Systematic Review of Psychological Interventions for Quality of Life, Mental Health, and Hair Growth in Alopecia Areata and Scarring Alopecia

A Three-Step Diagnostic Algorithm for Alopecia: Pattern Analysis in Trichoscopy

Background/Objectives: Alopecia is a common and distressing hair loss condition that poses a major diagnostic challenge. While histopathology is the gold standard, its invasive nature limits its routine use. Trichoscopy, a non-invasive imaging technique, has shown promises in diagnosing and differentiating the various alopecia subtypes. However, existing diagnostic algorithms primarily rely on dermoscopic findings. To address this, we developed a novel, three-step algorithm that integrates clinical and trichoscopic features and employs pattern analysis as a diagnostic tool. Methods: A comprehensive literature review was conducted to identify key trichoscopic features associated with different alopecia types. The gathered data were used as a base for the description of trichoscopic features and patterns for each subtype of alopecia, either scarring or non-scarring. Results: The proposed algorithm is analyzed into three steps. In the first step, alopecia is categorized by distribution into: patchy, patterned, or diffuse. In the second step, it distinguishes between scarring and non-scarring alopecia based on the absence or presence of follicular ostia, respectively. Lastly, in the third step, alopecias are distinguished based on specific trichoscopic clues, allowing for the identification of distinct trichoscopic patterns. Conclusions: The three-step diagnostic algorithm for alopecia, utilizing clinical and dermoscopic findings, performs a pattern analysis in trichoscopy, leading to a dermoscopic diagnosis with great confidence, and minimizing the need for invasive diagnostic procedures.

Alopecia Areata: Understanding the Pathophysiology and Advancements in Treatment Modalities

Alopecia areata (AA) is an autoimmune condition that presents with non-scarring hair loss affecting multiple patients worldwide during their lifetime. It ranges from well-defined patchy to diffuse total hair loss, impacting all hair-bearing areas of the body. AA most commonly predominantly manifests on the scalp. The pathophysiology of AA is complex and multi-faceted. The findings of our review article were consistent with the recent literature, delineating autoimmunity, genetic susceptibility, and environmental aspects to be the contributing factors. One of the main causes of AA is believed to be the disruption in the immune privilege of the hair follicles. Multiple genetic loci involved in hair follicle maturation and immune process have been linked to the development of AA as evidenced by several studies. It has been postulated that psychological stressors, smoking, alcohol consumption, sleep disturbances, gut microbiota, and drugs play a role in the pathogenesis of AA by exacerbating the immune response against the hair follicles. AA is a clinically diagnosed disorder. Topical, intra-lesional, and oral corticosteroids, topical and oral minoxidil, cyclosporine, and other immune therapy drugs are widely accepted first-line treatment options, although incomplete remission and relapses are common. Recently JAK-2 inhibitors and mesenchymal stem cell exosomes have shown promising results, potentially treating severe and refractory hair loss. AA has a bidirectional relationship with psychological symptoms as it can lead to social anxiety and depression, which in turn can aggravate hair loss. Hence, it is crucial to implement a holistic approach to managing AA including topical and systemic therapies, psychological counseling, and lifestyle modifications. It is imperative to fully declinate the pathophysiological mechanisms of the disease and formulate therapies in future research to help clinicians and dermatologists devise definitive guidelines to treat the condition for long-term remission.

A Clinical Evaluation of the Safety, Efficacy, and Tolerability of the Soulflower Rosemary Redensyl Hair Growth Serum, Tetragain™, in Healthy Female Subjects for the Treatment of Alopecia: Promoting Hair Growth and Reducing Gray Hair

