Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version

Advances in polymeric nano-delivery systems targeting hair follicles for the treatment of acne

Acne is a common chronic inflammatory disorder of the sebaceous gland in the hair follicle. Commonly used external medications cause skin irritation, and the transdermal capacity is weak, making it difficult to penetrate the cuticle skin barrier. Hair follicles can aid in the breakdown of this barrier. As nanomaterials progress, polymer-based nanocarriers are routinely used for hair follicle drug delivery to treat acne and other skin issues. Based on the physiological and anatomical characteristics of hair follicles, this paper discusses factors affecting hair follicle delivery by polymer nanocarriers, summarizes the common combination technology to improve the targeting of hair follicles by carriers, and finally reviews the most recent research progress of different polymer nanodrug-delivery systems for the treatment of acne by targeting hair follicles.

Small molecule agents against alopecia: Potential targets and related pathways

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

Long-term Treatment with a 5-Alpha-Reductase Inhibitor Alleviates Depression-like Behavior in Obese Male Rats

Several studies have reported side effects of finasteride (FIN), such as anxiety/depression in young men. Obesity is also positively associated with anxiety/depression symptoms; however, the impacts of long-term FIN treatment and FIN withdrawal in young obese individuals are still elusive. The present study aimed to investigate the effect of long-term treatment and its withdrawal on anxiety/depression and brain pathologies in lean and obese adult male rats. Forty-eight male Wistar rats were equally divided into two groups and fed either a normal or high-fat diet. At age 13 weeks, rats in each dietary group were divided into three subgroups: 1) the control group receiving drinking water, 2) the long-term treatment group receiving FIN orally at 5 mg/kg/day for 6 weeks, and 3) the withdrawal group receiving FIN orally at 5 mg/kg/day for 2 weeks followed by a 4-week withdrawal period. Anxiety/depression-like behaviors, biochemical analysis, brain inflammation, oxidative stress, neuroactive steroids, brain metabolites, and microglial complexity were tested. The result showed that lean rats treated with long-term FIN and its withdrawal exhibited metabolic disturbances, depressive-like behavior, and both groups showed increased neurotoxic metabolites and reduced microglial complexity. Obesity itself led to metabolic disturbances and brain pathologies, including increased inflammation, oxidative stress, and quinolinic acid, as well as reduced microglial complexity, resulting in increased anxiety- and depression-like behaviors. Interestingly, the long-term FIN treatment group in obese rats showed attenuation of depressive-like behaviors, brain inflammation, and oxidative stress, along with increased brain antioxidants, suggesting the possible benefits of FIN in obese conditions.

LncRNA RP11-818O24.3 promotes hair-follicle recovery via FGF2-PI3K/Akt signal pathway

A previous study indicated that patients with androgenic alopecia (AGA) have significantly reduced levels of LncRNA RP11-818O24.3. This study investigates whether LncRNA RP11-818O24.3 promotes hair-follicle recovery and its possible mechanism. Hair alteration and cutaneous histopathological changes induced by testosterone propionate were observed by H&E and bromodeoxyuridinc (BrdU) stain to evaluate the therapeutic effect of LncRNA RP11-818O24.3 in C57BL/6 J mice. The cellular viability was analyzed in LncRNA RP11-818O24.3-transfected human hair-follicle stem cells (HFSCs) in vitro. The signaling pathways and pro-proliferative factors were investigated by transcriptomic gene sequencing and qRT-PCR. LncRNA RP11-818O24.3 transfection successfully recovered hair growth and hair-follicle cells in AGA mice. In a series of HFSC studies in vitro, LncRNA RP11-818O24.3 transfection greatly promoted cellular proliferation and decreased cellular apoptosis. Transcriptome gene sequencing suggested that the phosphatidylinositol 3-kinase (PI3K)-Akt pathway was upregulated by LncRNA RP11-818O24.3. The qRT-PCR results showed that fibroblast growth factor (FGF)-2 was 14-times upregulated after LncRNA RP11-818O24.3 transfection. Hair-follicle recovery activity of LncRNA RP11-818O24.3 may involve the upregulation of FGF2 and PI3K-Akt to promote follicle stem cell survival. These data not only provide a theoretical basis for AGA development but also reveal a novel therapeutic method for AGA patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-024-00624-3.

Injectable platelet-rich fibrin for treatment of female pattern hair loss

This case series evaluated use of injectable platelet rich fibrin (termed i-PRF+) for the treatment of female pattern hair loss (FPHL). Eleven individuals underwent 3-monthly intradermal injections of i-PRF+ using a mesotherapy gun. The mean number of hair follicles containing hairs per unit area improved at 3- and 6-months follow-up (p < .001), and all participants had a negative hair pull test. Hair volume and thickness, and patient-reported outcome scores also improved at follow-up (p < .001). Adverse effects were minor and self-limited. A series of three i-PRF+ injection sessions were effective for the treatment of FPHL, as shown by improved hair analysis parameters and patient self-assessment scores.

Higher percentage of CD34+ stem cells and elevated efficacy in androgenetic alopecia treatment observed in CGF prepared from 640 nm laser-pretreated blood: A preliminary study

BACKGROUND

Concentrated growth factor (CGF) injection has proven effective in treating androgenetic alopecia (AGA). The primary mechanism of CGF in treating AGA is thought to be the CD34+ stem cells and platelets-associated growth factors being injected into the scalp. CGF efficacy in treating AGA may rely on the activation level of these stem cells and platelets. The 640 nm laser is a United States Food and Drug Administration approved AGA treatment that activates follicle stem cells. Therefore, we hypothesize that pretreating CGF with a 640 nm laser may further activate CD34+ stem cells and platelets, thereby improving the efficacy of CGF in treating AGA.

OBJECTIVE

This study aims to investigate whether 640 nm laser pretreated CGF (640CGF) has a greater effect in treating AGA than 640 nm laser non-pretreated CGF (N640CGF) and evaluate whether 640 nm laser pretreatment changed CD34+ cell percentage.

METHODS

This study enrolled 10 patients (8 male, 2 female) with AGA aged 18-60 years who received CGF injections. The 640CGF group was pretreated with a 640 nm laser at an energy density of 4 J/cm2, with a 30 cm irradiation distance for 30 min. Half of the scalp was treated with 640CGF, whereas the other half was treated with N640CGF. The injection was prepared by a doctor who did not know which blood tube had been pretreated. The treatment efficacy was evaluated using a trichoscope 1 month after injection.

RESULTS

All 10 (100%) patients participated in the follow-up visit, and a higher quantity of new hairs was observed on the side injected with 640CGF than N640CGF (p = 0.019). Additionally, fewer malnourished hairs were observed on the 640CGF pretreated side (p = 0.015). No serious adverse events were reported.

CONCLUSIONS

A higher percentage of CD34+ stem cells and improved efficacy in AGA treatment could be observed with CGF prepared from 640 nm laser-pretreated blood.

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.

