Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review

Homocysteine in androgenetic alopecia: A case control study and observational experiments on mice

OBJECTIVE

To investigate the relationship between homocysteine (HCY) and androgenetic alopecia (AGA).

METHODS

A case control study and two observational experiments on mice were conducted. In the first part, a total of 528 Chinese AGA patients and 500 age-matched healthy controls were included. Serum HCY levels of AGA and controls were compared. In the second part, eight mice were divided into two groups. Both groups of mice had their hair removed. AGA group received a DHT injection, and the other as control group. HCY levels in hair follicles (HFs) were detected by ELISA and compared. In the third part, twelve mice were divided into three groups and fed with different concentrations of methionine. After 4 weeks, serum HCY levels, parameters related to hair growth through observation and HE staining, and expression of immunohistochemistry (IHC) hair-growth-related markers Ki67, VEGF, IGF-1, Krt27, FGF9, and TGF-β1 were compared among the three groups.

RESULTS

In the first part, HCY levels were higher in AGA than the controls of both genders. However, there was no difference in HCY levels between groups with varying severity. Rates of hyperhomocysteinemia was higher in AGA patients than the controls. Logistic regression analysis showed serum HCY levels was positively correlated with the incidence of AGA. In the second part, HCY of the HFs in the AGA group was significantly higher than that in the control group. The third part showed that the increase in serum HCY levels inhibited the growth of mice hair, with the less expressed stimulative markers Ki67, VEGF, IGF-1, Krt27, and FGF9, while there was no difference in the expression of inhibitory markers TGF-β1.

CONCLUSION

There is a potential relationship between HCY and AGA. HCY had an inhibitory effect on hair growth. Further studies are necessary to explore the specific mechanism.

Hair transplantation versus scalp micropigmentation: A retrospective study of treatment selection in persons with female pattern hair loss

BACKGROUND

Hair transplant (HT) is the standard treatment for female pattern hair loss (FPHL), but scalp micropigmentation (SMP) is an alternative. Currently, there are no criteria to help choose between HT and SMP.

METHODS

Forty female patients with FPHL who had successfully undergone HT and SMP, were reviewed to identify factors that might help decide between treatments. Hair density (HD) and hair caliber were measured at the part line and mid-occipital region by a Folliscope. The sensitivity and specificity of HT and SMP were determined by area under the curve (AUC) and receiver operating characteristic curve.

RESULTS

Patients were divided into HT (n = 23) and SMP (n = 17) groups. The follicular unit density (FUD) (HT: 62.06 ± 4.8551/cm2; SMP: 66.59 ± 3.4971/cm2) and HD (HT: 96.16 ± 16.6954/cm2; SMP: 116.08 ± 17.0520/cm2) were significantly different (p < 0.01) between groups. The AUC for FUD was 77.6% with a cutoff value of 66.83 and 87.0% (1-0.412) sensitivity. The AUC for HD was 82.4% with a cutoff value of 96.17 and 69.6% (1-0.118) sensitivity.

CONCLUSIONS

HD was the most important factor when deciding between HT surgery and SMP. SMP is recommended when the HD is ≥104.6 hairs/cm2 and HT surgery is strongly recommended when the HD is ≤96.17 hairs/cm2.

Comprehensive transcriptome profiling between balding and non-balding scalp of female pattern hair loss in Asian

While many gene expression studies have focused on male pattern baldness (MPB), few studies have investigated the genetic differences between bald and non-bald hair follicles in female pattern hair loss (FPHL). This study aimed to identify molecular biomarkers associated with FPHL through genetic analysis of paired bald and non-bald hair follicles from 18 FPHL patients, using next-generation sequencing (NGS) techniques. RNA transcriptome analysis was performed to identify differentially expressed genes (DEGs) between bald and non-bald hair follicles in FPHL. The DEGs were validated using real-time PCR, and protein expression was confirmed through immunohistochemistry and western blot analysis. Our findings suggest that HOXB13, SFRP2, PTGDS, CXCR3, SFRP4, SOD3, and DCN are significantly upregulated in bald hair follicles compared to non-bald hair follicles in FPHL. SFRP2 and PTGDS were found to be consistently highly expressed in bald hair follicles in all 18 samples. Additionally, elevated protein levels of SFRP2 and PTGDS were confirmed through western blot and immunohistochemical analysis. Our study identified SFRP2 and PTGDS as potential biomarkers for FPHL and suggests that they may play a role in inducing hair loss in this condition. These findings provide a foundation for further research on the pathogenesis of FPHL and potential therapeutic targets.

Safety of Antiandrogens for the Treatment of Female Androgenetic Alopecia with Respect to Gynecologic Malignancies

The most common type of alopecia in women is female androgenetic alopecia (FAGA), characterized by progressive hair loss in a patterned distribution. Many oral therapies, including spironolactone (an aldosterone antagonist), androgen receptor blockers (e.g., flutamide/bicalutamide), 5-alpha-reductase inhibitors (e.g., finasteride/dutasteride), and oral contraceptives, target the mechanism of androgen conversion and binding to its respective receptor and therefore could be administered for the treatment of FAGA. Despite significant advances in the oral treatment of FAGA, its management in patients with a history of gynecological malignancies, the most common cancers in women worldwide, may still be a concern. In this review, we focus on the safety of antiandrogens for the treatment of FAGA patients. For this purpose, a targeted literature review was conducted on PubMed, utilizing the relevant search terms. To sum up, spironolactone seems to be safe for the systemic treatment of FAGA, even in high-risk populations. However, a general uncertainty remains regarding the safety of other medications in patients with a history of gynecologic malignancies, and further studies are needed to evaluate their long-term safety in patients with FAGA and risk factors to establish an optimal risk assessment and treatment selection protocol.

Repeated finasteride administration promotes synaptic plasticity and produces antidepressant- and anxiolytic-like effects in female rats

Finasteride is used in female-pattern hair loss, hirsutism, and polycystic ovarian syndrome. It inhibits 5α-reductase, which is an important enzyme in the biosynthesis of neurosteroids. The effects of finasteride treatment on mental health in female patients as well as the effects of repeated/chronic finasteride administration in female rodents are still unknown. Accordingly, in our study, we administered finasteride (10, 30, or 100 mg/Kg, s.c.) for 6 days in female rats and evaluated behavior, plasma steroid levels, and synaptic plasticity. Depression-like behavior was evaluated using forced swim test (FST) and splash test. Anxiety-like behavior was evaluated using novelty-suppressed feeding task (NSFT), elevated plus maze (EPM), open field test (OFT), and light-dark test (LDT). Plasma steroid levels were assessed using ELISA and synaptic plasticity by field potential recordings. We observed that finasteride decreased total immobility duration in FST, indicating antidepressant-like effect and decreased the latency to first bite in NSFT, showing anxiolytic-like effect. We also found a significant increase in plasma estradiol and a significant decrease in plasma corticosterone level. Furthermore, field potential recordings showed that finasteride increased hippocampal long-term potentiation. These results indicate that repeated finasteride administration in female rats may have antidepressant- and anxiolytic-like effect, which might be mediated by enhanced estradiol levels or decreased corticosterone levels. Further studies are required to validate the molecular mechanisms underlying the effects of finasteride in female rats. Understanding the mechanisms will help us in developing novel neurosteroid-based therapeutics in the treatment of neuropsychiatric disorders in women.