Introduction Alopecia and graying hair, common conditions influenced by aging, genetics, and environmental factors, often see limited success with traditional treatments. Rosemary extract, valued for its antioxidant and anti-inflammatory benefits, has gained attention for promoting hair growth and reducing graying. Redensyl™, a plant-based ingredient, supports hair follicle regeneration and enhances hair density. This study examines the effectiveness of Soulflower Rosemary Redensyl Hair Growth Serum (Tetragain™), which is formulated using Redensyl, Oryza sativa (rice) water extract , Salvia hispanica (chia) seed extract, rosemary oil, MelanoGray™, and AnaGain™, in promoting hair growth, enhancing follicular activity, and reducing graying. Methods This open-label, single-arm, prospective interventional study evaluated the safety, efficacy, and tolerability of a hair growth and anti-gray hair serum. Ethical approval was obtained, and participants provided informed consent. The study measured changes in hair growth rate, length, density, thickness, anagen:telogen (A:T) ratio, hair fall, graying severity, and scalp appearance using a phototrichogram (CASLite Nova, Catseye Systems & Solutions Pvt Ltd, Navi Mumbai, Maharashtra, India), the 60-second hair comb test, and dermatological evaluations. Consumer perception of the test treatment was evaluated using a questionnaire. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 29.0.1.0 (Released 2023; IBM Corp., Armonk, New York, United States) and Microsoft Excel 2019 (Microsoft Corporation, Redmond, Washington, United States), with results reported at a 5% significance level. Results The study found that applying a test treatment led to a significant reduction in gray hairs and an improvement in hair growth over the study duration of 120 days after the use of the test treatment. Hair growth rate was enhanced by 46.71% on Day 90, hair length improved by 35.40% on Day 87, A:T Ratio improved by 48.26% on Day 90, hair density improved by 37.92%, hair thickness improved by 80.85% on Day 120, reduction in hair fall observed by 64.89% on Day 120, improvement in Graying Severity Score improved by 64.89% after the use of the test treatment, which was statistically significant (p-value of <0.001). The experience of the test was reported by all the subjects as 'effective' in improving hair growth and gray hairs and they were satisfied after use. No adverse effects were observed during the study.  Conclusion The test treatment, Soulflower Rosemary Redensyl Hair Growth Serum (Tetragain), exhibited a favorable safety profile, with no reported adverse reactions, making it suitable for regular use in daily hair care routines. Its formulation effectively enhances hair density, reduces hair fall, and addresses early signs of graying, providing a clinically supported option for individuals seeking to improve hair health and maintain natural color. This formulation can normalize the hair growth cycle, thereby fostering an optimal environment for sustained hair growth.

Integrating Psychological Support and Topical Therapy for the Effective Management of Stress-Induced Alopecia Areata: A Case Report

Alopecia areata is an autoimmune disorder characterized by hair loss in defined patches. Genetic factors are considered primary contributors to the onset and exacerbation of certain conditions. However, environmental triggers, particularly psychological stress, also play a significant role. This case report presents a 28-year-old woman with no prior history of autoimmune or immune-related conditions who developed severe alopecia areata following prolonged emotional stress. Despite the absence of systemic or nutritional deficiencies, she experienced significant hair loss, which improved with 5% Minoxidil and psychological stress management. However, a relapse occurred after another period of acute stress, highlighting the relationship between psychological stress and disease progression. This case underscores the need for a comprehensive treatment approach, combining pharmacological interventions like Minoxidil with stress reduction strategies to manage stress-induced autoimmune disorders and prevent relapses effectively. Such a combined approach is crucial in treating and managing alopecia areata, especially in patients with psychological stress triggers.

Hair Growth Effect and the Mechanisms of Rosa rugosa Extract in DHT-Induced Alopecia Mice Model

Rosa rugosa is a medicinal plant known for its potential anti-inflammatory, antioxidant, anti-cancer, and antimicrobial benefits. The pharmacological effects of Rosa rugosa extract on hair loss have not yet been documented. This research sought to assess the inhibitory effects and mechanisms of action of Rosa rugosa water extract (RWE) in a mouse model of dihydrotestosterone (DHT)-induced alopecia. The study was conducted using C57BL/6 mice, which were assigned to five groups: control, DHT-treated, Rosa rugosa water extract (RWE) at doses of 25 mg/kg and 100 mg/kg body weight, and bicalutamide-treated. To induce hair loss, dihydrotestosterone (1 mg/day per body weight) was administered via intraperitoneal injections, and dorsal hair removal was timed to align with the telogen phase. Each group received oral treatments for a period of 23 days. In this study, we assessed hair growth activity, examined histological changes, and performed immunoblot analysis. We noted improvements in hair length and thickness. Additionally, the protein expression of growth factors associated with hair growth, including vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and insulin-like growth factor-1 (IGF-1), showed significant increases in the group treated with RWE. Additionally, treatment with RWE suppressed the protein expression of hair growth inhibitory factors, including dickkopf WNT signaling pathway inhibitor 1 (DKK1) and interleukin (IL)-6. Moreover, hair growth regulatory pathway related factors, including ERK, AKT, and GSK-3β, were activated. These findings indicate that RWE could serve as a promising natural therapy for preventing hair loss by enhancing the production of factors that promote hair growth while inhibiting those that suppress it.

Psychological stress impact neurotrophic factor levels in patients with androgenetic alopecia and correlated with disease progression

BACKGROUND

Androgenetic alopecia (AGA) is a common form of hair loss that can be influenced by psychological factors.

AIM

To investigate the impact of mental stress on neurotrophic factors in patients with AGA and correlate the findings with the progression of AGA.

