The Trichoscopy Derived Sinclair Scale: Enhancing visual assessment through quantitative trichoscopy

Incidence of alopecia in brain tumour patients treated with pencil scanning proton therapy and validation of existing NTCP models

BACKGROUND AND PURPOSE

Radiation-induced alopecia (RIA) is one of the most frequent and upsetting cosmetic side effects after radiotherapy (RT) for brain cancer. We report the incidence of RIA in a cohort of brain tumours patients treated with Proton Therapy (PT) and externally validate published NTCP models of grade 2 (G2) RIA for their implementation in clinical practice.

METHODS

Data for patients treated for brain tumours with scanning beam PT between 2018 and 2022 were extracted. Acute, late and permanent RIA events were evaluated according to CTCAE 5.0. Lyman-Kutcher-Burman (LKB) and multivariable logistic regression (MLR) published models were computed from the relative dose-surface histogram of the scalp. External validity of models was assessed in terms of discrimination and calibration.

RESULTS

In the 264 patients analysed, rates of any grade acute (≤90 days after PT completion), late (>90 days) and permanent RIA (persisting for> 12 months) were 61.8 %, 24.7 % and 14.4 %, respectively. In our independent cohort, LKB- and MLR-NTCP showed a good discrimination for G2 RIA (0.71≤ROC-AUC≤0.83) while model calibration was unsatisfactory possibly due to a different outcome evaluation between training and validation cohorts, as well as differences in clinical and treatment related variables between the two groups.

CONCLUSIONS

Despite the reasonable sensitivity and specificity of the NTCP models for RIA in the validation cohort, our study emphasizes the significance of differences between the cohorts utilized for model development and validation. Specifically, variations in the reporting of clinical outcomes inevitably jeopardize the validation of NTCP models. A standardize and objective RIA scoring system is essential.

Shock Waves for Hair Growth and Regeneration in Patients With Female Pattern Hair Loss

BACKGROUND

Female pattern hair loss (FPHL) is women's most common form of alopecia. The study aimed to evaluate the efficacy of extracorporeal shock waves for hair growth and regeneration in women with FPHL.

METHODS

A prospective single-center noncontrolled study was conducted in patients with FPHL who underwent eight treatment sessions with C-Actor, a shock wave applicator. Outcome measures included total hair count, number of follicular units (FUs)-single FUs, double FUs, triple and bigger FUs-the average thickness, cumulative hair thickness, and changes in the Derived Sinclair scale, assessed with Tricholab (Fotofinder System). Patients completed a survey to assess their subjective perceptions of hair improvement regarding softness, hair loss, quality, and volume.

RESULTS

Twenty women were included with a mean age of 43 (SD = 5.65). The mean increase in total hair count was 8.9% (p < 0.00001), in number of FUs 4.6% (p = 0.00031), in number of triple and bigger FUs 18.4% (p = 0.0004), in cumulative hair thickness 8.0% (p < 0.00001), with a decrease of 5.7% in mean Derived Sinclair scale value by 2.2-2.1 (p < 0.0001). After 3 months, 85% of patients perceived improvement in hair volume.

CONCLUSION

Extracorporeal shock waves for hair growth and capillary regeneration in women with FPHL showed statistically significant outcomes, and all patients reported an improvement in hair characteristics.

Efficacy of autologous dermal sheath cup cell transplantation in male and female pattern hair loss: A Single-Arm, Multi-Center, phase III equivalent clinical study

A previous, proof-of-concept clinical study suggested that dermal sheath cup cell injections into the affected areas of male/female pattern hair loss (PHL) may have some amelioratory effects, the clinical efficacy of which needs further examination. A phase III equivalent clinical study was conducted to further probe the therapeutic potential of this novel approach and verify its safety and efficacy in improving the appearance of PHL. Thirty-six participants with PHL were injected with dermal sheath cup cell harvested from non-affected occipital hair follicles twice in quarterly intervals. Global photographic assessment and phototrichogram were performed in a blinded manner. Patient-reported outcomes were assessed for 12 months. On global photographic assessment, 30% of the participants showed improvement. The analysis of phototricogram data detected the increases in the cumulative hair diameter, hair cross-sectional area, and mean hair diameter of 107.6 ± 152.6 μm/cm2 , 13069.1 ± 10960.7 μm2 /cm2 , and 0.9 ± 0.9 μm (ratios vs. baseline: +1.4%, +3.4%, and +2.2%), respectively. The female and high terminal hair ratio groups achieved better improvement. Of the total participants, 62.9% noted some degree of improvement. No serious adverse events were detected. This novel approach exhibited visible effects while ensuring safety and patient satisfaction. Therefore, it holds promise as a possible therapeutic option for treating PHL, especially in women.

