A New Classification of Early Female Pattern Hair Loss

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

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

Female Pattern Hair Loss-An Update

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

Broussonetia papyrifera Promotes Hair Growth Through the Regulation of β-Catenin and STAT6 Target Proteins: A Phototrichogram Analysis of Clinical Samples

Broussonetia papyrifera (B.papyrifera), belonging to the Moraceae family, is known to elicit anti-inflammatory, antioxidant, anti-tyrosinase, anticancer, antinociceptive, and antimicrobial effects. The present study has been designed to examine the effects of B. papyrifera extract on hair growth through in vitro and clinical samples. Real-time cell growth assay, T-cell factor/lymphoid enhancer-binding factor (TCF/LEF), activation of signal transducer and activator of transcription-6(STAT6) and STAT3 reporter gene function, and Western blotting was performed to examine whether B. papyrifera regulates the expression of target proteins implicated in the proliferation of human hair follicle dermal papilla (hHFDP) cells. In this human trial, using a phototrichogram, the effect of B. papyrifera on hair growth was examined by reconstitution analysis after shaving the hair of the clinical subject’s dorsal skin. B. papyrifera promoted growth equally in hHFDP cells, which is comparable to that of minoxidil and tofacitinib. Treatment with B. papyrifera extract enhanced the TCF/LEF-luciferase activity and increased the level of β-catenin protein. Moreover, B. papyrifera extract significantly suppressed interleukin-4 (IL4)-induced STAT6 phosphorylation. In clinical trial, using a phototrichogram, we assessed the hair density and total hair counts at 0, 6, and 12 weeks after the use of hair tonic containing B. papyrifera extract. After using the hair tonic for 12 weeks, the total hair count was significantly increased as compared with the subjects at the start date (n = 11). B. papyrifera promotes dermal papilla cells proliferation in vitro and clinically among human volunteers through the regulation of WNT-β-catenin and STAT6 pathways.