Patient-reported outcomes of topical finasteride/minoxidil treatment for male androgenetic alopecia: A retrospective study using telemedical data

BACKGROUND

Oral finasteride and topical minoxidil are the current standard of care for male androgenetic alopecia and a combination of the two treatments can be considered for greater efficacy. Clinical trials of topical finasteride have also yielded promising results, but routine care data are lacking.

AIMS

To examine patient-reported outcomes of men with androgenetic alopecia who received topical finasteride admixed with minoxidil compared to the current standard of care (oral finasteride).

METHODS

Retrospective, cross-sectional study with data from a German direct-to-consumer teledermatology platform between December 2021 and January 2023. Patient-reported outcomes were collected through voluntary follow-up questionnaires provided after 6 weeks on topical finasteride/minoxidil or oral finasteride treatment.

RESULTS

A total of 1545 patients who received topical finasteride/minoxidil treatment were included; 238 (15.4%) participated in the follow-up questionnaire. At week six, 62.2% (148/238) reported positive changes in their hair appearance, and 44.1% (105/238) reported an improvement of self-esteem. Treatment-related adverse events were reported in 11.8% (28/238). Full treatment adherence was observed in 74.4% (177/238). Comparing the topical treatment group to those receiving oral finasteride, lower treatment adherence was reported, along with higher rates of local adverse events; no difference was found in the incidence of sexual adverse events.

CONCLUSION

Based on patient-reported outcomes, topical finasteride/minoxidil seems to be effective and well tolerated, but not superior to oral finasteride. Lower treatment adherence for topical usage must be considered when considering treatment options. Additional real-world data are needed to further evaluate the efficacy and safety of topical finasteride/minoxidil.

Lasers in the management of alopecia: a review of established therapies and advances in treatment

Alopecia, also known as hair loss, is a highly prevalent condition affecting millions of men and women in the United States and worldwide, making it one of the most common complaints by patients presenting to a dermatologist. The symptomology on the presentation of alopecia can be highly variable, ranging from diffuse thinning of hair, discrete and localized patches completely absent of hair, or noticing significant shedding when brushing and showering. Although alopecia does not have a direct negative health impact on patients, it is nonetheless a debilitating disease as it can profoundly impact an individual's self-image and psychosocial well-being. There are multiple treatment options available to patients with alopecia, and they are typically tailored to the patient's needs and preferences. The most common of these is the Food and Drug Administration-approved drugs for alopecia, minoxidil, and finasteride. However, both of these are known to be partially efficacious for all patients, so clinicians often use different modalities in conjunction with them, in particular laser-based therapies. This review article will provide a comprehensive assessment of lasers and other light therapies that may be used to manage the two most common types of alopecia: androgenetic alopecia and alopecia areata.

[Translated article] Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Hair Disorders Group of the Spanish Academy of Dermatology and Venererology (AEDV)

Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Hair Disorders Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.

Psychosocial impact of androgenetic alopecia on men: A systematic review and meta-analysis

The adverse psychosocial impact of androgenetic alopecia (AGA) is often framed as an essential motivation for developing efficacious treatments to halt hair loss or promote regrowth, especially since AGA is common among men but does not result in physically harmful or life-limiting consequences. Yet, empirical evidence documenting the impact of AGA on men's psychological wellbeing and quality of life is patchy and has not previously been subject to systematic review. This systemic review and meta-analyses aim to integrate and evaluate evidence regarding the psychosocial impact of AGA on men. A database and manual reference search identified English-language articles which reported: 1) empirical research; of ii) psychosocial distress (mental health, depression, anxiety, self-esteem, or quality of life); and iii) data separately for male AGA participants. Screening of 607 articles resulted in 37 (6%) for inclusion. PRISMA guidelines, the (modified) AXIS quality assessment tool, and independent extraction were deployed. Heterogeneity in measures and study aims, moderate study quality (M = 7.37, SD = 1.31), probable conflicts of interest (78%) and biased samples (68%) suggest that results should be treated cautiously. Meta-analyses revealed no impact on depression (pooled M = 8.8, 95% CI = 6.8-10.8) and moderate impact on quality of life (pooled m = 9.12, 95% CI = 6.14-12.10). Men with AGA were found to have average or better mental health compared to those without AGA. Overall, there was limited evidence of a severe impact on mental health and quality of life for men experiencing hair loss, with most studies evidencing (at best) a moderate impact. Good dermatological care includes accurately educating about the psychosocial impact of AGA on men, taking care not to overstate levels of distress, and screening for distress using validated measures which have clear clinical thresholds.

Diagnostic and grading criteria for androgenetic alopecia using dermoscopy

OBJECTIVES

To establish accurate and objective dermoscopic diagnostic criteria and grading standards for males and females with androgenetic alopecia (AGA).

METHODS

Twenty patients each with AGA, diffuse alopecia areata, telogen effluvium, and healthy controls were enrolled in the current study. In addition, 60 patients with grades F1/V1, F2/V2, and F3/V3 AGA (20 cases each) were enrolled. The patients underwent dermoscopic examinations. The sensitivity and specificity of the diagnostic criteria were based on the 60 AGA and 60 non-AGA. In addition, 150 patients diagnosed with AGA clinically and by dermoscopy were enrolled to calculate the accuracy of the grading criteria.

RESULTS

The diagnostic criteria included primary, secondary, and exclusion criteria. The grading criteria included three indices, which divided the severity of AGA into grades 1, 2, and 3. The sensitivity and specificity of the diagnostic criteria were 98.3% and 96.7% respectively. The accuracy of grade 1, 2, and 3 dermoscopic grading criteria were 96%, 92%, and 100% respectively, with a total accuracy of 96%.

LIMITATIONS

To test the diagnostic and grading criteria, more patients need to be collected.

CONCLUSIONS

The dermoscopic diagnostic and grading criteria are objective with good accuracy, which could provide a reasonable basis for the early diagnosis, grading treatment, and improved prognosis for AGA.

Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Trichology Group of the Spanish Academy of Dermatology and Venererology (AEDV)

Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Trichology Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.

Safety and efficacy of REGENDIL™ infused hair growth promoting product in adult human subject having hair fall complaints (alopecia)

BACKGROUND

Hair serum is recommended therapy for the management of hair fall problems. People of all ages suffer from hair fall.

AIM

To evaluate safety and efficacy of hair growth promoting product in healthy adult subjects with hair fall complaints (Alopecia).

METHODS

In this safety and efficacy clinical study, 32 healthy individuals (aged 18-45 years) experiencing hair loss were enrolled. Participants applied 0.5 mL of the product to the affected scalp area daily for 60 days. The study evaluated various factors, including hair growth rate, thickness, density, scalp condition using CASLite-Nova, anagen-to-telogen ratio, hair fall reduction, overall hair and scalp appearance, hair strength, and participants' subjective perceptions of the product.

RESULTS

Highly statistically significant improvement was observed in hair growth rate, thickness, and density at Day 30 and Day 60. Hair growth rate increased (p-value <0.01) by 10.52% in 30 days and 31.62% in 60 days after test product application. Average hair growth increased by 424.21 μm/day and 487.31 μm/day at Day 30 and 60 respectively. The hair growth improved by up to 1.5 times after 60 days of usage in healthy subjects with hair fall complaints. No adverse events or product-related adverse events were reported.

