High migratory activity of dermal sheath cup cells associated with the clinical efficacy of autologous cell-based therapy for pattern hair loss

BACKGROUND

Autologous cell-based therapy using dermal sheath cup (DSC) cells was reported as a new treatment for male and female pattern hair loss. However, the mechanisms underlying its action remain unclear.

OBJECTIVE

We investigated the mechanisms underlying the efficacy of DSC cells in cell-based therapy.

METHODS

We conducted multivariate analysis to categorize individuals based on treatment response as responders and non-responders. The differentially expressed genes in DSC cells from the two groups were evaluated using bulk transcriptome, quantitative polymerase chain reaction, and single-cell transcriptome analyses. We performed live cell imaging combined with immunostaining to characterize the DSC subpopulation associated with responders.

RESULTS

We identified nine and three genes as high efficacy (HE) and low efficacy (LE) marker genes, respectively. The HE subpopulations were enriched for cell migration-related genes in single-cell analysis. In contrast, the LE subpopulation was enriched for basement membrane and vasculature-related genes. Moreover, DSC cells in culture were immunocytochemically and morphologically heterogeneous, expressing characteristic factors. Furthermore, live cell imaging showed that DSC cells expressing integrin subunit alpha 6 (ITGA6), an HE subpopulation gene, had markedly higher mobility than those expressing the LE subpopulation genes collagen type IV or CD36.

CONCLUSIONS

ITGA6-positive DSC cells, with superior migratory activity, may contribute to cell-based therapy by promoting cell migration into nearby hair follicles.

Relative Effects of Minoxidil 5%, Platelet-Rich Plasma, and Microneedling in Pattern Hair Loss: A Systematic Review and Network Meta-Analysis

Background

Combination treatments may improve the utility of approved agents for the treatment of pattern hair loss (PHL); however, head-to-head comparisons are lacking.

Objective

The aim of the study was to compare the efficacy of 5% minoxidil, platelet-rich plasma (PRP), and microneedling across adults with PHL insofar as change in total hair density at 24 weeks.

Methods

We conducted a literature search in July 2022. Through our Bayesian network meta-analysis, we estimated treatments' surface under the cumulative ranking distribution (SUCRA) values and relative effects - in terms of mean difference (MD).

Results

Data from 27 trials, totaling 1,110 patients, were extracted. Interventions were ranked based on the probability of inducing hair density improvements: 5% minoxidil plus microneedling (SUCRA = 95.8%), 5% minoxidil plus PRP (SUCRA = 64.7%), 5% minoxidil (SUCRA = 53.9%), PRP (SUCRA = 34.9%), microneedling (SUCRA = 27.8%), and PRP with microneedling (SUCRA = 22.9%). The efficacy of 5% minoxidil plus microneedling in improving total hair density was significantly greater (p < 0.05) than 5% minoxidil monotherapy (MD = 13 hairs/cm2), PRP monotherapy (MD = 16 hairs/cm2), and microneedling monotherapy (MD = 17 hairs/cm2).

Conclusion

Five percent minoxidil plus microneedling is an effective treatment option for improving hair density at 6 months in adult PHL patients.

Compliance to Topical Minoxidil and Reasons for Discontinuation among Patients with Androgenetic Alopecia

INTRODUCTION

This study assessed the levels of compliance to topical minoxidil (TM) among male and female patients with androgenetic alopecia (AGA) and analyzed the factors associated with minoxidil discontinuation.

METHOD

A retrospective study was conducted among 400 consecutive patients with AGA who presented to a dermatology clinic and who were prescribed minoxidil 2% or 5% in the past 5 years. Demographic factors, other previous treatments, and minoxidil parameters including the dose (2% or 5%), total duration of use, treatment results, and side effects were collected.

RESULT

The mean age of the patients was 32.41 years [standard deviation (SD) 8.18], and 66.5% were female. The majority of patients (82.5%) did not receive any previous treatment for AGA. Of the total patients, 345 (86.3%) have discontinued minoxidil. Discontinuation rate showed no association with sex (p = 0.271), age category (p = 0.069), or previous treatment (p = 0.530). Furthermore, the likelihood of minoxidil discontinuation decreased with the increase in treatment duration (p < 0.001) and was significantly lower among patients who reported improvement (69.3%) or stabilization of hair shedding (64.1%) compared with those who reported baby hair (88.9%) or no efficacy (95.3%) (p < 0.001). Furthermore, having experienced an adverse effect of minoxidil was associated with 93.6% discontinuation rate compared with 75.8% in the case of no side effects (p < 0.001). Adjusted analysis showed that minoxidil discontinuation was independently association with longer duration of use [> 1 year; odds ratio (OR) 0.22; p < 0.001], perceived improvement (OR 0.17; p < 0.001) or stabilization (OR 0.14; p < 0.001), and the occurrence of side effects (OR 3.06; p = 0.002).

CONCLUSIONS

The clinical use of TM in AGA is limited by a substantially low compliance even in absence of adverse effects. We emphasize the importance of educating patients regarding the treatment's side effects and the need to use minoxidil for a minimum of 12 months to assess treatment efficacy.