Patient perspectives on topical minoxidil for hair loss: a survey-based study from the University of Michigan Alopecia Clinic

Topical minoxidil is a widely used therapy for alopecia. Its availability over the counter in the United States makes it easily accessible. Various factors impact whether an individual decides to pursue treatment and/or continue long-term use. Our study aimed to investigate patient awareness, opinions, and hesitations regarding topical minoxidil use for hair loss treatment. The study also aimed to identify information sources influencing these viewpoints. A survey was administered to new patients seeking evaluation for alopecia aged 18 and above at the University of Michigan Alopecia Clinic. Data collection occurred between August 2022 and August 2023. Demographics, patient-reported hair loss diagnosis, history of minoxidil use, opinions on minoxidil, influential information sources, and concerns about minoxidil were collected. A total of 47 surveys were completed, primarily by females (78.7%) ages 18-40 years (44.7%). Respondents were aware of minoxidil (97.9%), with 63.8% reporting they had heard of minoxidil, but had not used it. Medical professionals were the most influential information source (34%), followed by close contacts (17%), internet searches (10.6%), and television (10.6%). Overall, positive opinions on minoxidil were expressed by 51.1%, negative opinions by 31.9%, and neutral opinions by 17%. Most common concerns included the need for continuous use (46.8%), required regular application (31.9%), skepticism about hair regrowth (29.8%), and expense (25.5%). Addressing personalized concerns and tailoring communication based on hair loss type and information sources may lead to more informed decisions and improved adherence. Gauging the opinions of this population provides valuable insights, aiding dermatologists in patient education and counseling strategies.

Comparative efficacy of 2% minoxidil alone against combination of 2% minoxidil and low-level laser therapy in female pattern hair loss-A randomized controlled trial in Chinese females

OBJECTIVES

To investigate the effectiveness and safety of combination of 655 nm low level laser helmet device with topical 2 % minoxidil solution at FPHL in Chinese population.

MATERIALS AND METHODS

Randomized, parallel, controlled, single-blind clinical trial was conducted. FPHL subjects were randomly allocated into 2 % minoxidil group and combination group. The 2 % minoxidil group received 1 ml topical 2 % minoxidil solution twice daily for 24 weeks. The combination group received 1 ml topical 2 % minoxidil solution twice daily together with 20 min 655 nm low-level laser helmet once every other day for 24 weeks. Hair parameters in two scalp areas including midscalp and vertex were evaluated at baseline, 12th week and 24th week.

RESULTS

In midscalp area, the combination group showed a lower increase in intermediate hair percentage than 2 % minoxidil group, which was statistically significant. Besides, the combination group had statistically significant increase than 2 % minoxidil group in mean hair diameter. Reported relative adverse events included slightly hair loss (27.8 %), desquamation (19.0 %), pruritus (15.2 %), seborrhea (2.5 %) and hypertrichosis (2.5 %).

CONCLUSION

In our trial, LLLT was demonstrated as a useful supplementary treatment for FPHL and the combination with 2 % minoxidil accomplished better improvement in intermediate hair enlargement and hair diameter of midscalp for FPHL.

CBD: A Potential Lead against Hair Loss, Alopecia, and its Potential Mechanisms

BACKGROUND

Nowadays, the majority of the population suffers from the problem of hair loss. It leads to disturbed mental health, lower self-confidence, and a lot more problems. A lot of the hair loss therapies available are not reliable and lead to recurrence and side effects after some time. Cannabinoids (CBD) have recently become quite popular for their benefits against hair loss. CBD oil preparations have been used both internally and externally for oral and topical use, respectively. Due to the presence of the endocannabinoid system (ECS) in the body, which naturally targets CB1 and CB2 receptors, the control of hair fall is possible. CBD is used topically for hair loss, whereas it is administered orally for the treatment and management of a medical condition, i.e., alopecia.

AIM/OBJECTIVE

The present review aimed to provide an in-depth study on hair loss and its management using CBD and its associated mechanisms.

METHODS

Electronic databases, such as ScienceDirect, Google Scholar, PubMed, Wiley, Springer, and Scopus, were thoroughly searched for information about how CBD is used, how it works, and what role it plays in treating alopecia and hair loss.

RESULTS

This review has highlighted the use of CBD-based hair loss therapy, and described various types of hair loss and their treatments. This review also details the phytocannabinoids and the potential mechanisms of CBD's activity against hair loss and alopecia.

CONCLUSION

The data obtained from the literature regarding CBD and hair loss provide a scientific basis for CBD use in alopecia. Additionally, a more precise and comprehensive study concerning CBD needs to be carried out at the pre-clinical and clinical levels.

Clinical and phototrichogrammatic evaluation of estradiol replacement therapy on hair growth in postmenopausal Japanese women with female pattern hair loss: a pilot study

Background

Female pattern hair loss (FPHL) is known to present with characteristic pathological conditions, including reduced overall hair density. Female hormones affect hair condition; however, the detailed mechanism is unknown. Furthermore, research on the topic is complicated by the fact that senescent alopecia often occurs concurrently with FPHL. Therefore, we investigated the effect of estradiol, a female hormone, on hair growth by eliminating aging factors and objectively evaluating hair changes caused by female hormone replacement therapy (HRT).

Objective

This study was conducted to elucidate the mechanism through which female hormones exert their effects on hair.

Methods

The study included 11 female patients undergoing HRT who were evaluated before initiating HRT, 3 months after initiating HRT, and 6 months after initiating HRT. The thinning hair score, hair density, telogen hair rate, telogen plucking strength, hair growth rate, and hair thickness were measured and evaluated. Furthermore, hematological tests were performed to assess the general physical condition of the participants.

Results

HRT increased the telogen hair rate (P = .010, paired t test) at 3 months, improved frontal hairline thinning score (P = .008, Wilcoxon test), and increased the plucking strength (P = .013, paired t test) at 6 months.

Limitations

The limitation of this study included the relatively small sample size, inability to conduct further long-term tests because of participant burden, and lack of a control group.

Conclusion

The results suggested that HRT improved the appearance of the frontal hairline. As few studies have analyzed the effects of female hormones on human hair, a novel finding of this study was the effects of estradiol on the plucking strength after excluding age as a factor. We believe that these findings will contribute to understanding FPHL and developing female hormone-related treatments.

The Menopausal Transition: Is the Hair Follicle "Going through Menopause"?

This article explores the link between menopause and changes in the hair follicle (HF) lifecycle, focusing on hormonal and metabolic dynamics. During menopause, hormonal fluctuations and aging can impact the HF, leading to phenomena such as thinning, loss of volume, and changes in hair texture. These changes are primarily attributed to a decrease in estrogen levels. However, not all women experience significant hair changes during menopause, and the extent of transformations can vary considerably from person to person, influenced by genetic factors, stress, diet, and other elements. Furthermore, menopause mirrors the aging process, affecting metabolism and blood flow to the HFs, influencing the availability of vital nutrients. The article also discusses the key role of energy metabolism in the HF lifecycle and the effect of hormones, particularly estrogens, on metabolic efficiency. The concept of a possible "menopause" clinically independent of menopause is introduced, related to changes in HF metabolism, emphasizing the importance of individual factors such as estrogen receptor responses, genetics, and last but not least, the microbiota in determining these dynamics.