CONCLUSION

Hair serum containing REGENDIL™ (Redensyl, AnaGain, Procapil, Capilia longa), and 5 kDa hyaluronic acid was efficacious and well tolerable in reducing hair fall (Alopecia). Hair serum significantly improved hair growth, hair density, hair thickness, and hair strength within 60 days of usage, thereby demonstrating it worth as a beneficial inclusion as a daily haircare product.

Efficacy of the association of topical minoxidil and topical finasteride compared to their use in monotherapy in men with androgenetic alopecia: A prospective, randomized, controlled, assessor blinded, 3-arm, pilot trial

PURPOSE

Topical minoxidil (MNX) 2%-5% and oral finasteride (F) 1 mg/day are the only two pharmacological treatments authorized for androgenetic alopecia (AGA). Recently, a 2.2 mg/mL topical formulation of F was developed to minimize the systemic adverse effects associated with the oral formula. MNX and F act through different mechanisms; therefore, their association could improve clinical efficacy. To evaluate the efficacy of the association of 5% MNX and 0.25% topical F compared to their use in monotherapy, a 6-month, prospective, randomized, assessor-blinded trial was conducted.

PATIENTS AND METHODS

Forty-two males, mean age 24 ± 3 years, with AGA (I-VII of Norwood-Hamilton Grading Scale), treatment naive or free from any therapy for at least 6 months, were enrolled and randomly assigned to three arm treatment groups (2:1:1): group A (n = 19, the subjects applied 5% MNX in the morning and F spray in the evening), group B (n = 12, the subjects applied F spray in the evening), and group C (n = 11, the subjects applied 5% MNX twice daily). The efficacy of treatments was evaluated at baseline and after 3 and 6 months using a global photography score (GPAS; from -3 to +3) and trichoscopy evaluation and assessed by an investigator unaware of treatment allocation. At baseline and after treatments, the serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-S), and testosterone were also evaluated.

RESULTS

All treatments resulted in an increase in hair density compared to baseline. However, this improvement was significant only for group A (MNX + F), both at three (+56 density/cm2 , p < 0.05) and six (+81 density/cm2 , p < 0.001) months. The mean change from baseline in hair density was higher for group A compared to other groups and statistically different compared to group B (F) (p < 0.01), both after 3 and 6 months. Group A showed a global photographic assessment score (GPAS) significantly higher compared to group B (p < 0.001) and group C (p < 0.05) both at 3 and 6 months (2.0 ± 0.7 vs. 0.6 ± 0.8 and 1.3 ± 0.6; respectively). A significantly greater percentage of subjects in Group A achieved a GPAS score of ≥2 in comparison with Groups B and C both after 3 and 6 months (79% vs. 8% and 41%, respectively). No significant differences were observed in mean hair diameter and hormonal levels between the three groups. Good tolerability was observed in all treated groups.

CONCLUSION

The association of 5% MNX lotion and 0.25% F in spray formulation in patients with AGA showed a significantly higher clinical and instrumental efficacy compared to the monotherapies, with comparable tolerability and safety profile.

Cosmetic Dermatology Concerns in Older Adults

It is important to understand that each layer of facial tissue, from the underlying facial skeleton to the overlying skin, undergoes significant changes during the aging process. Bony support is lost along the mandible and maxilla and the orbital aperture widens. Superficial and deep fat pads undergo volume loss and migration and the overlying skin begins to reveal signs of both intrinsic aging with skin laxity and fine rhytids as well as extrinsic aging in the form of coarse, deeper rhytids and dyspigmentation.

Cyanidin-3-O-glucoside and its derivative vitisin A alleviate androgenetic alopecia by exerting anti-androgen effect and inhibiting dermal papilla cell apoptosis

Androgenetic alopecia (AGA), one of the most common forms of hair loss, lacks satisfactory treatment methods in modern society. This study employed an experimental design combining in vitro and in vivo approaches to explore the effects of Cyanidin-3-O-glucoside (C3G) and Carboxypyranocyanidin-3-O-glucoside (Vitisin A) on AGA. In human dermal papilla cells (HDPCs), both anthocyanins demonstrated inhibitory effects on androgen receptors, significantly reduced dihydrotestosterone (DHT) induced apoptosis of HDPCs, and regulated the secretion of Fibroblast growth factor 7 and Transforming growth factor beta 1. In vitro transdermal experiment revealed that both C3G and Vitisin A could penetrate mice skin, aided by the application of cream. Furthermore, in vivo experiments with mice indicated that application of C3G or Vitisin A cream effectively improved hair follicles miniaturization, regression, and apoptosis caused by DHT. The repression of Wnt10b and β-catenin expression induced by DHT was prevented by C3G and Vitisin A in both cell and mouse model. Consequently, these findings suggest that C3G and Vitisin A could be considered as alternative methods for alleviating AGA.

Duo-role Platelet-rich Plasma: temperature-induced fibrin gel and growth factors' reservoir for microneedles to promote hair regrowth

INTRODUCTION

Alopecia concerns more than half our adult population. Platelet-rich plasma (PRP) has been applied in skin rejuvenation and hair loss treatment. However, the pain and bleeding during injection and the troublesome for fresh preparation of each action limit PRP's in-depth applying dedication to clinics.

OBJECTIVES

We report a temperature-sensitive PRP induced fibrin gel included in a detachable transdermal microneedle (MN) for hair growth.

RESULTS

PRP gel interpenetrated with the photocrosslinkable gelatin methacryloyl (GelMA) to realize sustained release of growth factors (GFs) and led to 14% growth in mechanical strength of a single microneedle whose strength reached 1.21 N which is sufficient to penetrate the stratum corneum. PRP-MNs' release of VEGF, PDGF, and TGF-β were characterized and quantitatively around the hair follicles (HFs) for 4-6 days consecutively. PRP-MNs promoted hair regrowth in mice models. From transcriptome sequencing, PRP-MNs induced hair regrowth through angiogenesis and proliferation. The mechanical and TGF-β sensitive gene Ankrd1 was significantly upregulated by PRP-MNs treatment.

CONCLUSION

PRP-MNs show convenient, minimally invasive, painless, inexpensive manufacture, storable and sustained effects in boosting hair regeneration.

The Current Status and Future Direction of Extracellular Nano-vesicles in the Alleviation of Skin Disorders

Exosomes are extracellular vesicles (EVs) that originate from endocytic membranes. The transfer of biomolecules and biological compounds such as enzymes, proteins, RNA, lipids, and cellular waste disposal through exosomes plays an essential function in cell-cell communication and regulation of pathological and physiological processes in skin disease. The skin is one of the vital organs that makes up about 8% of the total body mass. This organ consists of three layers, epidermis, dermis, and hypodermis that cover the outer surface of the body. Heterogeneity and endogeneity of exosomes is an advantage that distinguishes them from nanoparticles and liposomes and leads to their widespread usage in the remedy of dermal diseases. The biocompatible nature of these extracellular vesicles has attracted the attention of many health researchers. In this review article, we will first discuss the biogenesis of exosomes, their contents, separation methods, and the advantages and disadvantages of exosomes. Then we will highlight recent developments related to the therapeutic applications of exosomes in the treatment of common skin disorders like atopic dermatitis, alopecia, epidermolysis bullosa, keloid, melanoma, psoriasis, and systemic sclerosis.