Sleep quality in men with androgenetic alopecia

PURPOSE

Sleep disturbances affect human health and contribute to several comorbidities. In men, androgenetic alopecia (AGA) is a common, non-scarring form of hair loss that affects a patient's self-esteem. There are limited data regarding the association between poor sleep quality and male AGA. We aimed to compare the prevalence of sleep abnormalities between male patients with AGA and controls to identify an association between the two conditions.

METHODS

A case-control study on patients with AGA and age-matched controls was conducted. Participants completed a standardized questionnaire that contained self-evaluated sleep measures, including Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and STOP-BANG questionnaire. Patients with AGA were classified into mild, moderate, and severe subgroups according to the Hamilton-Norwood classification for stratified analyses. Data between groups and among subgroups were compared.

RESULTS

Of 446 male participants, 223 (50%) were in the AGA group, and the remainder (50%) were in the control group. Multivariable logistic regression analysis revealed that hypertension (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.16-3.11, p = 0.011) and STOP-BANG score ≥ 5 (OR = 2.05, 95%CI = 1.15-3.66, p = 0.015) were associated with AGA. For subgroup analyses, ordinal logistic regression model showed a significant association between severe AGA and three sleep profiles, namely total sleep time ≤ 6 h (OR = 2.16, 95%CI = 1.02-4.57, p = 0.044), PSQI > 5 (OR = 3.72, 95%CI = 1.42-9.72, p = 0.008), and STOP-BANG score ≥ 5 (OR = 3.01, 95%CI = 1.11-8.13, p = 0.030).

CONCLUSION

Our findings revealed an association between sleep disturbances and AGA, which may help guide appropriate management in these patients.

Serum Ferritin Levels amongst Individuals with Androgenetic Alopecia in Ile-Ife, Nigeria

BACKGROUND

Androgenetic alopecia (AGA) is the most common form of alopecia, affecting 50% of the adult population world-wide. The exact mechanisms of this common hair disorder are yet to be fully elucidated. It is believed to be related to high circulating androgen levels in the blood and it is genetically determined. Deficiencies of micronutrients such as iron in the development of AGA have been a subject of debate.

OBJECTIVE

This study sought to determine the association between serum ferritin levels and androgenetic alopecia among patients attending the Dermatology clinic at a tertiary health facility in South-Western Nigeria.

METHODS

This was a hospital based cross sectional study with a total of 114 participants, which consisted of 57 subjects with AGA and 57 age and sex-matched healthy adults without AGAwho met the inclusion criteria. The diagnosis of AGA was made clinically and with the aid of a Dermatoscope (Wi-Fi Digital Microscope RoHS YPC_X03 V2018, HD Colour CMOS sensor with 50X-1000X magnification and HD resolution 1920x1080P).

RESULTS

The mean age of the study participants was 41.68 ± 12.86 years with age ranging from 24 to 80 years. The mean serum ferritin levels among the subjects and control group were 188.65 ±97.92ng/ml and 194.49 ± 76.67ng/ml respectively but this difference was not statistically significant (p = 0.724). However, subjects with premature AGA had a significantly lower serum ferritin level compared to those with adult-onset AGA (p = 0.020).

CONCLUSION

Iron deficiency is known to cause quantitative defect in haemoglobin production, limiting the amount of oxygen transported for hair growth and this, in addition to genetic factors, may explain why individuals with premature AGA have a significantly low serum ferritin levels.

Understanding Pattern Hair Loss-Hair Biology Impacted by Genes, Androgens, Prostaglandins and Epigenetic Factors

Pattern hair loss (PHL) is the most frequent cause of hair loss in men and women, accounting for 65% of consultations in a hair referral center. PHL is understood to represent a hereditary, age-dependent progressive thinning of the scalp hair, which follows distinct clinical patterns with notable differences depending on sex and age of onset. Clinical and investigative advances have helped us to understand some of the pathogenic steps, leading to PHL. Besides genetic factors and peculiarities of androgen metabolism, additional pathogenic factors that are suspected include microbiomata, oxidative stress, and microinflammation. While further suspects are likely to be exposed, individual diversity of causal agents, as well as of the sequence of events, or combined factors, must be kept in mind. A large number of therapeutic molecules claimed to be active and patented in this field, and their limited efficacy in offering a definitive cure of PHL confirm the complexity of PHL. The aim of therapy is to retard progression of hair thinning and increase hair coverage of the scalp. As yet, two FDA-approved drugs are available for this purpose, oral finasteride, and topical solution of minoxidil. Variations in posology and formulation allow for an enhancement of patient comfort and treatment efficacy. Antiandrogen treatments in women with normal androgen levels have questionable efficacy while having health risks.

A Systematic Review and Meta-analysis of Randomized Controlled Trials of United States Food and Drug Administration-Approved, Home-use, Low-Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology

BACKGROUND

Low-level light/laser therapy (LLLT) can potentially stimulate hair growth in pattern hair loss (PHL), with many available home-use LLLT devices of different designs and technology on the market. However, not all devices are cleared by the United States (US) Food and Drug Administration (FDA), with very few studies to support their efficacy.