Diagnosis and treatment of female alopecia: Focusing on the iron deficiency-related alopecia

Objectives

Alopecia is a soft but meaningful complaint affecting women's physical and psychological health. Female alopecia (FA) has diverse etiologies. Nonetheless, FA is stereotyped as female pattern hair loss, also known as female androgenetic alopecia, and has not been thoroughly investigated. This study aimed to identify the etiologies of FA at a tertiary medical center in Eastern Taiwan.

Materials and Methods

This retrospective study enrolled female patients with hair loss who visited the dermatology department of (blinded information). A complete history taking was obtained, including the onset and duration of alopecia, menstruation, gynecologic diseases, psychological stress, underlying diseases, vaccination, and dietary habits, etc., Blood tests were performed, including hemoglobin (Hb), ferritin, Zn, autoimmune and thyroid profiles, etc., Iron deficiency (ID) was defined as serum ferritin level <60 ng/mL. The hair condition, ferritin, and Hb levels were monitored every 3 months after supplementation.

Results

A total of 155 patients were recruited. The etiologies of FA were diverse; the top five etiologies were nutrient deficiencies (83.9%), autoimmune (14.8%) and thyroid (7.7%) diseases, psychological stress (12.3%), and coronavirus disease 2019 (COVID-19) vaccination (6.5%). ID accounted for 70.3% of cases. The disease duration was an important prognostic factor for the improvement of serum ferritin. Patients with subjective improvement of hair regrowth also had more increase of ferritin levels after iron supplementation. The corresponding ferritin level for female anemia (Hb: 12.0 g/dL) was 5.1 ng/mL, lower than the adequate level for hair growth (40-60 ng/mL), the corresponding Hb level of which was 13.1-13.8 g/dL.

Conclusion

The causes of FA varied, including nutrient deficiencies, autoimmune diseases, psychological stress, thyroid diseases, and COVID-19 vaccination, etc., Therefore, a complete survey before treatment is essential. Seventy percentage of FA cases were ID-FA. We suggest to redefine the serum ferritin level ≥60 ng/mL, with the corresponding Hb ≥13.0 g/dL as the normal range for early diagnosis. Initiation of iron supplementation within 6 months would result in a better prognosis.

Assessment of Occipital Involvement Among a Large Population of Females with Pattern Hair Loss in Saudi Arabia

Background

Cumulative evidence suggests the involvement of the occipital region in female pattern hair loss (FPHL). However, most of the studies that have been published so far concerned relatively small samples of patients.

Purpose

To assess the occipital involvement in FPHL and analyze its correlation with disease severity among a large sample of patients.

Patients and Methods

A retrospective study involved 1000 adult women with FPHL, between January 2020 and August 2022. Occipital involvement was defined as more than 10% of thin hairs (<0.03 mm). Baseline trichometry parameters in the frontal and occipital regions were analyzed.

Results

Occipital involvement was observed in 32.4% of the patients. Positive correlations between frontal and occipital regions were observed for all trichometry parameters; the strongest concerned average hair shaft thickness (Pearson's coefficient r=0.708), cumulative hair thickness (r=0.673), and trichometry-derived Sinclair scale (r=0.656). The risk of occipital involvement increased independently with the disease severity in frontal region; however, the disease progression was slower in the occipital compared to frontal region.

Conclusion

One-third of females in our study with FPHL had occipital involvement. This has a major impact on the methods used to diagnose pattern hair loss in females and their treatment plan including hair restoration surgery.

SARS-CoV-2 Infection-A Trigger Factor for Telogen Effluvium: Review of the Literature with a Case-Based Guidance for Clinical Evaluation

Telogen effluvium post-COVID-19 is a condition characterized by the diffuse and reversible loss of scalp hair in the period following infection with SARS-CoV-2, and it is currently the second cause of alopecia in women. In the context of the COVID-19 infection, intense psychological stress contributes to alopecia appearance, along with systemic inflammation, autoimmune reactions, oxidative stress, and virally induced hypoxia. Cytokines with proinflammatory action and vasoactive substances negatively modulate the metabolism of some molecules, such as proteoglycans, involved in the hair follicle's growth cycle. Studies show that a large percentage of hairs will suddenly enter the catagen phase during a moderate to severe COVID-19 infection. In the present paper, we update the data from the literature with a clinical example. Our case highlighted that the telogen effluvium after infections with SARS-CoV-2 is reversible with appropriate dermatological treatment. For therapeutic success, informing the patient about this pathology's self-limited and reversible character is essential to reduce the emotional stress that may aggravate the disease.

The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications

BACKGROUND

Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress.

OBJECTIVES AND PROJECT DESCRIPTION

The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth.

FUTURE IMPACT

With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.

Female Pattern Hair Loss and Negative Psychological Impact: Possible Role of Brain-derived Neurotrophic Factor (BDNF)

INTRODUCTION

Female Pattern Hair Loss (FPHL) is considered the most common type of hair loss in females. Women with FPHL may suffer from psychological distress and defective social functioning. Patients with psychiatric and neurodegenerative disorders almost have a deficient brain and blood brain-derived neurotrophic factor levels (BDNF). This serum BDNF level may act as a diagnostic marker for negative psychological impact in FPHL patients.

OBJECTIVES

Evaluate the levels of serum BDNF in patients with FPHL and correlate its level to the severity of alopecia and the degree of psychological impact.

METHODS

Forty-six female patients with FPHL and 41 healthy age-matched female volunteers as a control were included in the study. Patients filled out a Dermatology Life Quality Index questionnaire. Both patients and controls filled Beck Depression Inventory, Beck Anxiety Inventory, and Perceived Stress Scale (PSS) questionnaires. Serum levels of BDNF were measured for all the participants using the ELISA technique.

RESULTS

Patients with FPHL had significantly lower levels of BDNF and significantly higher Beck depression inventory score and PSS questionnaire scores. There is a significant negative correlation between serum levels of BDNF and Beck Depression Inventory, Beck Anxiety Inventory, and PSS questionnaire scores.

CONCLUSIONS

Patients with FPHL are at a high risk to develop chronic stress and depression. The serum level of BDNF is a good predictor for the assessment of chronic stress and depression in FPHL patients.

Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases

Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.

Prevention and Treatment of Chemotherapy-Induced Alopecia: What Is Available and What Is Coming?

Millions of new cancer patients receive chemotherapy each year. In addition to killing cancer cells, chemotherapy is likely to damage rapidly proliferating healthy cells, including the hair follicle keratinocytes. Chemotherapy causes substantial thinning or loss of hair, termed chemotherapy-induced alopecia (CIA), in approximately 65% of patients. CIA is often ranked as one of the most distressing adverse effects of chemotherapy, but interventional options have been limited. To date, only scalp cooling has been cleared by the US Food and Drug Administration (FDA) to prevent CIA. However, several factors, including the high costs not always covered by insurance, preclude its broader use. Here we review the current options for CIA prevention and treatment and discuss new approaches being tested. CIA interventions include scalp cooling systems (both non-portable and portable) and topical agents to prevent hair loss, versus topical and oral minoxidil, photobiomodulation therapy (PBMT), and platelet-rich plasma (PRP) injections, among others, to stimulate hair regrowth after hair loss. Evidence-based studies are needed to develop and validate methods to prevent hair loss and/or accelerate hair regrowth in cancer patients receiving chemotherapy, which could significantly improve cancer patients’ quality of life and may help improve compliance and consequently the outcome of cancer treatment.