Herpes zoster ophthalmicus (HZO) secondary to platelet-rich plasma (PRP) therapy - A case report

Androgenetic alopecia (AGA) is a common and benign cause of chronic hair loss that affects both males and females. Platelet-rich plasma (PRP) is a safe and minimally invasive technique with promising outcomes in patients with AGA, alongside other therapeutics use. The currently available data in the literature assures that the rate of side effects is low but includes infection and localized reaction (Stevens and Khetarpal, Feb. 2019) [1]. This article describes a case of herpes zoster ophthalmicus (HZO) following PRP treatment for androgenic alopecia, while shedding light on the importance of respecting the guidelines when injecting PRP therapy to ensure a safe outcome with no complications.

Clinical study on the efficacy and tolerability of a topical regenerative treatment in patients with telogen effluvium and mild androgenetic alopecia

Hair loss may change the quality of life since modern society considers hair an essential element in beauty definition. The most common causes of hair loss are androgenetic alopecia (AGA) and telogen effluvium (TE). AGA requires a lifetime use of minoxidil or finasteride (and sometimes they lose efficacy over the years), whereas TE has no standardized therapy available. Our study focuses on a novel topical regenerative preparation that, by mimicking autologous PRP, can safely and efficiently improve hair loss in patients affected by TE and AGA.

Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.

Favorable effect of herbal extract on androgenic alopecia: A case report

RATIONALE

Androgenic alopecia (AGA) is a prevalent condition with progressive miniaturization of hair follicles. Currently, reliable treatments have remained limited, and complementary medications for AGA are still being investigated. Traditional Chinese medicine formulas have conspicuous advantages in the treatment of AGA with good development prospects. Zimmer aqueous spray (ZAS) is a water spray containing Zimmer herbal extract powder (ZMWP), which consists of Ligustri lucidi Fructus, Ecliptae Herba, Fallopia multiflora (Thunb.) Harald. and Polygonatum sibiricum Delar. ex Redoute, etc. ZMWP is an active ingredient in the prevention of hair loss. Our aim is to provide evidence for the effectiveness of ZAS in the treatment of AGA.

PATIENT CONCERNS

A 41-year-old man had suffered from hair loss for 8 years.

INTERVENTIONS

The patient with moderate AGA received 3 to 4 mL ZAS daily or every other day for 3 months.

OUTCOMES

The hair density obviously increased after 3 months of therapy. The improvement of hair diameter, vellus hair rate, and 1 hair pilosebaceous unit rate were observed with a trichoscopy and quantitatively analyzed. Besides, honeycomb pigment pattern mitigated and arborized red lines.

LESSONS

The results suggested that ZMWP might have the capability of improving hair growth and attenuating AGA, which can be a promising alternative treatment of AGA.

Dissolving microneedles for alopecia treatment

Alopecia is a treatable benign disease, however, approximately 15-30% of women and 50% of men suffer from alopecia, which greatly affects patient's self-esteem and quality of life. Currently, commercial products for alopecia treatment include topical minoxidil solution, oral finasteride tablets and oral baricitinib tablets. However, the barrier of stratum corneum, systemic adverse effects and poor cure rate limit the application of commercial products. Therefore, researchers investigated the mechanism of alopecia, and developed new drugs that could target lactate dehydrogenase-related pathways, remove excessive reactive oxygen in hair follicles, and reduce the escape of hair follicle stem cells, thus injecting new strength into the treatment of alopecia. Moreover, starting from improving drug stratum corneum penetration and reducing side effects, researchers have developed hair loss treatment strategies based on dissolved microneedles (MNs), such as drug powders/microparticles, nanoparticles, biomimetic cell membranes, phototherapy and magnetically responsive soluble microneedles, which show exciting alopecia treatment effects. However, there are still some challenges in the practical application of the current alopecia treatment strategy with soluble microneedles, and further studies are needed to accelerate its clinical translation.

Growth Factor Cocktail Including Fibroblast Growth Factor 9 (Cellcurin) in the Treatment of Androgenetic Alopecia in Men and Women: A Randomized Controlled Trial

Objectives

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women, affecting about 30% of men and 15% of women at 30 years and 80% and 48% at 70 years, respectively. This study aims to assess the effectiveness of growth factor cocktail therapy including fibroblast growth factor 9 (FGF9) (Cellcurin) in men and women with AGA.

Materials and Methods

This is a single-center randomized controlled trial, conducted with 10 men and 10 women with AGA. Eight men participated in the therapeutic group and two men in the control group. Eight women participated in the therapeutic group and two women in the control group. All were classified by sex, age, duration, and degrees of progression of AGA. The study obtained approval from the Research Ethics Committee (REC) of the Federal University of Uberlandia at approval number: 36918620.8.0000.5152. Six microneedling sessions were performed with an electromedical pen with an interval of 15 days between sessions. In the therapeutic group, sterile injectable Cellcurin was used and, in the control group, injectable sterile minoxidil 5 mg/ml 2 ml, both through the drug delivery system. Trichoscopic photos were taken before and after 12 weeks in the frontal and vertex regions. Descriptive statistics were performed using the t-test with the IBM SPSS-25 software.

Results

Men and women showed an expressive and significant increase in the amount of hair per cm2 after Cellcurin therapy, as well as an increase in the amount of terminal hair, vellus hair, sum of the terminal hair diameters, and mean of the terminal hair diameters in both regions, frontal and vertex.

Conclusions

In this study, we demonstrated that the use of Cellcurin in the treatment of AGA in men and women is associated with an increase in the amount of hair per cm2, in the amount of terminal hair per cm2, in the amount of vellus hair per cm2, in the number obtained by the sum of the terminal hair diameters per cm2, as well as an increase in the mean diameter of the terminal hairs.

Noninvasive Hair Rejuvenation

Both nonsurgical and surgical modalities for the treatment of hair loss are being used by providers at an increasing rate worldwide. Men and woman are affected by hair loss, but the pathophysiology of the hair loss is thought to be different between sexes; therefore, gender must play a role in treatment decisions. Currently, there are 3 Food and Drug Administration-approved nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy. Platelet-rich plasma injections are showing promise as a single modality and as an adjunct to other nonsurgical and surgical treatments of androgenetic alopecia.