METHODS

A total of 120 patients with AGA were analyzed in this study, which were divided into a non-stress group (n = 30) and a stress group (n = 90) on the basis of the presence or absence of psychological stress confirmed by Depression Anxiety Stress Scale-21 scale. The baseline demographic characteristics, serum cortisol levels, hair growth parameters, neurotrophic factors, and AGA progression scores between the non-stress and stress groups were compared. Correlation analyses were conducted to assess the relationships among stress, neurotrophic factors, hair loss progression, and AGA progression.

RESULTS

This study revealed significantly higher cortisol levels throughout the day in the stress group than in the non-stress group. The stress group exhibited lower levels of nerve growth factor, brain-derived neurotrophic factor, and glial cell line-derived neurotrophic factor and higher expression levels of neurotrophin (NT)-3 and NT-4 than the non-stress group. Hair parameters indicated lower hair diameter, decreased hair density, and more severe AGA grading in the stress group, whereas follicle count and terminal/vellus hair ratio showed no significant differences between the two groups. After 1 year of treatment with 5% minoxidil, efficacy was observed to be lower but AGA progression was notably more pronounced in the stress group than in the non-stress group. Disease progression was positively correlated with high stress and NT-4 levels.

CONCLUSION

This study provides compelling evidence of the influence of mental stress on neurotrophic factors and its correlation with the progression of AGA. The findings underscore the need for a comprehensive approach to the management of AGA that considers the physiological and psychosocial aspects. Further research is warranted to validate the findings and explore targeted therapeutic interventions for individuals with stress-related AGA.

Assessing a measure for Quality of Life in patients with severe Alopecia Areata: a multicentric Italian study

Objective

The prevalence of anxiety and depression in patients diagnosed with Alopecia Areata (AA) is very high and this significant burden of psychological symptoms threatens the Health-Related Quality of Life (HRQoL) of affected patients. Indeed, AA often does not produce significant physical symptoms, but it nonetheless disrupts many areas of mental health. Clinical assessment of disease severity may not reliably predict patient's HRQoL, nor may it predict the patient's perception of illness. For this reason, considerable effort has been made to apply and develop measures that consider patient's perception and assess the HRQoL of individuals affected by AA. The aim of this multicentric study was to provide the Italian version of the Skindex-16AA and to evaluate its psychometric properties in a clinical sample of consecutive patients with moderate-to-severe AA.

Methods

This is a longitudinal, multicenter, observational study. Patients returned for follow-up visits at 4-, 12-, and 24-weeks. The analyses of the current work aimed to confirm the factorial structure of the Skindex-16AA. In the case of non-fit, an alternative structure for the model was proposed, using an Exploratory Graph Analysis and the Bayesian approach.

Results

The sample was composed of 106 patients with AA. Alopecia Universalis was the most frequently diagnosed type of alopecia at all time points. The analyses on the Skindex-16AA revealed that a two-factor structure with eight items fit the data best (Bayesian Posterior Predictive Checking using 95% Confidence Interval for the Difference Between the Observed and the Replicated Chi-Square values = -6.246/56.395, Posterior Predictive P-value = 0.06), and reported satisfactory psychometric properties (i.e., internal consistency and convergent validity).

Conclusion

The Skindex-8AA demonstrated optimal psychometric properties (i.e., convergent and construct validity, and test-retest reliability) measured in a sample of patients with AA, that may suggest that it is an appropriate tool to measure the HRQoL in AA patients. However, further studies are needed in order to confirm and tested other psychometric features of this tool.

Impact of Hair Transplantation on Quality of Life

BACKGROUND

Alopecia is defined as partial or complete hair loss. The most common form is androgenetic alopecia, which occurs in both men and women. Despite the nonsurgical options available for treatment, the only permanent solution is hair transplantation. Hair loss has been shown to have significant psychological consequences associated with loss of self-confidence, poor self-image and difficulties in social functioning. We aim to examine the effect of hair transplantation on quality of life and psychosocial functioning.

METHODS

Forty-eight patients with androgenetic alopecia were enrolled in this two-center prospective study and underwent hair transplantation by the Follicular Unit Extraction method. Different questionnaires were used to assess their quality of life and other psychosocial parameters before and after hair transplantation.

RESULTS

According to SF-36 Physical and Mental Health Score patients showed significant improvement in life quality after hair transplantation. Diener's Life Satisfaction Scale (DASS-21) revealed increased life satisfaction after the procedure. Stress and anxiety DASS-21 subscales showed significantly reduced results; while, the DASS-21 depression scale and MSPSS were not significantly changed.

