An oral French maritime pine bark extract improves hair density in menopausal women: A randomized, placebo-controlled, double blind intervention study

Background and Aims

Female pattern hair loss affects females of all ages with a trend to increase after menopause. This disorder may have significant psychological impact and lead to anxiety and depression.

Objective

In a single center, double blind, randomized, placebo-controlled study, the effects of oral Pycnogenol® intake (3 × 50 mg/day for a total of 6 months) on hair density, scalp microcirculation, and a variety of skin physiological parameters was studied in Han Chinese menopausal women (N = 76) in Shanghai, China.

Methods

Measurements were taken at the beginning and after 2 and 6 months, respectively. Hair density was determined by digital photographs and further evaluated by Trichoscan software. Transepidermal water loss was measured by a humidity sensor in a closed chamber on the skin surface. Changes in microcirculation were detected as resting flux on the scalp by reflection photoplethysmography.

Results

Pycnogenol® intake significantly increased hair density by 30% and 23% after 2 and 6 months of treatment, respectively, as detected by Trichoscan® evaluation of digital photographs. Interestingly, photoplethysmography revealed that this beneficial effect was associated with a decrease in resting flux of the scalp skin, which might indicate an improvement of microcirculation. None of these effects were observed in the placebo taking group. In addition, a significant transient decrease of transepidermal water loss was observed in scalp skin under Pycnogenol,® but not placebo treatment.

Conclusion

Oral intake of Pycnogenol® might have the potential to reduce hair loss in postmenopausal women.

Evaluation of Scalp Hair Density and Diameter in the Arab Population: Clinical Office-Based Phototrichogram Analysis

Background

Knowing normal values of scalp hair thickness and density is beneficial for diagnosing hair disorders, monitoring responses to therapy, performing hair transplants, and conducting relevant research. Such normal values have not yet been studied for Arabs.

Objective

To assess the hair density and diameter of the Arab population at different scalp sites using phototrichogram.

Methods

A cross-sectional descriptive study was performed at King Saud University Medical City from December 2021 to August 2022. The study was conducted on Arab adults who were not suffering from any hair disorder. The study was conducted using a questionnaire and clinical examination by phototrichogram.

Results

A total of 120 participants were enrolled in this study. The mean hair density was 147.1± 7.8 hairs/cm2, and the mean hair diameter was 87±4.9 μm. There were significant differences between hair density (P=0.0001) and diameter (P=0.0001) in different regions of the scalp. Females had higher hair density than males at occiput (P=0.038).

Conclusion

Arab hair has a higher thickness and lower density than hair of other ethnicities. This needs to be considered when diagnosing and/or treating hair problems in Arabs.

The Predictive Value of Midscalp Hair Density and Terminal Hair Percentage in the Severity Evaluation of FPHL Assessed by Trichoscan in a Sample of Chinese Population

BACKGROUND

Female pattern hair loss (FPHL) is the most common hair loss disorder in women, which may impair patient's self-identity. It presents as a diffuse reduction in hair density at the mid and frontal regions of the scalp with preservation of the frontal hairline. TrichoScan can be used as a diagnostic tool and for monitoring patients in male pattern hair loss, but little is known in FPHL with Chinese population.

OBJECTIVE

To explore the predictive value of various TrichoScan characteristics at different areas of the scalp in the diagnosis and evaluation of FPHL.

MATERIALS AND METHODS

A total of 261 FPHL subjects were divided into three groups according to Ludwig classification. Together with 108 healthy controls, they were evaluated by computer-assisted TrichoScan. Various hair parameters were analyzed in the frontal, midscalp, vertex, parietal, and occipital areas of the scalp.

RESULTS

Declining hair densities, terminal hair percentage, hair follicular unit density, mean hair diameter, and average hair/unit combined with increased intermediate hair percentage, and vellus hair percentage were observed across all areas of the scalp for FPHL subjects. Hair density and terminal hair percentage in the midscalp area were the factors most affecting Ludwig classification. The two parameters combined achieved 85.12% correct classification rate and an area under the ROC curve of 0.88 in the diagnosis of FPHL. Additionally, we reported a unique type of FPHL which mostly affected the parietal area, occurring with or without traditional midline changes.

CONCLUSION

FPHL in a Chinese population presented characteristics of reduced hair density and miniaturization of hair follicles in the midline scalp and to a lesser extent in the parietal area. Hair density and terminal hair percentage in the midscalp exhibited the greatest predictive value of Ludwig classification. Our results may further provide the basis for quantitative classification of FPHL.

Evaluation of the safety and efficacy of platelet-rich plasma in the treatment of female patients with chronic telogen effluvium: A randomised, controlled, double-blind, pilot clinical trial

BACKGROUND

Chronic telogen effluvium is characterised by diffuse loss of hair of the scalp. One of the emerging lines of treatment is platelet-rich plasma. However, not much of published data exist.