Platelet Rich Plasma Combination Therapies for Treatment of Androgenetic Alopecia: A Systematic Review

Androgenetic alopecia (AGA) is the most common cause of alopecia in males and females. Minoxidil and finasteride are the only FDA-approved treatments for AGA. New treatments including Platelet Rich Plasma (PRP) and microneedling have shown promising results. The purpose of this literature review was to highlight recent studies examining the effects of topical minoxidil combined with PRP to minoxidil or PRP monotherapy. The method used for this paper includes a systematic review of the literature from 2010 to 2022 using the PubMed, EMBASE, and MEDLINE databases examining studies evaluating combination therapies for AGA. Three randomized control trials compared combination PRP + topical 5% minoxidil to either no treatment, 5% minoxidil, or PRP only. Two studies found increased hair growth at five months and at six months following combined therapy. Another study found an increase in hair density and improved patient satisfaction with combination therapy compared to monotherapy. A prospective study revealed that patients treated with combined 5% minoxidil, PRP, and microneedling reported the highest patient and physician satisfaction compared to minoxidil monotherapy. An observational study evaluating topical 5% minoxidil with PRP reported an increase in hair diameter after one year of combination treatment compared to minoxidil monotherapy. PRP therapy combined with minoxidil and microneedling in a retrospective study was shown to increase hair growth compared to PRP with minoxidil as well as PRP or minoxidil monotherapy. In conclusion, a variety of studies demonstrated superior treatment response with a combination of PRP and minoxidil therapy in patients with AGA. Limitations to this study include different PRP preparation protocols, few randomized control studies, and small sample sizes.

Female Pattern Hair Loss: An Overview with Focus on the Genetics

Pattern hair loss can occur in both men and women, and the underlying molecular mechanisms have been continuously studied in recent years. Male androgenetic alopecia (M-AGA), also termed male pattern hair loss, is the most common type of hair loss in men. M-AGA is considered an androgen-dependent trait with a background of genetic predisposition. The interplay between genetic and non-genetic factors leads to the phenotype of follicular miniaturization. Although this similar pattern of phenotypic miniaturization can also be found in female pattern hair loss (FPHL), the corresponding genetic factors in M-AGA do not account for the phenotype in FPHL, indicating that there are different genes contributing to FPHL. Therefore, the role of genetic factors in FPHL is still uncertain. Understanding the genetic mechanism that causes FPHL is crucial for the future development of personalized treatment strategies. This review aims to highlight the differences in the ethnic prevalence and genetic background of FPHL, as well as the current genetic research progress in nutrition, Wnt signaling, and sex hormones related to FPHL.

Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.

Prospective Efficacy and Safety Study of an Innovative Kerascalp Hair Growth Serum in Mild-to-Moderate Alopecia in India: Regrowth Study

BACKGROUND AND AIM

Male and female pattern baldness, commonly known as androgenetic alopecia is the most common type of alopecia, often predetermined genetically, which generally affects the scalp and is characterized by progressive terminal hair loss, known as miniaturization. This study aimed to assess the safety and efficacy of Kerascalp hair serum, a unique combination of esculin, ximenynic acid, and lauric acid, extracted from natural sources in subjects with mild to moderate androgenetic alopecia.

METHODS

An open-label, single-arm clinical study was conducted on healthy males and females aged 18-60 years. Each subject applied the hair serum once daily for 90 days. The efficacy of hair serum was evaluated in terms of the following outcome variables: anagen and telogen ratio (A:T ratio), hair thickness, hair density, hair fall, and hair strength assessment. Subjects were assessed on day 0, day 30, day 60, day 90, and on follow-up day 120.

RESULTS

Thirty subjects completed all assessment visits. After using the hair serum for 90 days, statistically significant (p<0.0001) improvement was observed in A:T ratio, hair density, hair thickness, and hair strength; a statistically significant reduction (p<0.0001) in hair fall was also observed. Moreover, improvement in general appearance of hair (in terms of hair volume and density) and scalp (in terms of itchiness, redness, roughness, and dryness) was recorded through dermatological assessment at each treatment visit and at follow-up visit compared to baseline. No adverse event was recorded during the study period, and on follow-up.

CONCLUSIONS

The results of this clinical study suggest that a 90 days treatment with a phyto-ingredient-based Kerascalp hair serum is safe and effective in significantly improving A:T ratio, hair density, hair thickness, and hair strength, while reducing hair shedding. The improvement in the test parameters persists, even 30 days after stopping the usage of the serum.

Online Traffic Analysis of Direct-to-Consumer Websites for Hair Loss Treatment and Characterization of Finasteride Patients on a Platform in Germany: A Potential Paradigm Shift in the Treatment of Androgenetic Alopecia

Purpose

The number of online prescription platforms (OPPs) offering telemedical diagnosis and treatment, including finasteride, for androgenetic alopecia (AA) by using medical questionnaires (MQs) has increased. This type of care delivery differs completely from traditional forms. This study aimed to investigate a potential paradigm shift in AA treatment by measuring the extent of traffic generated by OPPs that exclusively treat AA and furthermore by characterizing sociodemographic features of men undergoing finasteride treatment from an OPP in Germany.

Patients and Methods

Examination of three OPPs (Keeps, Shapiro MD, Myspring), offering finasteride treatment via MQ between Q1 2018 and Q1 2022 was performed by using SEMRush, a marketing software platform for traffic analysis. Further data regarding sociodemographic characteristics were collected from Myspring by recruiting men with AA who obtained finasteride prescriptions between March 2021 and January 2022.

Results

A high number of unique quarterly visitors was recorded. The number of visitors increased on all platforms (Keeps 846%, Shapiro MD 109%, Myspring 427%). Most patients had accessed the platforms from mobile devices. Further data from Myspring included a total of 2904 men. Of all patients who answered the follow-up questionnaire (n = 177), 33.9% had been referred to the platform by television advertising. Of all respondents, 21.5% reported a monthly net income below 1000 euros. 45.2% of responding patients reported being single, while 15.3% considered themselves homosexual, and 4.5% bisexual. Convenience was the most common reason indicated for using an OPP (79.1%).

Conclusion

The tremendous increase in the number of visits to OPPs for AA suggests a paradigm shift in medical care, particularly regarding MQ-based finasteride treatment. Sociodemographic data and reasons for platform use suggest that the shift away from traditional care models may increase in the future. The broad use of these digital health services warrants further investigation, particularly regarding patient safety.

Combination and Rotational Therapy in Androgenetic Alopecia

Management of androgenetic alopecia is a challenge because of its long course, need for continuous treatment, and potential adverse effects of the therapies. In order to enhance efficacy, minimize side effects, and ensure patient compliance, the authors propose a scheme for using combination treatments with a rotational scheme, based on current evidence for efficacy, pharmacokinetic properties, convenience of administration over long term, side effect profile, and patient acceptance.

The efficacy of topical prostaglandin analogs for hair loss: A systematic review and meta-analysis

Background

Prostaglandin analogs have been found to have more versatile uses: treatment of open-angle glaucoma, high intraocular pressure, vitiligo, and other treatments. And prostaglandin analogs have been found to have an important role in the hair growth cycle. However, prostaglandin analogs have not been sufficiently studied for hair (including hair, eyelashes, and eyebrows) regeneration. In this study, a systematic review and meta-analysis of topical prostaglandin analogs on hair loss was performed.

Objective

The purpose of this meta-analysis is to determine the efficacy and safety of topical prostaglandin analogs for treating hair loss.

Methods

We searched PubMed, Embase, and Cochrane Library databases comprehensively. Data were pooled using Review Manager 5.4.1, and subgroup analyses were performed if necessary.

