521773 DOI: 10.1097/dss.0000000000003881] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Follicular unit excision is a favored minimally invasive hair transplantation method. However, it is suboptimal for many patients of African descent because of wide variations in hair and skin characteristics. OBJECTIVE To evaluate the performance of a skin-responsive follicular unit excision device, which accommodates hair curliness, skin thickness, and firmness in patients of African descent. MATERIALS AND METHODS The authors retrospectively evaluated patients who underwent scalp follicular unit (FU) excision using a skin-responsive technique at 7 multinational clinics. The preoperative donor grading for the anticipated difficulty used a scale with Class V indicating the highest degree of hair curliness, skin thickness, and firmness. RESULTS Of 64 eligible patients (45 males and 19 females), 28 had Class V FU excision donor grades. The mean transection rate for all patients was 3%-6%, which was highest in class V patients. Skin thickness and firmness had a greater effect on the maximum transection rate than hair curliness. Only 19 or 18 G punches were used. CONCLUSION The authors report consistence success of a new skin-responsive FU excision device for all patients of African descent with a mean graft transection rate of less than 10%. The findings support skin thickness and firmness as major influencers of graft attrition rate.
Collapse
Affiliation(s)
- Sanusi Umar
- Dermatology Division, Department of Medicine, University of California, Los Angeles, California
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, California
- Dr. U Hair and Skin Clinic, Manhattan Beach, California
| | - Raveena Khanna
- Dr. U Hair and Skin Clinic, Manhattan Beach, California
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | | | | | | | | | | | - Kavish Chouhan
- Department of Dermatology, DermaClinix, Clinic, New Delhi, India
| | - Aron Nusbaum
- Hair Transplant Institute Miami, Coral Gables, Florida
| |
Collapse
|
3
|
Umar S, Shitabata P, Rose P, Carter MJ, Thuangtong R, Lohlun B, Benhiba H, Oguzoglu T, Zollinger MM, Maldonado J, Gonzalez A, Novosilska M, Gómez Zubiaur A, Marti M. A New Universal Follicular Unit Excision Classification System for Hair Transplantation Difficulty and Patient Outcome. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1133-1147. [PMID: 35784270 PMCID: PMC9249093 DOI: 10.2147/ccid.s369346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022]
Abstract
Introduction The difficulty of the follicular unit excision (FUE) hair transplantation procedure is currently attributed to hair curliness and subsurface angulation. Patients possessing the curliest hair shafts are considered the most challenging. Consequently, patients with these features are often denied FUE. However, this practice does not consider intrapatient variation in the graft attrition rate and the rates themselves, which are frequently low in very curly hair where the skin firmness/thickness is average. To better aid practitioners in predicting FUE performance, we have developed a new scoring system (the Sanusi FUE Score Scale [SFS Scale]) based on two major donor variables (hair and skin characteristics). Material and Method The scale assigns scores to each of three hair subtypes (straight-wavy, curly, and coily-kinky) and each of three skin subtypes (thick/firm, soft/thin, and medium thickness/firmness). The scores were weighted based on the assessment of 13 experienced FUE practitioners from around the globe, who were asked to score each of the three skin and hair characteristics for their contribution to FUE difficulty. Results On the contribution of skin characteristics to FUE difficulty, 12/13 (92%) practitioners assigned the highest (most difficult) score to thick/firm skin, with medium skin thickness/firmness being the least challenging. The same percentage of practitioners gave the highest difficulty score to coiled-kinky hair subtypes regarding the contribution of hair characteristics to FUE difficulty. All agreed that straight-wavy hair presents the least challenge to FUE performance. Tallying the scores of the skin and hair variables generates a final score range of 2–9, which is associated with five grades/classes of challenge in the FUE procedure, influencing the need for a specialized skill/nuanced approach or equipment. Conclusion We developed a universal FUE donor scoring scale that accounts for the diversity of human hair and skin types. Further evaluation to determine the validity of this new classification system in predicting and grading FUE difficulty and patient outcomes is warranted. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/_O2E-rw-x0E
Collapse
Affiliation(s)
- Sanusi Umar
- Department of Medicine, Dermatology Division, University of California, Los Angeles, CA, USA
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA
- Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA
- Correspondence: Sanusi Umar, Dr. U Hair and Skin Clinic, 2121 N. Sepulveda Boulevard, Suite 200, Manhattan Beach, CA, 90266, USA, Tel +1-310-318-1500, Fax +1-310-318-1590, Email
| | - Paul Shitabata
- Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA
- Dermatopathology Institute, Torrance, CA, USA
| | - Paul Rose
- Miami Skin and Hair Institute, Coral Gables, FL, USA
| | | | - Rattapon Thuangtong
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
- Department of Medicine, Division of Dermatology, Mahidol University, Bangkok, Thailand
- Hairderma Clinic, Bangkok, Thailand
| | | | | | | | | | | | | | - Myroslava Novosilska
- Department of Dermatology and Oncology, Aesthetic Medical Clinic Myroslava Novosilska, Lviv, Ukraine
| | | | - Miguel Marti
- Dr. Marti Hair and Scalp Diseases Group, Buenos Aires, Argentina
| |
Collapse
|
4
|
Umar S, Lohlun B, Ogozuglu T, Carter MJ. A Novel Follicular Unit Excision Device for All-Purpose Hair Graft Harvesting. Clin Cosmet Investig Dermatol 2021; 14:1657-1674. [PMID: 34815683 PMCID: PMC8605797 DOI: 10.2147/ccid.s333353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
Purpose A challenge in follicular unit excision (FUE) is the lack of a single device that can adequately meet the requirements of a range of patient donor variables, such as hair curliness, race, body and head hair locations, and non-shaven short- and long-hair FUE. This study aimed to describe a novel FUE device developed based on skin responsiveness to serve as a single all-purpose FUE donor harvester. Patients and Methods We describe an all-purpose FUE device that consists of an all-purpose punch and a functionally complementing punch driver. The mechanism of action and method of use are reported. Several patients with a diversity of FUE challenges for three experienced FUE practitioners using the novel device are presented using photos and videos. The practitioners also reported their comparative experiences with using prior FUE systems in similar situations. Results The novel device demonstrated success in a variety of FUE scenarios without requiring specialized provider skills. The device responds to changing skin firmness and thickness, which are the primary causes of inconsistent performance in FUE devices between patients and within patients from one body/head area to another. It also minimized challenges of unpredictable hair curliness and angles by its innate ability to self-navigate the subsurface course of hair follicles, to which the FUE practitioner is typically blinded. Conclusion We describe a novel FUE device that overcomes the challenges of previous FUE technologies and has potential applicability to a diverse range of FUE scenarios. Our experience suggests that further validation is warranted.