AIMS

A pilot study was conducted on chronic telogen effluvium patients to evaluate the efficacy and safety of platelet-rich plasma, and to compare two different methods of platelet-rich plasma preparation.

METHODS

The study included 30 female patients with chronic telogen effluvium. Patients were randomised into three groups: Group (1): Special platelet-rich plasma tubes centrifuged at 3500 rpm; Group (2): Ordinary laboratory tubes centrifuged at 1000 rpm; Group (3): Normal saline as a placebo. Patients' evaluation was done with visual analog scale, hair pull test, trichoscopy, photos, satisfaction questionnaire, and safety. All patients received four monthly sessions. Patients were evaluated one month and three months after the last session.

RESULTS

The hair pull test,visual analogue scale, and patient satisfaction results showed a statistically significant difference between group 1 vs. group 3 and group 2 vs.group 3 at one and three months after the sessions, while there was no difference between group1 vs. group 2. Trichoscopy results (baseline, one and three months after treatment) showed a significant increase in hair density and thickness in the frontal area, temporal area, and the vertex in groups 1 and 2 only. There was no statistically significant difference between the three groups with regards to side effects.

LIMITATIONS

The sample size was small with ten patients in each group. Furthermore, the follow-up of patients was for only three months.

CONCLUSIONS

Platelet-rich plasma could be considered as a promising therapy for patients with chronic telogen effluvium with an excellent safety profile. The ordinary laboratory low-cost tubes might be a reliable alternative to the expensive special platelet-rich plasma kits tubes. The trial registry number is PACTR202006539654415.

Trichoscopic features of hair and scalp in noncomplaining individuals: A descriptive study

BACKGROUND

Trichoscopy is a simple noninvasive tool that is used in calculating different hair parameters and the diagnosis of different hair/scalp diseases at variable magnifications.

OBJECTIVE

The aim of this work is to describe the features and parameters of hair and scalp in a healthy sample of Egyptian population using videodermoscopy. This may help to provide standard range of measurements of normal hair in both males and females.

METHODS

A nonrandomized, observational study for features and parameters of hair structure, performed on 368 healthy Egyptian subjects with no hair/scalp complaint.

RESULTS

Each scalp area has its own vascular pattern. Male subjects showed different values regarding their hair parameters from the female subjects. No significant difference was seen after application of hair dye, except for few values. In both genders, there was a change in hair parameters with age. Smoking had a negative influence on hair parameters.

CONCLUSION

Hair features and parameters observed in our population are different from those reported by other populations. Smoking affects hair thickness and density. Dyed hair has greater thickness mostly due to the protective effect of hair conditioners.

Three wavelengths integrated: Efficacy and safety of a novel combination for hair removal

BACKGROUND

Laser hair removal is one of the most popular aesthetic procedures.

AIMS

The study aimed to assess the efficacy and safety of a novel applicator combining three wavelengths (1064 nm, 810 nm, and 755 nm) for hair removal.

PATIENTS/METHODS

This prospective study included a four-session hair removal treatment with three wavelengths combined and emitted simultaneously using an in-motion technique. Patients were treated in eight-week intervals between each session and a follow-up of 3 months.

RESULTS

Twenty-two men (mean age 41.5 years, SD = 6.1) were included: two (9.1%) Fitzpatrick skin type II, 19 (86.4%) type III, and one (4.5%) type IV. Treated areas were two abdomens (14%), fourteen backs (64%), and five thoraxes (23%). Hair characteristics were evaluated with a dermatoscopic imaging system. Three months after the last session, the mean decrease in the hair count was of 75.6% (SD 5.9) (p < 0.0001), in hair density of 75.6% (SD 5.9) (p < 0.0001), in the terminal hair number of 60.1% (SD 55.0) (p < 0.0001), and in the vellus hair number of 39.7% (SD 72.9) (p = 0.0001).

CONCLUSION

The combined three different wavelengths in a single device provided a wide range of absorption and penetration, allowing for a safe and effective treatment.