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.

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

Introduction

Precise evaluation of changes in hair count is crucial for monitoring progression of hair loss and the effects of treatment. The focus of this study is the comparison of the various examination and assessment techniques in terms of the precision of hair count change observed in trichoscopy images.

Methods

Controlled hair extraction of the same scalp spot was used to simulate hair loss, and the different examination techniques were performed to detect this change. The investigators who performed the counting were blinded.

Results

For trichoscopy images, the average error in determining the terminal hair count change (relative to total hair count) was 9 ± 1% for automatic assessment with manual correction and 0.4 ± 0.2% for hair-to-hair matched images. For phototrichogram, the automatic measurement results were found to deviate from truth on average by 12 ± 2%. The manually corrected hair count results were much closer to the truth with average deviation at the level of 7 ± 1%. The hair-to-hair matched results corresponded to approximately 0.6 ± 0.3% average discrepancy.

Conclusion

Combination of manually corrected image processing, follicular mapping, and hair-to-hair matching appears to be the most precise way of evaluating the change in hair count over time. These novel techniques should be considered valuable, especially in research and clinical trials.

Short-Term Efficacy of Autologous Cellular Micrografts in Male and Female Androgenetic Alopecia: A Retrospective Cohort Study

Purpose

Autologous cellular micrografts (ACM) is a novel treatment method in hair loss, and few data are available regarding its efficacy. The present study was carried out to assess the short-term clinical efficacy of a single application of ACM in the treatment of male and female androgenetic alopecia (AGA).

Materials and Methods

This was a single-center retrospective study involving 140 consecutive adults with confirmed AGA, who received a single session of ACM (Regenera Activa®). Efficacy was evaluated 1–6 months after treatment, by analyzing the change of trichometry parameters, which were assessed using TrichoScan digital image analysis.

Results

Depending on the scalp region, there was increase in mean hair density by 4.5–7.12 hair/cm², average hair thickness by 0.96–1.88 μm, % thick hair by 1.74–3.26%, and mean number of follicular units by 1.30–2.77, resulting in an increase of cumulative hair thickness by 0.48–0.56 unit. Additionally, the frontal region showed a significant decrease in % thin hair (−1.81%, p = 0.037) and yellow dots (−1.93 N/cm², p = 0.003). A favorable response was observed in 66.4% of the participants in the frontal region. Further, a gender-specific effect of treatment was observed.

Conclusion

ACM is a promising treatment in AGA with a short-term favorable response observed in up to approximately two-thirds of patients.

Platelet-Rich Plasma in Female Androgenic Alopecia: A Comprehensive Systematic Review and Meta-Analysis

Introduction: The population of young women who suffered from female pattern hair loss (FPHL) or female androgenic alopecia (AGA) is gradually increasing. Platelet-rich plasma is a novel and promising therapeutic method as a nonsurgical treatment for FPHL. Objective: To summarize different preparation methods of PRP and treatment regimes in FPHL, qualitatively evaluate the current observations, and quantitively analyze the efficacy of PRP in FPHL treatment. Methods: Six databases, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, LILACS, and CNKI, were searched with terms "platelet-rich plasma," synonyms for AGA and FPHL. Meta-analysis was conducted with enrolled observational studies and randomized controlled trials separately. Results: We evaluated 636 studies and 12 trials from all searched databases. A total of 42 studies of 1,569 cases, including 776 female participants covering 16 randomized controlled trials and 26 observational trials, were included for qualitative synthesis study and systematic review. PRP showed positive efficacy in treating FPHL in hair density compared to the control groups with odds ratio (OR) 1.61, 95% CI 0.52-2.70, and compared to baseline with OR 1.11, 95% CI 0.86-1.37. Conclusion: PRP showed excellent efficiency as a novel therapy of FPHL through hair density evaluation. Further studies are needed to define standardized protocols, and large-scale randomized trials still need to be conducted to confirm its efficacy.