Assessment of quality of life and self-esteem in male patients with androgenetic alopecia before and after hair transplantation

BACKGROUND

Patients with androgenetic alopecia experience a significant decrease in self-esteem and quality of life. There are several methods by which these factors may be improved.

AIMS

Determining whether patients feel better about themselves with a better quality of life after undergoing hair transplant procedure.

PATIENTS/METHODS

35 people were chosen from Jordan Skin and Hair Clinic in Tehran, Iran. Following hair transplant, follow-up subjects had their quality of life and level of self-esteem assessed using the Rosenberg Self-Esteem Scale (RSES) and Dermatology Life Quality Index (DLQI), respectively. The means of quantitative results were compared using paired T-test. The chi-square test was done to compare preoperative and postoperative characteristics qualitatively. Differences were regarded significant if p < 0.05. Analysis of covariance was applied to evaluate the effect of marital status and educational level on outcome variables (ANCOVA).

RESULTS

Our findings showed a statistically significant difference (p < 0.001) between pre- and post-operative hair transplantation for quality of life, and mean score increased to 2.17. There was a statistically significant difference between the two groups, with an average self-esteem score on RSES rising to 5.35 (p < 0.001). A statistically significant link between educational achievement and quality of life was found (p < 0.001).

CONCLUSION

This study found postoperative psychological aspects of AGA patients significantly improve than preoperative. Our results show that there is a statistically significant difference between the self-esteem and quality of life of AGA patients before and after hair restoration surgery.

An oral French maritime pine bark extract improves hair density in menopausal women: A randomized, placebo-controlled, double blind intervention study

Background and Aims

Female pattern hair loss affects females of all ages with a trend to increase after menopause. This disorder may have significant psychological impact and lead to anxiety and depression.

Objective

In a single center, double blind, randomized, placebo-controlled study, the effects of oral Pycnogenol® intake (3 × 50 mg/day for a total of 6 months) on hair density, scalp microcirculation, and a variety of skin physiological parameters was studied in Han Chinese menopausal women (N = 76) in Shanghai, China.

Methods

Measurements were taken at the beginning and after 2 and 6 months, respectively. Hair density was determined by digital photographs and further evaluated by Trichoscan software. Transepidermal water loss was measured by a humidity sensor in a closed chamber on the skin surface. Changes in microcirculation were detected as resting flux on the scalp by reflection photoplethysmography.

Results

Pycnogenol® intake significantly increased hair density by 30% and 23% after 2 and 6 months of treatment, respectively, as detected by Trichoscan® evaluation of digital photographs. Interestingly, photoplethysmography revealed that this beneficial effect was associated with a decrease in resting flux of the scalp skin, which might indicate an improvement of microcirculation. None of these effects were observed in the placebo taking group. In addition, a significant transient decrease of transepidermal water loss was observed in scalp skin under Pycnogenol,® but not placebo treatment.

Conclusion

Oral intake of Pycnogenol® might have the potential to reduce hair loss in postmenopausal women.

The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review

Introduction

Androgenetic alopecia (AGA) has negative impacts on both men and women in terms of appearance and mental stress. Spironolactone is a synthetic aldosterone receptor antagonist known to stimulate hair growth and has been widely used by dermatologists to treat AGA.

Objective

To conduct a systematic review evaluating the efficacy and safety of topical and oral spironolactone in AGA treatment.

Methods

We searched PubMed, Embase, the Cochrane Library, and the Web of Science until October 23rd, 2022, for human studies evaluating the efficacy of spironolactone for the treatment of AGA, regardless of doses and routes.

Results

We retrieved 784 papers and ultimately 7 articles matched our inclusion criteria and comprised 618 AGA patients (65 men, 553 women), 414 of them received spironolactone treatment. Oral spironolactone doses ranged from 25mg to 200mg daily, with the vast majority between 80mg and 110 mg. Dosage forms for topical spironolactone use include gels of 1% and solutions of 5% twice daily. Both oral and topical spironolactone have been shown efficacy for alopecia recovery, but topical use has significantly fewer side effects and is suitable for any gender. It showed better efficacy in combination with other therapies such as oral or topical minoxidil compared with monotherapy.

Conclusion

Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil. Topical spironolactone is safer than oral administration and is suitable for both male and female patients, and is expected to become a common drug for those who do not have a good response to minoxidil. Furthermore, more high-quality clinical randomized controlled studies should be performed.

The Association of Serum Ferritin Levels With Non-scarring Alopecia in Women

Objective We designed this study to evaluate the association of serum ferritin levels with non-scarring alopecia in women. Methodology All patients were diagnosed by performing a clinical examination of the crown part width and occiput. Ludwig's classification was used to categorize the cases into grades I-III. Different laboratory tests were performed for the baseline investigation, including serum iron, total iron-binding capacity (TIBC), hemogram, and thyroid function tests. Of the 5 ml of venous blood drawn for routine biochemical tests, 3 ml was stored at -20°C for measuring serum ferritin, while the other 2 ml was sent for a complete blood count. Student's t-test, a chi-square test, and Fisher's exact test were used for comparing the variables. Results This study recruited 100 cases of alopecia. Out of them, 46% of patients were diagnosed with alopecia areata, 25% of cases reported androgenetic alopecia, and 29% of cases of telogen effluvium were also observed. We observed overall mean serum ferritin levels of 20.47±17.50 and 27.87±17.51 in the case versus the control group with a statistically significant difference of 0.005. Conclusion Our study shows that iron stores are one of the independent hazards of alopecia in non-menopausal women. Thus, proper laboratory examination is needed to manage the disease prevalence and prognosis.

Oral Minoxidil for Chemotherapy-Induced Alopecia

Introduction

Chemotherapy-induced alopecia (CIA), one of the most dramatic side effects of chemotherapy, occurs in approximately 65% of patients receiving cytotoxic drugs.

Case Presentation

We report the case of a patient, 64 years old, affected by chemotherapy-induced alopecia treated with oral minoxidil with good results.

Discussion/Conclusion

Our case may be useful in the literature to propose a new therapy for this pathology that is fundamentally very difficult to treat.

Intermediate Hair Follicles from Patients with Female Pattern Hair Loss Are Associated with Nutrient Insufficiency and a Quiescent Metabolic Phenotype

Female pattern hair loss (FPHL) is a non-scarring alopecia resulting from the progressive conversion of the terminal (t) scalp hair follicles (HFs) into intermediate/miniaturized (i/m) HFs. Although data supporting nutrient deficiency in FPHL HFs are lacking, therapeutic strategies are often associated with nutritional supplementation. Here, we show by metabolic analysis that selected nutrients important for hair growth such as essential amino acids and vitamins are indeed decreased in affected iHFs compared to tHFs in FPHL scalp skin, confirming nutrient insufficiency. iHFs also displayed a more quiescent metabolic phenotype, as indicated by altered metabolite abundance in freshly collected HFs and release/consumption during organ culture of products/substrates of TCA cycle, aerobic glycolysis, and glutaminolysis. Yet, as assessed by exogenous nutrient supplementation ex vivo, nutrient uptake mechanisms are not impaired in affected FPHL iHFs. Moreover, blood vessel density is not diminished in iHFs versus tHFs, despite differences in tHFs from different FPHL scalp locations or versus healthy scalp or changes in the expression of angiogenesis-associated growth factors. Thus, our data reveal that affected iHFs in FPHL display a relative nutrient insufficiency and dormant metabolism, but are still capable of absorbing nutrients, supporting the potential of nutritional supplementation as an adjunct therapy for FPHL.