Results

There were six randomized controlled trials included in this meta-analysis. All studies compared prostaglandin analogs with placebo, and one trial consisted of two sets of data. The results showed that prostaglandin analogs could significantly improve the hair length and density (p &lt; 0.001). As far as adverse events are concerned, there was no significant difference between the experimental group and the control group.

Conclusion

In patients with hair loss, the topical prostaglandin analogs have better therapeutic efficacy and safety than placebo. However, the best dose and frequency of experimental treatment require further studies.

Oral minoxidil use in androgenetic alopecia and telogen effluvium

While current studies have supported oral minoxidil as a novel, adjunctive therapy in non-scarring forms of alopecia, there continues to be limited data on oral minoxidil for these conditions. To assess oral minoxidil use in the treatment of androgenetic alopecia and telogen effluvium, a multi-center, retrospective analysis was conducted in 105 adult patients treated for androgenetic alopecia and/or telogen effluvium with oral minoxidil (dose range 0.625-2.5 mg) once daily for ≥ 52 weeks, case matched by age (± 5 years) and gender with 105 controls with androgenetic alopecia and/or telogen effluvium who were not treated with oral minoxidil. 80 women (76.2%) with a mean age of 57.5 ± 13.56 (range 24-80) and 25 men (23.8%) with a mean age of 40.4 ± 13.79 (range 19-63) were included. Efficacy was evaluated based on provider assessment of clinical response and clinical photographic evaluation using a 3-point scale (worsening, stabilization, and improvement). 52.4% of patients demonstrated clinical improvement and 42.9% demonstrated stabilization. There was a significant difference in clinical response between the patient and control group, p < 0.001. Retrospective study design. These results suggest that oral minoxidil can be an effective treatment in androgenetic alopecia and telogen effluvium.

The Association of Serum Adipokines, Insulin Resistance and Vitamin D Status in Male Patients with Androgenetic Alopecia

Background

The frequent coexistence of obesity and metabolic syndrome in patients with Androgenetic alopecia (AGA), may indicate a common pathogenetic pathway with adipokines being a possible implicating cytokine.

Objective

This study was conducted to investigate the changes in serum levels of adipokines, insulin resistance, vitamin D status and their relationship with AGA, and the relationship between serum levels of adipokines and insulin resistance.

Methods

80 male patients with AGA were selected as the experimental group and 60 healthy males served as the control group. Both the AGA group and healthy control group were divided into 2 groups according to the presence or absence of insulin resistance (IR): the IR group and the NIR group. Serum levels of leptin, adiponectin, resistin, visfatin, insulin and 25(OH)D were evaluated in all subjects.

Results

Compared with the control group, AGA patients showed higher serum levels of leptin and lower adiponectin/leptin (Adpn/Lep) ratio (P<0.05), and both were positively correlated with the severity of the disease. Compared with the AGA NIR group, serum leptin levels were increased in the AGA IR group (P<0.05). AGA IR group and AGA NIR group possessed lower Adpn/Lep ratio when compared with the healthy IR group and healthy NIR group respectively (P<0.05). The multi-factor logistic regression analysis results showed decreased Adpn/Lep level and increased leptin level as risk factors for AGA. AGA Patients had lower vitamin D levels than healthy controls (P<0.05).

Conclusion

Patients with AGA show an imbalance between pro- and anti-inflammatory adipokines, and probably be involved in AGA pathogenesis. Insulin resistance may influence levels of adipokines, but the present findings cannot indicate insulin resistance plays a role in the onset of AGA. The insufficiency and deficiency of vitamin D are common health concern in our subjects and may be involved in the dysfunction of adipocytes and the development of AGA.

Digital health platforms expand access and improve care for male androgenetic alopecia

INTRODUCTION

Digital health solutions, specifically direct-to-consumer platforms, have been touted to make care accessible and convenient for patients. The aim of this article is to evaluate patients' reported reasons for choosing a platform for the treatment of hair loss and their experience. This platform (Keeps) is focused exclusively on the treatment of male pattern hair loss (MPHL) with approved medications such as oral finasteride and topical minoxidil.

METHODS

In order to evaluate patients' motivations to choose the platform and their experience, we administered two distinct questionnaires, with a total of 8983 respondents.

RESULTS

The results showed that patients on the platform report positive health outcomes at approximately 6 months, as 81% of respondents report hair regrowth or cessation of hair loss, and 91% never or rarely miss their medication. Additionally, the platform is expanding the market through education and awareness, as nearly 1 in 3 new patients, mostly in their 20s and early 30s, had never considered treating their hair loss before learning about this virtual care model.

CONCLUSION

Such a model provides further insights into how digitally enabled care focused on a chronic condition, backed by quality and evidence-based initiatives, can expand access and improve care for androgenetic alopecia (AGA).

Alopecia areata and pattern hair loss (androgenetic alopecia) on social media - Current public interest trends and cross-sectional analysis of YouTube and TikTok contents

BACKGROUND

With an ever-growing influence of social media in healthcare, concurrent with increased emphasis on patient autonomy and shared decision-making, dermatologists treating hair loss need to be cognizant of online interest trends and the types of information disseminated across popular platforms.

OBJECTIVES

To evaluate recent health-related interest trends and assess engagement, quality, and accuracy of alopecia areata (AA) and pattern hair loss (PHL, androgenetic alopecia) contents on social media.

METHODS

Relative search volumes (RSVs) were extracted from Google Trends using the search category 'alopecia areata' and 'pattern hair loss'. Eighty matching videos on TikTok and YouTube were also extracted and characterized. Viewer engagement was estimated using the engagement ratio, and quality and accuracy were assessed using DISCERN and Dy et al. Accuracy Scale (DAS).

CONCLUSIONS

AA-related contents on TikTok discussing personal experiences of female subjects were significantly more engaging. DISCERN and DAS scoring showed significantly higher quality and accuracy in videos created by healthcare providers on YouTube, but not TikTok, which could in part be related to YouTube videos being longer. RSV fluctuations corresponding to news in popular culture had high impact. Sponsorship disclosures were generally not reported in product promotional videos.

Oral supplementation in female telogen effluvium: a clinical and instrumental objective evidence of efficacy and tolerability of new oral cosmetic treatment

BACKGROUND

Telogen effluvium and androgenetic alopecia (AGA) represent the most common non scarring hair diseases. In addition to medical treatments such as finasteride and minoxidil, recommendations for telogen effluvium or AGA include oral supplementation, that can be prescribed in association or before starting medical therapies. The objective of our study was to evaluate the tolerability, efficacy and the compliance of the patient of a treatment with oral supplementation in patients affected by telogen effluvium eventually associated with grade I/II of AGA according to the Ludwig Scale.

METHODS

We enrolled a total of 20 female patients affected by telogen effluvium, in 7 cases associated with grade I/II of AGA according to the Ludwig scale. Patients were asked to take a supplement containing sulfurated aminoacids (L-cystine, L-methionine, liposomal glutathione) and trace elements (zinc, copper, iron, selenium) with ubidecarenone and vitamin B5. All patients underwent the dermatological examination, photography and trichoscopy, at the first visit, after 3 months and after 6 months.