CONCLUSION

Taken together, quality of life and psychosocial functioning increased after hair transplantation. Structured abstract is required. Please provide.I insert name of paragraphs within abstract as follows: background, methods, results, conclusion Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Progress on the mechanism of natural products alleviating androgenetic alopecia

Androgenetic alopecia (AGA) has become a widespread problem that leads to considerable impairment of the psyche and daily life. The currently approved medications for the treatment of AGA are associated with significant adverse effects, high costs, and prolonged treatment duration. Therefore, natural products are being considered as possible complementary or alternative treatments. This review aims to enhance comprehension of the mechanisms by which natural products treat AGA. To achieve this, pertinent studies were gathered and subjected to analysis. In addition, the therapeutic mechanisms associated with these natural products were organized and summarized. These include the direct modulation of signaling pathways such as the Wnt/β-catenin pathway, the PI3K/AKT pathway, and the BMP pathway. Additionally, they exert effects on cytokine secretion, anti-inflammatory, and antioxidant capabilities, as well as apoptosis and autophagy. Furthermore, the review briefly discusses the relationship between signaling pathways and autophagy and apoptosis in the context of AGA, systematically presents the mechanisms of action of existing natural products, and analyzes the potential therapeutic targets based on the active components of these products. The aim is to provide a theoretical basis for the development of pharmaceuticals, nutraceuticals, or dietary supplements.

The psychosocial burden of androgenetic alopecia in Saudi Arabia: A cross-sectional study

Background

The most prevalent cause of hair loss is androgenetic alopecia. Improved therapeutic modalities may result from knowing how stress affects hair growth, incorporating stress-coping methods into the treatment of hair loss disorders, and developing new pharmacotherapeutic approaches. This study aimed to examine the psychosocial burden of androgenetic alopecia in Saudi Arabia.

Materials and Methods

A cross-sectional online survey study was conducted among patients with androgenetic alopecia in Saudi Arabia in February 2023. A previously developed questionnaire was adapted from a previously published tool and used in this study. This association between patients' characteristics and the level of psychosocial disease was identified using binary logistic regression analysis.

Results

This study included 1230 patients. The majority of the patients (78.0%) reported that they felt embarrassed by their androgenetic alopecia. The median score of the psychosocial impact of androgenetic alopecia on the patients was 1.00 (0.00-2.00), which is equal to 10.0%, reflecting a low level of psychosocial burden on the patients by their condition. Binary logistic regression analysis identified that patients without a family history of androgenetic alopecia were 36.0% less likely to be affected psychosocially by their condition (P < 0.01).

Conclusions

A low-level psychosocial effect was seen in our study among individuals with androgenetic alopecia. Further research should be done to determine how the type of alopecia affects patients' psychological results, as well as the influence of the disease's duration on those outcomes. Dermatologists are recommended to raise patients' knowledge of their disease and lessen stigmatization in the meantime.

Common Skin Diseases and Their Psychosocial Impact among Jazan Population, Saudi Arabia: A Cross-Sectional Survey during 2023

Background and Objectives: Skin problems are a widespread issue that affects people in both developing and wealthy countries, posing significant public health concerns. These disorders can profoundly impact individuals' social and psychological well-being. In this study, we aimed to determine the prevalence of the most common skin diseases in the Jazan region of southwestern Saudi Arabia and investigate their impact on patients' quality of life and psychological and social well-being. Materials and Methods: An observational cross-sectional survey conducted among a random sample of 940 adults ≥ 18 years in the Jazan region, Saudi Arabia. Four standardized questionnaires were used for data collection: Patient Health Questionnaire (PHQ-9), a five-dimension questionnaire (EQ-5D), Rosenberg Self-Esteem Scale, and Loneliness Scale (ULS-8). Results: The most prevalent skin conditions involved hair loss, which was reported by (61.1%) of the study population. These disorders significantly affected a higher percentage of females (71.9%) compared to males (46.3%) (p < 0.001). Melasma was more common in females (14.1%) than in males (4.3%) p < 0.001. The lowest prevalence was found for urticaria. Those with acne and hair loss reported higher mean scores on the PHQ-9 Scale than the group without these conditions (p < 0.05 for all). Patients with alopecia, acne, and melasma also reported significantly lower self-esteem scores compared to those without these skin conditions (p < 0.05 for all). Regarding the activity domain of QoL, participants with skin conditions reported no problems doing usual activities, compared to those without skin problems (p < 0.001). Conclusions: In conclusion, research revealed that the most prevalent skin condition was hair loss. Further, an association was found between skin diseases and the mental and social well-being of those affected, resulting in a negative impact on their quality of life. The results call for improving the condition of patients with skin diseases, improving their quality of life, and providing appropriate interventions.