The effects of magnesium supplementation on abnormal uterine bleeding, alopecia, quality of life, and acne in women with polycystic ovary syndrome: a randomized clinical trial

BACKGROUND

Abnormal uterine bleeding (AUB), alopecia, low quality of life, and acne are considered as complications of polycystic ovary syndrome (PCOS). We hypothesized that magnesium supplementation would yield beneficial effects on PCOS related complications.

OBJECTIVE

To examine the effects of magnesium supplementation on AUB, alopecia, quality of life, and acne.

METHODS

In this parallel randomized clinical trial, we randomly assigned 64 women with PCOS to the magnesium group (n = 32) or placebo group (n = 32) for 10 weeks. AUB, alopecia, quality of life, and acne were assessed by the International Federation of Gynecology and Obstetrics criterion, the Sinclair Scale, the Health Survey Quality of Life Questionnaire, and the Global Acne Grading System, respectively. This randomized clinical trial was registered at IRCT.ir (IRCT20130903014551N9).

RESULTS

Magnesium supplementation significantly improved the components of quality of life including physical functioning (p = 0.011), role limitations due to physical health (p = 0.012), role limitations due to emotional problems (p < 0.001), energy/fatigue (p = 0.005), emotional wellbeing (p < 0.001), social functioning (p = 0.002), general health (p = 0.013), and total quality of life (p < 0.001), compared with placebo. No significant effect was observed on acne, alopecia, and AUB.

CONCLUSION

Magnesium supplementation in women with PCOS had a significant positive effect on improving total quality of life.

TRIAL REGISTRATION

This randomized clinical trial was registered at IRCT.ir on 2020-10-18 (Registration Code: IRCT20130903014551N9 ).

Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female Pattern Hair Loss: A Prospective, Single-Center, Parallel-Group, Evaluator Blinded, Randomized Trial

Background

The efficacy of topical minoxidil (MX) alone on female pattern hair loss (FPHL) is limited. Combination therapy based on topical MX is currently expected to provide better outcomes.

Objectives

This study aimed to assess whether the combined therapies including MX plus oral spironolactone (SPT) and MX plus microneedling (MN) have advantages in efficacy and safety over topical MX alone on mild-to-moderate FPHL with normal hormone levels in the blood and regular menstrual cycle.

Methods

A prospective, single-center, parallel-group, evaluator blinded, randomized trial including 120 non-menopause women with proven FPHL (Sinclair class II-III) was performed in China. Patients were randomly assigned to three groups, namely, the MX group (5% topical MX alone, once daily), the MX + SPT group (MX plus SPT 80–100 mg daily), and the MX+MN group (MX plus MN every 2 weeks, 12 sessions). The change from the baseline to week 24 was assessed in hair growth (hair density and diameter under dermoscope), scalp tissue structure (epidermal thickness, dermis thickness, and average hair follicle diameter under ultrasound biomicroscopy), physician's global assessment (using a 7-point global-assessment scale and Sinclair's stage change), patient evaluation (Women's Androgenetic Alopecia Quality of Life Questionnaire and Sinclair's hair-shedding score) and side effects.

Results

In total, 115 participants completed the trial. At week 24, the hair density increased most in MX + MN group and increased least in MX group (p < 0.001 for MX + MN group vs. MX + SPT group; p = 0.009 for MX + SPT group vs. MX group). The hair shaft diameter significantly increased in all groups (p < 0.001, respectively), but there were no significant differences among the three groups (p = 0.905). The epidermal thickness and average hair follicle diameter only increased in MX + MN group. Dermis thickness increased in all groups, but there were no significant differences among the three groups. Both physician's and patient assessments showed improvement in all three groups. Scalp pruritus was the most common side effect. The MX + SPT group had the most reported adverse effects.

Limitations

The main limitations of this study are the relatively small sample size, the exclusion of severe FPHL patients, and the potential bias from unblinded treatments among the 3 groups.

Conclusion

Topical MX combined with MN is a better choice than either MX plus oral SPT or MX alone for the treatment of mild-to-moderate FPHL patients.

Scalp vascularization as a marker of topical minoxidil treatment efficacy in patients with androgenetic alopecia

Introduction

Androgenetic alopecia is the most common type of non-cicatricial hair loss both in male and female patients. The pathomechanism of the disease involves chronic and progressive miniaturization of hair follicles, which leads to the conversion of terminal hair to vellus hair. Minoxidil is a first-line drug in the treatment of female pattern hair loss (FPHL).

Aim

The study is aimed at verifying whether the degree of scalp vascularization has an impact on the efficacy of topical 5% minoxidil treatment.

Material and methods

The study involved a group of 76 patients diagnosed with FPHL, who underwent a scalp biopsy for a histological examination of their scalp vascularization. The patients were divided into two groups, with rich and poor scalp vasculature. In all patients, topical treatment with 5% minoxidil was applied for a minimum of 6 months, followed by video-trichoscopic assessment.

Results

A significant increase in the total count was observed 6 months into the treatment as compared with baseline, and a decrease in the number of single hair per follicle. It was observed that the number of single hair units had gone down in 50.67% of patients. The study also demonstrated an increase in the total hair count in 57.33% of patients as well as no drops in the total count in 68% of patients, following 6 months of treatment.

Conclusions

Patients responded equally well to the applied topical minoxidil treatment, irrespectively of the number of blood vessels in the scalp.

A Prospective Six-month Single-blind Study Evaluating Changes in Hair Growth and Quality Using a Nutraceutical Supplement in Men and Women of Diverse Ethnicities

OBJECTIVE

The goal of this study was to assess the perceived efficacy of a standardized nutraceutical to improve hair growth and quality in men and women of various ethnicities with self-perceived hair thinning.

METHODS

This prospective, single-blind study enrolled healthy men aged 20 to 55 years (n=47) and premenopausal women aged 20 to 45 years (n=51) with self-perceived, mild-to-moderate hair thinning and included African American, Asian, Hispanic Caucasian and Non-Hispanic Caucasian participants. The nutraceutical supplement (Nutrafol® Men or Women Capsules, Nutraceutical Wellness Inc., New York, New York) was taken daily for six months. Subjects were evaluated in the clinic at baseline and Weeks 12 and 24 with two self-assessments at Weeks 4 and 8. Study endpoints were standardized digital imaging and investigator rated assessments. Self-assessment questionnaires rated hair growth, hair satisfaction, and lifestyle factors.

RESULTS

Investigator ratings for baseline hair growth, coverage, density, and volume were significant at Weeks 12 and 24 for all subjects (for each, p<0.001). These significant improvements were seen in 83.7 percent of men and 79.5 percent of women at Week 24. Results were similar across ethnic subgroups with significant benefit at Weeks 12 and 24 (for each, p<0.05). All subjects reported significant improvements in baseline hair appearance/quality, volume/fullness, scalp coverage, thickness, and shedding at Weeks 4, 8, 12 and 24 (for each, p<0.01).

CONCLUSION

A standardized nutraceutical supplement improved visible hair growth with less notable shedding based on subjects' and investigators' overall perception of treatment benefit for men and women of various ethnic backgrounds.