RESULTS

At the end of the study, clinical healing was assessed in 14 patients while 6 patients showed good improvement. 4 patients rated moderate satisfaction; 16 patients were very satisfied of the results. Trichoscopy showed important improvement in 17 patients and only 3 patients showed a moderate improvement in the hair density and diameter. All patients tolerated very well the treatment, and none of patients needed to discontinue the assumption of the tablets.

CONCLUSIONS

The results of our study demonstrate the ability of a new tablet supplement with sulfurate amino acids and trace elements ingredients to effectively and safely improve the hair growth and hair loss in patients with telogen effluvium associated with mild to moderate AGA. The supplement was found to be excellently tolerated from all the patients, safe, and easily incorporated into daily routines.

Hair regrowth treatment efficacy and resistance in androgenetic alopecia: A systematic review and continuous Bayesian network meta-analysis

Background

Androgenetic alopecia (AGA) affects almost half the population, and several treatments intending to regenerate a normal scalp hair phenotype are used. This is the first study comparing treatment efficacy response and resistance using standardized continuous outcomes.

Objective

To systematically compare the relative efficacy of treatments used for terminal hair (TH) regrowth in women and men with AGA.

Methods

A systematic literature review was conducted (from inception to August 11, 2021) to identify randomized, Placebo-controlled trials with ≥ 20 patients and reporting changes in TH density after 24 weeks. Efficacy was analyzed by sex at 12 and 24 weeks using Bayesian network meta-analysis (B-NMA) and compared to frequentist and continuous outcomes profiles.

Results

The search identified 2,314 unique articles. Ninety-eight were included for full-text review, and 17 articles met the inclusion criteria for data extraction and analyses. Eligible treatments included ALRV5XR, Dutasteride 0.5 mg/day, Finasteride 1 mg/day, low-level laser comb treatment (LLLT), Minoxidil 2% and 5%, Nutrafol, and Viviscal. At 24 weeks, the B-NMA regrowth efficacy in TH/cm² and significance (^**) in women were ALRV5XR: 30.09^**, LLLT: 16.62^**, Minoxidil 2%: 12.13^**, Minoxidil 5%: 10.82^**, and Nutrafol: 7.32^**, and in men; ALRV5XR: 21.03^**, LLLT: 18.75^**, Dutasteride: 18.37^**, Viviscal: 13.23, Minoxidil 5%: 13.13^**, Finasteride: 12.38, and Minoxidil 2%: 10.54. Two distinct TH regrowth response profiles were found; Continuous: ALRV5XR regrowth rates were linear in men and accelerated in women; Resistant: after 12 weeks, LLLT, Nutrafol, and Viviscal regrowth rates attenuated while Dutasteride and Finasteride plateaued; Minoxidil 2% and 5% lost some regrowth. There were no statistical differences for the same treatment between women and men. B-NMA provided more accurate, statistically relevant, and conservative results than the frequentist-NMA.

Conclusion

Some TH regrowth can be expected from most AGA treatments with less variability in women than men. Responses to drug treatments were rapid, showing strong early efficacy followed by the greatest resistance effects from flatlining to loss of regrowth after 12-16 weeks. Finasteride, Minoxidil 2% and Viviscal in men were not statistically different from Placebo. LLLT appeared more efficacious than pharmaceuticals. The natural product formulation ALRV5XR showed better efficacy in all tested parameters without signs of treatment resistance (see Graphical abstract).

Systematic review registration

www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021268040, identifier CRD42021268040.

A practical approach to the management of hair loss in patients with polycystic ovary syndrome

Female patterned hair loss (FPHL) is a common form of androgenetic alopecia in women and is characterized by a hormonally directed diffuse hair loss on the scalp. Management of FPHL is well described in the literature; however, treatment of FPHL in patients with co-morbid polycystic ovarian syndrome (PCOS), an endocrinologic condition found in reproductive-aged women, has not yet been reviewed. Due to the different pathomechanism of the diseases and complexity of FPHL in PCOS patients, this study aimed to review current diagnosis and management approaches for hair loss in PCOS patients specifically and highlight the growing need for more research in this growing patient population.

Patient-reported treatment outcomes and safety of direct-to-consumer teledermatology for finasteride treatment in male androgenetic alopecia: A cross-sectional study

Objective

The use of direct-to-consumer (DTC) teledermatology platforms has increased, particularly for androgenetic alopecia (AGA). However, little is known about the efficacy and safety of these platforms. This study aimed to investigate the patient-reported treatment outcomes and safety of DTC teledermatology for the finasteride treatment of male AGA.

Methods

This retrospective, cross-sectional study used data from a German DTC platform for finasteride treatment between December 2021 and January 2023. Patient-reported outcomes were collected through voluntary follow-up questionnaires provided to the patients six weeks after the first prescription to assess treatment outcomes and safety.

Results

Data collection included 2269 patients. Of all patients who answered the follow-up questionnaire (n = 191), 79% (150 out of 191) self-reported positive changes in hair appearance, and 59% (113 out of 191) reported an improvement in self-esteem under treatment. Patients with self-reported positive changes in hair appearance were more likely to report improved self-esteem (P < 0.0001). Treatment-related adverse events occurred in 12% (22 out of 191) of the patients. Full treatment adherence was reported in 87% (167 out of 191) of patients.

Conclusion

From the patient's perspective, DTC teledermatology has the potential to improve hair appearance and self-esteem. Our results suggest that it may be an effective and safe treatment option for men with AGA, justifying low-threshold access. However, treatment-related adverse events should be closely monitored during follow-up. Further studies are required to evaluate the long-term effects of the DTC teledermatology treatment. By collecting real-world data, teledermatology platforms could be useful beyond their primary focus and could play an important role in the context of future research.

[Alopecia and COVID-19: possible etiopathogenetic variants and therapeutic approach]

Sudden hair thinning, phantom trichalgia in the early and late rehabilitation period after novel coronavirus infection (COVID-19) are the most common complaints of patients, that can be considered by both dermatocosmetologist and medical rehabilitation specialist. A telogen hair loss was found in 19.8% of patients, whereby 27.3% of patients suffering from hair loss during disease and 72.7% - at 3rd-6th month after recovery. Most commonly, hair loss is non-structural and associated with an abnormal ovulatory cycle shift and diffuse asynchronous loss of hair follicles in telogen phase, as well as with an increase of total predisposed to loss hair follicles number. Nevertheless, the analysis of clinical observations of patients with post-COVID hair loss has shown that this disorder is registered not only in telogen phase. There is a rapid disease progression up to the final stages in the presence of verified androgenetic alopecia diagnosis. The cases of alopecia areata and cicatricial alopecia, associated with previous COVID-19, also were registered. Androgenetic alopecia is the first (30.7%) and diffuse alopecia is the second (19.8%) by degree of incidence. The relapses or much less frequently the onsets of alopecia areata and the unexplained pronounced pain at the hair roots in parietal region (7.8%) are in the third place. The article presents in detail the possible reasons and mechanisms of hair loss associated with COVID-19, determines necessary examinations with consideration to the scientific analysis of domestic and foreign literature sources.