OBJECTIVES

This systematic review and meta-analysis aimed to investigate the effectiveness of FDA-approved LLLT devices for PHL treatment.

METHODS

We included articles related to FDA-approved home-use LLLT devices on PubMed and Medline, using the FDA 510(K) Premarket Notification database and the systematic search of articles up to January 2020. The standardized mean difference (SMD) for the changes of hair density treated by LLLT versus sham devices was analyzed.

RESULTS

Only 32 home-use LLLT devices have been approved by the FDA as of January 2020. The meta-analysis comprised seven double-blinded, randomized, controlled trials. The overall quantitative analysis yielded a significant increase in hair density in those treated by LLLT versus sham groups (SMD: 1.27, 95% confidence interval [CI]: 0.993-1.639). The subgroup analysis demonstrated the increased hair growth in male and female subjects with both comb- and helmet-type devices. There were significant LLLT sources in the LDs alone (SMD: 1.52, 95% CI: 1.16-1.88) and the LDs combination (SMD: 0.85, 95% CI: 0.55-1.16) (p=0.043).

CONCLUSION

LLLT is potentially effective for PHL treatment. Nonetheless, the long-term follow-up study in patients with severe PHL with combined standard treatment and comparison between LLLT devices and energy sources is recommended.

Fibrosing Alopecia in a Pattern Distribution: A Case Report and Literature Review

Fibrosing alopecia in a pattern distribution (FAPD) is a relatively new entity in the family of cicatricial alopecia. It has been categorized as a member of the lichen planopilaris (LPP) group due to its similarity in clinical and histopathological presentation. Nonetheless, the disease earns its own entity due to its lichenoid inflammation exclusively involving miniaturized hair and area of involvement mimicking pattern hair loss which differentiates itself from other types of LPP or pattern hair loss. Since its first introduction by Zinkernagel and Trüeb in 2000, there have been only few case reports and series of FAPD. We herein report a case of FAPD in a postmenopausal woman who had progressive hair loss over the course of 10 years.

[Injection of PRP (Platelet-rich plasma) as a treatment for androgenetic alopecia : a systematic review of the literature]

INTRODUCTION

Androgenetic alopecia is the most frequent alopecia both in men and women. Despite it affects a large proportion of the population, they are few therapeutic options often restrictive. The injection of PRP in alopecic areas is a new and easy therapeutic option. The aim of this article is to systematically review the literature about this topic by analysing the articles describing the clinical results of this new technique in the treatment of androgenetic alopecia in men and / or women with a follow-up of minimum 6 months.

MATERIAL AND METHODS

A systematic review of the PRISMA type from several databases was carried out and identified 7 articles meeting the following inclusion criteria: 1) articles describing the clinical results of the injection of PRP for the treatment of androgenetic alopecia, 2 ) in men and / or women, 3) written in English or French, 4) with clinical follow-up of at least 6 months, and 5) with objective criteria for follow-up of patients and observed complications. These prospective clinical studies are analyzed and compared qualitatively.

CONCLUSION

This systematic review of the literature resulted in a qualitative analysis of 7 scientific studies on the effect of PRP injection as a treatment for androgenetic alopecia. Although all the studies concluded in a favorable effect of this new treatment, a larger, rigorous study with objective analysis of the therapeutic effect is necessary.

Efficacy of a Complex of 5-Aminolevulinic Acid and Glycyl-Histidyl-Lysine Peptide on Hair Growth

BACKGROUND

Pattern hair loss is a very common problem. Although effective therapeutics for the treatment of pattern hair loss have been used, novel therapeutic modalities are still required to enhance hair growth.

OBJECTIVE

We investigated the efficacy and safety of a complex (ALAVAX) of 5-aminolevulinic acid (5-ALA) and glycyl-histidyl-lysine (GHK) peptide for the treatment of pattern hair loss.

METHODS

Forty-five patients with male pattern hair loss were treated with ALAVAX 100 mg/ml (group A), ALAVAX 50 mg/ml (group B) or placebo (group C) once a day for 6 months. Total hair count, hair length, hair thickness, patient's assessment and adverse events were evaluated at month 1, 3, and 6.

RESULTS

An increase in hair count for 6 months was 52.6 (p<0.05) in group A, 71.5 (p<0.05) in group B, and 9.6 in group C. The ratio of changes in hair count between group B (2.38) and group C (1.21) at 6 months showed a statistically significant difference (p<0.05). The proportion above good satisfaction was higher in group A (26.7%) than in the other groups (group B: 14.3%, group C: 7.1%). There was no statistically significant difference in hair length and hair thickness among 3 groups at 6 months. There was no adverse event in 3 groups.

CONCLUSION

Our study showed that a complex of 5-ALA and GHK peptide may be considered as one of the complementary agents for the treatment of male pattern hair loss.