Collapse
Affiliation(s)
- Sanusi Umar
- Department of Medicine, Dermatology Division, University of California, Los Angeles, CA, USA.,Division of Dermatology, Harbor-UCLA Medical Center, Torrance, CA, USA.,Dr. U Hair and Skin Clinic, Manhattan Beach, CA, USA
| | | | | | | |
Collapse
|
5
|
Abstract
The demand for minimally invasive cosmetic procedures is rising, and the public and other physicians deem dermatologists as top providers of these services. Given these expectations, dermatologic residency training must equip resident physician trainees to care for the growing population of patients with aesthetic concerns. As stands, formal hands-on cosmetic dermatology training in residency is lacking specific structure. Educational, cultural, time, and monetary barriers exist, among others, which restrict residents from attaining proficiency in cosmetic dermatology procedures prior to graduation. This may adversely impact patient safety and deter graduates from offering aesthetic procedures. The standardization of core residency competencies in minimally invasive cosmetic procedures is fundamental to guarantee patient safety and satisfaction while ensuring practitioner competence. The balance between these elements is essential for optimal patient care. We review and debate for modifying and strengthening the current curriculum requirements while presenting means to overcome barriers.
Collapse
Affiliation(s)
- Elizabeth J Kream
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Virginia A Jones
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA.
| |
Collapse
|
6
|
Current and emerging treatment strategies for hair loss in women of color. Int J Womens Dermatol 2019; 5:37-45. [PMID: 30809578 PMCID: PMC6374709 DOI: 10.1016/j.ijwd.2018.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 11/22/2022] Open
Abstract
Hair loss is common in women of color, and is associated with significant psychosocial complaints. Early clinical recognition and prompt initiation of intervention with medical treatment is critical to halt the disease process. In this article, we review the clinical presentations of nonscarring and scarring alopecias in women of color, use of dermoscopy for early recognition of the disease process, and medical, procedural, and surgical interventions. In conditions that result in scarring alopecia, such as late-stage traction, frontal fibrosing, or central centrifugal cicatricial alopecia, patients may benefit from procedural interventions, such as hair transplantation, platelet rich plasma injections, low-level laser therapy, or scalp therapy.
Collapse
|
7
|
Dlova NC, Salkey KS, Callender VD, McMichael AJ. Central Centrifugal Cicatricial Alopecia: New Insights and a Call for Action. J Investig Dermatol Symp Proc 2017; 18:S54-S56. [PMID: 28941495 DOI: 10.1016/j.jisp.2017.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 05/28/2023]
Abstract
Central centrifugal cicatricial alopecia (CCCA) is a common and progressive form of lymphocyte predominant scarring alopecia which impacts negatively on the quality of life of those affected. It is seen more commonly in women of African descent with prevalence ranging from 2.7% to 5.7%. Current postulates include genetic inheritance, with traction inducing hairstyling practices and hair chemicals as aggravating factors. Histology reveals a perifollicular lymphocytic inflammation of the lower infundibulum, premature desquamation of the inner root sheath, and fibrous connective tissue. Treatment remains challenging and is directed at suppressing and preventing the inflammation, thus aborting scarring, with surgical intervention reserved for those who have stable disease or absence of histological inflammation. Future research with more patient numbers, focusing on the genetics of CCCA may prove useful in order to fully understand the etiology, thus providing more effective treatments for CCCA.
Collapse
Affiliation(s)
- Ncoza C Dlova
- Department of Dermatology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Kimberly S Salkey
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Valerie D Callender
- Howard University College of Medicine, Washington, DC, USA; Callender Dermatology and Cosmetic Center, Glenn Dale, Maryland, USA
| | - Amy J McMichael
- Department of Dermatology, Wake Forest Baptist Health Medical Center, Winston-Salem, North Carolina, USA
| |
Collapse
|
8
|
Comparative Study of a Novel Tool for Follicular Unit Extraction for Individuals with Afro-textured Hair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1069. [PMID: 27757365 PMCID: PMC5055031 DOI: 10.1097/gox.0000000000001069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
Abstract
Hair transplantation involving patients with tightly curled Afro-textured hair using follicular unit extraction (FUE) employing conventional rotary punches frequently leads to unacceptably high transection rates. These patients are unsuitable candidates for FUE hair transplantation. Transection rates were observed during FUE in a case series of 18 patients with tightly curled Afro-textured hair using different punches.
Collapse
|