Prevalence of alopecia and its contributing factors among primary healthcare attendees in the Jazan region, Saudi Arabia

Background

Alopecia is a common health condition that can be associated with social and psychological consequences.

Aims

This study aims to estimate the prevalence of hair loss and its associated risk factors among primary healthcare center (PHC) attendees in the Jazan region.

Methods

This investigation was a cross-sectional study conducted in the Jazan region of southwest Saudi Arabia. A total of 23 PHCs were randomly selected from five governorates in the region. Data were collected via interviewing PHCs attendees and were asked about their demographic characteristics, presence of hair loss, and among attendees who confirmed having hair loss, they were further asked about associated clinical features, healthcare-seeking behavior, and factors that might contribute to the development of their condition.

Results

A total of 729 participants consented to be involved in this study. The number of respondents who reported having hair loss was 483, representing 66.3% of the whole sample. Gender appears to have the highest level of variability, with the majority of participants reporting hair loss being female (P < 0.001). The most frequently reported type of hair loss was telogen effluvium, followed by androgenic alopecia. A total of 185 respondents reported taking medications to treat their hair loss, of whom 108 (58.3%) did not seek any medical advice to identify the cause of their condition.

Limitations

The main weakness of this investigation is related to relying on a reported presence of hair loss without having it confirmed with a clinical diagnosis.

Conclusion

A minority of participants who reported suffering from hair loss were further evaluated by healthcare professionals to learn the cause of their hair loss. This may indicate the presence of poor hair care and the probability of a higher risk of hair loss requiring the development of suitable preventive strategies.

Frontal edema due to mesotherapy for androgenetic alopecia: A case series

Androgenetic alopecia (AGA) is the most common form of non-cicatricial alopecia in both genders. Currently approved drugs for the treatment of AGA include topical minoxidil in women and topical minoxidil and oral finasteride in men. Other routes of administration of approved drugs have been proposed to enhance therapeutic results for AGA, including intradermal injections, known as mesotherapy. Mesotherapy-or intradermotherapy-is a non-surgical procedure, consisting of multiple intradermal injections of pharmacological substances diluted in small doses. Although minimally invasive, mesotherapy may be related to mild side effects like burning, erythema and headaches, as a few reports indicate. Among the most serious adverse events, subcutaneous necrosis, scalp abscesses, and angioedema have been described. This multicenter retrospective, descriptive study aims to report 14 cases of frontal edema resulting from mesotherapy for AGA treatment. In our patients, the edema mostly arose in the first two sessions and lasted between 1 and 4 days, with a favorable outcome after a local cold compress. In all our cases of edema, lidocaine was the anesthetic used. Minoxidil and dutasteride might also play a role as causative agents. To the best of our knowledge, this is the largest case series focused on frontal edema after mesotherapy for AGA and gives clinicians helpful information for when performing this technique. Dermatologists should already consider and be conscious of this possible mesotherapy side effect, as it can be remarkably disruptive to affected patients.

Engineered extracellular vesicle mimetics from macrophage promotes hair growth in mice and promotes human hair follicle growth

Recent studies clearly show that cell-derived extracellular vesicles (EVs, including exosomes) can promote hair growth. However, large-scale production of EVs remains a big hurdle. Recently, extracellular vesicle mimetics (EMs) engineered by extrusion through various membranes are emerging as a complementary approach for large-scale production. In this study, to investigate their ability to induce hair growth, we generated macrophage-engineered EMs (MAC-EMs) that activated the human dermal papilla (DP) cells in vitro. MAC-EMs intradermally injected into the skin of C57BL/6 mice were retained for up to 72 h. Microscopy imaging revealed that MAC-EMs were predominately internalized into hair follicles. The MAC-EMs treatment induced hair regrowth in mice and hair shaft elongation in a human hair follicle, suggesting the potential of MAC-EMs as an alternative to EVs to overcome clinical limitation.

Female Pattern Hair Loss: Why the Follicular Unit Transplantation Surgical Technique Remains a Good Option

BACKGROUND

Female pattern hair loss is a common nonscarring alopecia that can present with several patterns of decreased hair density. The condition is very bothersome to affected women, and although there are multiple nonsurgical options, surgical follicular unit transplantation remains one of the most effective options.

METHODS

A retrospective chart review was performed of the senior author's (C.O.U.) experience and technique of follicular unit transplantation for treatment of female pattern hair loss.

RESULTS

A total of 751 patients with female pattern hair loss underwent follicular unit transplantation over the past 31 years. Average patient age was 48 years. Patients with small areas of hair loss made up 40 percent of the group (Ludwig stage I), those with medium-sized areas constituted 45 percent (Ludwig stage II), and those with large areas constituted 15 percent (Ludwig stage III). The average operative time was 3 hours 21 minutes. One hundred thirty-five patients (18 percent) underwent a second replacement, at an average period of 4 years after the procedure, because of the progressive nature of female pattern hair loss. Complications included donor-site scar widening in six patients and folliculitis in 17 patients.

CONCLUSION

Follicular unit transplantation is an excellent option for treatment of female pattern hair loss patients, as there is no need to shave the recipient sites, operative times are shorter than for follicular unit excision techniques, and the incidence of complications is very low.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Alopecias in humans: biology, pathomechanisms and emerging therapies

BACKGROUND

The hair follicle is a complete mini-organ with a complex biology. Recent discoveries have shed light on the pathogenesis and genetic basis of a number of hair loss conditions, offering novel treatment alternatives.

OBJECTIVE

To explore the biology and physiology of hair growth, the pathomechanism behind alopecias and emerging therapies.

CONCLUSION AND CLINICAL IMPORTANCE

Hair growth is influenced by numerous physiological moderators. Greater understanding of the biology and physiology of the hair follicle and the pathomechanisms of hair disease facilitates development of targeted treatments. Sublingual minoxidil is a promising therapy in humans where optimised drug delivery enhances efficacy and reduces systemic adverse effects. Janice kinase inhibitors, which disrupt the inflammatory cascade, help maintain the hair follicle, preserve immune privilege, and regrow hair in alopecia areata. As the pathomechanisms of other forms of alopecia become better understood, new targeted therapies with greater efficacy will emerge.

Urban-rural differences in the prevalence of female pattern hair loss among secondary school girls: A cross-sectional study

AIM

Female pattern hair loss (FPHL) is a common condition that is influenced by many external and internal factors. We aimed to identify the prevalence of FPHL among secondary school girls and identify possible associated factors.

METHODS

FPHL among 3405 adolescent females was identified using detailed history, physical examination, and dermoscopy in this cross-sectional study.

RESULTS

Among the 3405 included students, 2430 (71.4%) had no FPHL and 975 (28.6%) were diagnosed with FPHL (p = 0.001). The mean age of girls with FPHL was 16.43 ± 1.10 and ranged between 15 and 18 years. Among those with FPHL, 427 (43.8%) attended urban schools while 548 (56.2%) attended rural schools. No significant differences regarding paternal and maternal education, family income, or parental degree of education were observed among those with FPHL and those without (p = 0.230; p = 0.063; p = 0.276, respectively).

CONCLUSION

FPHL had an overall prevalence of 28.6% among secondary school girls with a significant predominance in rural over urban areas and with a significantly associated family history. Irregular menses, history of thyroid disease, and hirsutism were significant predictors for FPHL.