Positioning of Low Alcohol or Alcohol-Free Minoxidil Formulation for the Management of Androgenetic Alopecia: Indian Perspective

Topical minoxidil is used for treating different hair disorders. Even though it is an effective therapy, many patients show poor compliance due to the cost, side effects, and duration of treatment. Topical minoxidil is the mainstay treatment for androgenetic alopecia (AGA). Recently, low alcohol or alcohol-free topical minoxidil formulation has proven to be an alternative for patients suffering from AGA, including those with poor compliance with other therapies. Thus, the current article provides the positioning of low alcohol or alcohol-free topical minoxidil to manage AGA in Indian clinical practice.

Quality of Life and Its Association with Androgenetic Alopecia Patients in Shanghai: A Cross-Sectional Study

Background

Health-related quality of life (HRQoL) of androgenetic alopecia patients has become increasingly important, but the influencing factors associated with the different domains are poorly understood.

Objective

This study aimed to investigate the influencing factors in HRQoL of androgenetic alopecia patients and identify its strongly associated domains.

Patients and Methods

We enrolled 170 androgenetic alopecia patients. HRQoL was measured using the World Health Organization Quality of Life Brief Version (WHO-BREF), and Hairdex.

Results

HRQoL was significantly impaired in patients <30 years, (WHO-BREF: P=0.022, Hairdex: P=0.004), less educated (WHO-BREF: P=0.021, Hairdex: P=0.003), single patients (Hairdex: P=0.023), and urban residence (Hairdex: P=0.043). By domains, those <30 years were impaired by physical health (P=0.038) and psychological (P=0.030) by WHO-BREF, and symptoms (P=0.002) and emotions (P=0.002) by Hairdex. Singles were impaired by symptoms (P=0.020), and emotions (P=0.009) by Hairdex. Less-educated individuals had impaired all domains in the WHO-BREF and Hairdex, except for physical health. Women had impaired symptoms (P=0.013) and stigmatization (P=0.041) in Hairdex.

Conclusion

Androgenetic alopecia is associated with significantly reduced HRQoL in young, less educated, and single patients. Dermatologists should inquire about Quality of Life and appropriately support androgenetic alopecia patients.

Development and Skin Penetration Pathway Evaluation Using Confocal Laser Scanning Microscopy of Microemulsions for Dermal Delivery Enhancement of Finasteride

This study aimed to develop microemulsions using poloxamer 124 as a surfactant to improve the skin penetration of finasteride and to investigate the skin penetration pathways of these microemulsions by colocalization techniques using confocal laser scanning microscopy (CLSM). The prepared finasteride-loaded microemulsions had average particle sizes ranging from 80.09 to 136.97 nm with particle size distributions within acceptable ranges and exhibited negative surface charges. The obtained microemulsions could significantly increase the skin penetration of finasteride compared to a finasteride solution. According to the skin penetration pathway evaluation conducted with CLSM, the microemulsions were hair follicle-targeted formulations due to penetration via the transfollicular pathway as a major skin penetration pathway. Additionally, this study found that the microemulsions also penetrated via the intercluster pathway more than via the intercellular pathway and transcellular pathway. The intercluster pathway, intercellular pathway, and transcellular pathway were considered only minor pathways.

Hair Aging and Hair Disorders in Elderly Patients

Hair loss in elderly patients is a common complaint. It can be related to different conditions that affect patients' quality of life and represents a challenge for dermatologists. It affects both men and women during the aging process with an estimated percentage of balding after 65 years of age of 53% and 37%, respectively. Androgenetic alopecia, frontal fibrosing alopecia, senile alopecia, and erosive pustular dermatosis of the scalp are the hair diseases most frequently described in this age group. The objective of this review is to summarize the current knowledge about alopecia affecting elderly patients, differentiating between chronological hair aging signs and pathological changes, to help clinicians, offer an adequate management of these disorders to their patients.

Effects of microneedling with 5% minoxidil topical solution combination therapy in treatment of androgenetic alopecia

BACKGROUND

Microneedling (MN) therapy is one of minimal invasive operations with needles rolled over skin to puncturing the epidermis, and it is becoming a widely used treatment during various dermatological diseases includes androgenetic alopecia (AGA).

OBJECTIVE

The purpose of the current study is to investigate the clinical observation and safety of MN combined with 5% minoxidil on triggering hair growth in AGA patients.

MATERIAL AND METHODS

This retrospective study has analyzed 18 AGA patients who were treated by MN in combination with 5% minoxidil topical solution between July 2021 and February 2022. All patients received six sessions of treatment under aseptic condition at an interval of 1 week. Assessment of hair regrowth was done at the baseline and 10 weeks by photography, investigator, and patient assessment global scoring table on clinical improvement, and the patient's final satisfaction was investigated.

RESULTS

According to the standardized 7-point scale, mean scores of investigator and participant assessments were 1.44 ± 0.61 and 1.66 ± 0.59, respectively, indicating that the hair appearance was considerably improved by MN combined with 5% minoxidil treatment. Fifteen patients (83.3%) were satisfied with the improvement in hair growth. No severe adverse events were noted in patients during and after the procedure.

CONCLUSION

The combination of the length of 1.5 mm MN and 5% minoxidil in the treatment of AGA showed efficacy with high safety, which is worthy of clinical application.

Long-Term Effectiveness and Safety of Dutasteride versus Finasteride in Patients with Male Androgenic Alopecia in South Korea: A Multicentre Chart Review Study

Background

Dutasteride improves hair growth compared with finasteride in male androgenic alopecia (AGA) and is well tolerated. However, real-world evidence for long-term dutasteride use in AGA is lacking.

Objective

To describe baseline characteristics, treatment patterns and long-term safety and effectiveness of dutasteride versus finasteride.

Methods

This was a multicentre, retrospective medical chart review study conducted in South Korea. The index date was the first prescription of dutasteride or finasteride. Baseline characteristics were assessed 6 months prior to index. Safety and effectiveness (improvements in basic and specific [BASP] classification) data were collected from index throughout the observation period.

Results

Overall, 600 male adult patients were included (dutasteride, n=295; finasteride, n=305). Dutasteride-treated patients were older (p<0.001) and more likely to have moderate/severe BASP classification at baseline (p=0.010) compared with finasteride-treated patients. Among patients treated with recommended, on-label dosing exclusively (n=535: dutasteride, n=250; finasteride, n=285), dutasteride-treated patients showed greater improvement in hair growth than finasteride-treated patients, as measured by the BASP basic M classification (adjusted incidence rate ratio [95% confidence interval]: 2.06 [1.08, 3.95]; p=0.029). Among this same subset, overall occurrence of adverse events (AEs) during the observation period were not statistically equivalent between groups (dutasteride 7.6%, finasteride 10.5%; p=0.201), although reports of AEs of special interest were equivalent (p<0.001).

Conclusion

Dutasteride showed greater effectiveness than finasteride in improving BASP classification in treating male AGA and had a similar or possibly lower occurrence of overall AEs. Dutasteride may provide an effective and safe treatment option for male patients with AGA.