A novel automated approach to rapid and precise in vivo measurement of hair morphometrics using a smartphone

BACKGROUND

Although many hair disorders can be readily diagnosed based on their clinical appearance, their progression and response to treatment are often difficult to monitor, particularly in quantitative terms. We introduce an innovative technique utilizing a smartphone and computerized image analysis to expeditiously and automatically measure and compute hair density and diameter in patients in real time.

METHODS

A smartphone equipped with a dermatoscope lens wirelessly transmits trichoscopy images to a computer for image processing. A black-and-white binary mask image representing hair and skin is produced, and the hairs are thinned into single-pixel-thick fiber skeletons. Further analysis based on these fibers allows morphometric characteristics such as hair shaft number and diameters to be computed rapidly. The hair-bearing scalps of fifty participants were imaged to assess the precision of our automated smartphone-based device in comparison with a specialized trichometry device for hair shaft density and diameter measurement. The precision and operation time of our technique relative to manual trichometry, which is commonly used by hair disorder specialists, is determined.

RESULTS

An equivalence test, based on two 1-sided t tests, demonstrates statistical equivalence in hair density and diameter values between this automated technique and manual trichometry within a 20% margin. On average, this technique actively required 24 seconds of the clinician's time whereas manual trichometry necessitated 9.2 minutes.

CONCLUSION

Automated smartphone-based trichometry is a rapid, precise, and clinically feasible technique which can significantly facilitate the assessment and monitoring of hair loss. Its use could be easily integrated into clinical practice to improve standard trichoscopy.

Triboelectric Nanogenerators for Therapeutic Electrical Stimulation

Current solutions developed for the purpose of in and on body (IOB) electrical stimulation (ES) lack autonomous qualities necessary for comfortable, practical, and self-dependent use. Consequently, recent focus has been placed on developing self-powered IOB therapeutic devices capable of generating therapeutic ES for human use. With the recent invention of the triboelectric nanogenerator (TENG), harnessing passive human biomechanical energy to develop self-powered systems has allowed for the introduction of novel therapeutic ES solutions. TENGs are especially effective at providing ES for IOB therapeutic systems given their bioconformability, low cost, simple manufacturability, and self-powering capabilities. Due to the key role of naturally induced electrical signals in many physiological functions, TENG-induced ES holds promise to provide a novel paradigm in therapeutic interventions. The aim here is to detail research on IOB TENG devices applied for ES-based therapy in the fields of regenerative medicine, neurology, rehabilitation, and pharmaceutical engineering. Furthermore, considering TENG-produced ES can be measured for sensing applications, this technology is paving the way to provide a fully autonomous personalized healthcare system, capable of IOB energy generation, sensing, and therapeutic intervention. Considering these grounds, it seems highly relevant to review TENG-ES research and applications, as they could constitute the foundation and future of personalized healthcare.

Current insight into the functions of microRNAs in common human hair loss disorders: a mini review

Alopecia areata (AA) and Androgenic alopecia (AGA) are the most common multifactorial hair loss disorders that have a serious psychological impact on the affected individuals, while frontal fibrosing alopecia (FFA) is comparatively less common. However, due to the unknown etiology and the effect of many adverse factors, the prognosis of these conditions is challenging to predict. Moreover, no approved therapy has been available to date to prevent or treat these disorders. MicroRNAs (miRNAs) are a group of evolutionary conserved small non-coding RNA molecules with significant roles in the posttranscriptional gene regulation either through mRNA degradation or translational repression. A number of biological processes are controlled by these molecules, including cell growth and differentiation, proliferation, inflammation, immune responses, and apoptosis. Recently, a handful of studies have demonstrated the impact of miRNAs on common hair loss-related disorders; however, the exhaustive molecular mechanisms are still unclear. In this review, we discussed the functional implications of miRNAs in common hair loss-related disorders and addressed their efficacy to be used for theranostic purposes shortly.

Hair Transplantation: Basic Overview

Modern hair restoration surgery is based on a technique known as follicular unit transplantation in which follicular units (FUs) are the exclusive structures used as hair grafts. In Part 1 of this two-part review, we describe how the techniques employed in hair transplantation have evolved into their present forms. Anatomic concepts of specific relevance for dermatologists are discussed, including the distribution and ex-vivo morphology of scalp FUs. Male androgenetic alopecia and female pattern hair loss are the most common reasons for hair loss consultations with dermatologists and will be the primary focus of this review. However, as not all hair disorders are suitable for transplantation, this review will also describe which scalp conditions are amenable to surgery and which are not. In addition, guidelines are provided to help dermatologists better define good or bad candidates for hair transplantation. Finally, other conditions for which hair transplantation surgery is indicated are reviewed.

Pumpkin seed oil vs. minoxidil 5% topical foam for the treatment of female pattern hair loss: A randomized comparative trial

BACKGROUND

Pumpkin (Cucurbita pepo L.) is an annual climber plant, and its seeds have considerable amount of oil with nutritional and medicinal importance.

AIM

The present study aimed to investigate the clinical efficacy of pumpkin seed oil (PSO) in the treatment of female pattern hair loss (FPHL) and compare its effects with minoxidil 5% foam.

METHODS

Patients with FPHL were randomly assigned to pumpkin seed oil (n = 30; group A) or minoxidil 5% foam (n = 30; group B) for a period of 3 months. Patients were evaluated clinically and dermoscopically at baseline, at one and half months, and at the end of the 3-month study.

RESULTS

Among group A (pumpkin seed oil) candidates, a significant decrease was observed in hair shaft diversity before and after treatment (30.5 ± 6.2%, 24.0 ± 4.02, P < .001, respectively) as well as in the vellus hairs (22.5 ± 4.9, 15.8 ± 2.2, P < .001, respectively). Upright regrowing hairs significantly increased from (0.13 ± 0.5) before treatment to (0.9 ± 1.0) after treatment (P < .001). In group B (minoxidil applying) candidates, a significant decrease was observed in hair shaft diversity before and after treatment (31.5 ± 6.3%, 21.3 ± 2.2, P < .001, respectively) as well as in the vellus hairs (24.7 ± 6.4, 19.5 ± 5.4, P = .02, respectively). Conclusion Findings of the present trial provide evidence of a promising potential role of PSO in treating FPHL.

The role of prostaglandins in androgenetic alopecia

BACKGROUND

Though androgenetic alopecia (AGA) is one of the most common diseases affecting both sexes and all races, its pathogenesis is not completely clarified. The aim of this study was to investigate the role of the four major prostaglandins (PGs) (PGE₂ , PGD₂ , PGF_2α , and PI₂ or prostacyclin) in the pathogenesis of AGA in males and females.

METHODS

Human scalp biopsies were obtained from 30 adults (17 males and 13 females) suffering from AGA and from 30 healthy adults (18 males and 12 females). In each subject, two skin biopsies were performed, one from the frontal bald area and another one from the occipital area with normal hair growth. In the healthy group, biopsies were taken from both areas too. In each sample, all four PGs were measured.

RESULTS

In the patient group, PGD₂ and prostacyclin or PGI₂ levels were increased in bald compared to haired scalp. On the contrary, measurements of PGE₂ and PGF_2α showed that they were diminished in bald areas compared to haired areas. PG levels in healthy samples were comparable to the haired areas.

CONCLUSION

These results support that there is a fine balance between these four proteins in scalp hair follicles, and its maintenance may be crucial for hair growth. Furthermore, their receptors could be potential targets for treatment of AGA.

Is There Any Association Between Clinical and Biochemical Hyperandrogenism in Women With Female Pattern Hair Loss?

Background

The exact association between clinical and biochemical hyperandrogenism (HA) is heterogeneous and cannot be ascertained, especially in normoandrogenic women.

Objectives

Evaluate any association between clinical phenotypes and biochemical parameters of HA in premenopausal women with female pattern hair loss (FPHL).

Materials and methods

A cross-sectional observational study on 362 women, who were assessed for general characteristics, the different FPHL severities by Sinclair's score, hirsutism by modified Ferriman-Gallwey (mFG) score. Evaluation for biochemical HA included total, calculated free and bioavailable testosterone (TT), free testosterone (FT), and bioavailable testosterone (BT), respectively, and dehydroepiandrosterone sulfate. The variables of clinical HA were FPHL, hirsutism, and acne.

Results

The enrolled young premenopausal women's age range was (14-47 years). Around 78% were overweight or obese women. Eighty-percent of women had a mild FPHL, with a median of three years, where 2/3 of women had a duration <3 years with no significant relationship to FPHL severity. About 73% of women had either a mild to moderate hirsutism, and around 16% had acne. The biochemical HA was confirmed in around 52% of women (n=188), who show high levels of calculated FT. The calculated BT is high in 78.5% of women (n=284). The means of HA's biochemical indicators were in their reference ranges or slightly above, with no specific change pattern with the corresponding FPHL severity. None of these parameters had a significant relationship with the severity of FPHL. The FPHL duration was not affected by any presumed variable of clinical or biochemical HA.

Conclusions

FPHL severity was associated with other clinical HA signs like hirsutism and acne, but not to HA's biochemical parameter. Other parameters, like sex hormone-binding globulin (SHBG), and BMI, had no significant relation to the FPHL severity.

Hair Growth Activity of Three Plants of the Polynesian Cosmetopoeia and Their Regulatory Effect on Dermal Papilla Cells

Hair loss is becoming increasingly prevalent as dietary and living habits change. The search for natural products to limit hair loss has led to tapping into traditional cosmetic knowledge. We studied three plants of the Polynesian cosmetopoeia, Bidens pilosa, Calophyllum inophyllum and Fagraea berteroana, to determine their ability to promote hair growth. Their chemical content was characterized by liquid chromatography coupled to mass spectrometry (LC-MS). Their proliferative activity on dermal papilla cells (DPCs) was assessed via MTT assay and molecular targets were evaluated by RT-qPCR analysis of seven factors involved in the modulation of the hair cycle, CCND1, LEF1, DKK1, WNT5A PPARD, TGFΒ1, PPARD and RSPO2. Our results show that our extracts significantly increased proliferation of dermal papilla cells. Furthermore, LC-MS/MS analysis revealed a diversity of molecules, flavonoids, iridoids and organic acids, some known for hair-inducing properties. Finally, specific extracts and fractions of all three plants either upregulated CCND1, LEF1 and PPARD involved in stimulating hair follicle proliferation and/or lowered the gene expression levels of hair growth inhibiting factors, DKK1 and TGFB1. Our findings suggest that extracts from B. pilosa, C. inophyllum and F. berteroana are interesting candidates to stimulate hair growth.

Evaluation of efficacy of QR 678 and QR678 neo hair growth factor formulation for the treatment of female pattern alopecia in patients with PCOS-A prospective study

BACKGROUND

Hair is an essential identity of women. Femininity, sexuality, attractiveness, and personality are symbolically linked to a woman's hair. Female pattern hair loss is found in 20%-30% of patients with polycystic ovary syndrome (PCOS).

AIM

The aim of the present study was to evaluate the efficacy of QR678^® and QR678 Neo^® therapy in the treatment of female alopecia with PCOS.

METHOD

A total of 20 females diagnosed with PCOS in the age 25-50 years, with complaints of female pattern alopecia with Ludwig, grades I, and II were selected for the study. At each visit, 1.5 ml solution of QR678^® was injected in the scalp skin of patients. A total of eight sessions were performed at an interval of 3 week each. All the patients were evaluated with standard global photography at baseline, 4th and 8th session, and 2 months after 8th session.

RESULT

Marked improvement was seen in the global photographic assessment score (mean = 8) which was maintained for over 1 year. In videomicroscopic assessment, after four sessions the patients had 8.07 fewer vellus hair, 6.07 more terminal hair, and average hair shaft diameter was 0.82 μm wider. After eight sessions, they had 11.66 fewer vellus hair, 13.77 more terminal hair, and hair shaft diameter was 2.86 μm wider than at baseline.

CONCLUSION

Intra-dermal injections of QR 678^® hair growth factor formulation is an effective option for female pattern alopecia with PCOS. This is the first of its kind study using QR678^® and QR678 Neo^® in PCOS patients.

Female Pattern Hair Loss-An Update

Female pattern hair loss (FPHL) is nonscarring progressive thinning of hair with gradual decrease in the number of hair, especially in the frontal, central, and parietal scalp, due to a process known as follicular miniaturization. The etiopathogenesis of FPHL is complex with multiple factors such as genetics, inflammation, hormones, and environment playing role in it. It usually manifests as slowly progressive hair thinning, mainly over the vertex and upper parietal scalp, the frontal hairline is often spared and the miniaturization is also not as severe as in men. A thorough history, clinical examination, hair loss evaluation tests, dermoscopy, and scalp biopsy can help in establishing the diagnosis. Various biochemical tests may be needed in patients with hyperandrogenism. The treatment includes medical and surgical modalities. Topical minoxidil is still considered the first line of treatment. Along with medical therapy, cosmetic camouflage may also be needed in some cases.

Factors influencing the effect of photobiomodulation in the treatment of androgenetic alopecia: A systematic review and analyses of summary-level data

Low-level laser therapy (LLLT) is used to treat androgenetic alopecia (AGA). The therapeutic effect of LLLT on AGA has been evaluated; however, there is a paucity of studies that investigated device- and usage-related factors that may influence the effect of LLLT on hair regrowth. The literature was systematically searched to identify eligible studies; PubMed, Scopus, EMBASE and clinicaltrials.gov databases were searched on 30 April 2020. Eligible studies were randomized trials that investigated the effect of LLLT on hair density in AGA. Robust linear regressions were used to make comparisons. An increase in the per-session energy fluence by 1 J/cm² is significantly associated with an increase in hair density by 0.23 hairs/cm² (95% CI: 0.21 hairs/cm² , 0.25 hairs/cm² ). The number of laser or light-emitting diodes is not significantly associated with change in hair density. Increasing the total duration of exposure to treatment is associated with a significant increase in hair density (β = .53, P < .05). Switching from continuous to pulse irradiation was associated with a significant increase in hair density (β = 10.11, P < .01). Energy fluence, irradiation session duration, and light pulsing have a significant therapeutic effect on AGA, while the number of diodes does not.

Female pattern hair loss: A comprehensive review

Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that influence its onset. Female pattern hair loss may be viewed as a marker for an increased risk of cardiovascular and metabolic disease. New treatments include microneedling, low-level laser therapy, and autologous fat transfer. This article focuses on the pathophysiology, diagnosis, systemic associations, and current treatments for female pattern hair loss, which is the most common cause of alopecia in women.