Factors influencing the effect of photobiomodulation in the treatment of androgenetic alopecia: A systematic review and analyses of summary-level data

Low-level laser therapy (LLLT) is used to treat androgenetic alopecia (AGA). The therapeutic effect of LLLT on AGA has been evaluated; however, there is a paucity of studies that investigated device- and usage-related factors that may influence the effect of LLLT on hair regrowth. The literature was systematically searched to identify eligible studies; PubMed, Scopus, EMBASE and clinicaltrials.gov databases were searched on 30 April 2020. Eligible studies were randomized trials that investigated the effect of LLLT on hair density in AGA. Robust linear regressions were used to make comparisons. An increase in the per-session energy fluence by 1 J/cm² is significantly associated with an increase in hair density by 0.23 hairs/cm² (95% CI: 0.21 hairs/cm² , 0.25 hairs/cm² ). The number of laser or light-emitting diodes is not significantly associated with change in hair density. Increasing the total duration of exposure to treatment is associated with a significant increase in hair density (β = .53, P < .05). Switching from continuous to pulse irradiation was associated with a significant increase in hair density (β = 10.11, P < .01). Energy fluence, irradiation session duration, and light pulsing have a significant therapeutic effect on AGA, while the number of diodes does not.

Effectiveness of Low-dose Ethinylestradiol/Cyproterone Acetate and Ethinylestradiol/Desogestrel with and without Metformin on Hirsutism in Polycystic Ovary Syndrome: A Randomized, Double-blind, Triple-dummy Study

BACKGROUND: The effectiveness of different combined oral contraceptive pills and metformin in reducing hirsutism in patients with polycystic ovary syndrome (PCOS) remains unclear. OBJECTIVE: We sought to determine the effects of ethinylestradiol (35μg)/cyproterone acetate (2mg) (EE/CPA) and ethinylestradiol (20μg)/desogestrel (0.15mg) (EE/DES), alone or with metformin, on hirsutism in PCOS. METHODS: A randomized, double-blind, triple-dummy study was conducted on women with PCOS and hirsutism (N=107) who received one of four drug combinations (Arm A: EE/CPA; Arm B: EE/DES; Arm C: EE/CPA plus metformin; or Arm D: EE/DES plus metformin). Hirsutism was assessed at baseline, six months, and 12 months by using five outcomes variables. RESULTS: No outcomes variable showed a significant difference between the four arms at 12 months. There was a significant reduction in both hair density and modified Ferriman-Gallwey score (mFGS) in Arm A, mFGS in Arm B, hair density in Arm C, and diameter of sideburn hair in Arm D, respectively. Separately, there was a significant increase noted in the hair growth rate of chin and an improvement in patients' perceptions of hirsutism in all four study arms. CONCLUSION: EE/CPA and EE/DES were equally effective in improving hirsutism in PCOS, with no added benefit from low-dose metformin. Sri Lanka Clinical Trials Registry (http://www.slctr.lk) registration no. SLCTR/2015/007.

Donor site of follicular unit excision hair transplantation: the relationship between appearance and actual hair density, and hair diameter

Donor site morbidity is an important consideration for follicular unit excision (FUE). We examined 103 male patients with adult androgenic alopecia. Patients were divided into three groups (Good, Fair, and Poor) based on visual assessment of the donor site. Hair density and hair diameter were measured using digital photography. A total of 72, 21 and 10 patients were classified into the Good, Fair and Poor appearance groups. The average hair density of each group was 127.8 ± 22.6 hair/cm², 114.8 ± 23.1 hair/cm² and 94.9 ± 25.4 hair/cm². The hair density of the Good group was significantly higher than that of the Poor group (p = 0.003). The average hair diameter of each group was 0.0968 ± 0.0267 mm, 0.0754 ± 0.0299 mm and 0.0473 ± 0.0158 mm. The hair diameter of the Good group was significantly higher than that of the Poor group (p = 0.001). Thirty-three of 72 patients whose hair density was >130 hair/cm² belonged to the Good group. Seven of 10 patients whose hair density was <105.0 hair/cm² belonged to the Poor group, while 31 of 72 patients whose hair diameter was <0.101 mm were included in the Good group. Eight of 10 patients whose hair diameter was less than 0.070 mm were in the Poor group. Donor sites rated Good on appearance had both high hair density and thick hair diameter. To maintain a good appearance after FUE, donor site hair density should not be less than 105.0 hair/cm².

Characteristic findings by phototrichogram in southern Chinese women with Female pattern hair loss

OBJECTIVES

To investigate the characteristics of hairs in Female pattern hair loss (FPHL) patients and healthy females in Southern China.

MATERIALS AND METHODS

Three fundamental hair parameters in different scalp areas of 90 Southern Chinese FPHL patients and 83 healthy controls were analyzed by phototrichogram.

RESULTS

Female pattern hair loss patients showed reduced hair density, hair diameter, and terminal/vellus hair ratio. The reduction correlated with the severity of Ludwig staging. Midscalp was the most affected area in FPHL, but occipital and temporal sites were also involved. In normal women, the highest hair density was observed in midscalp, followed by occipital and temporal areas. Peak hair density at midscalp sites was reached at 20s group, then declined with age. Maximum hair diameter at midscalp and occipital sites occurred in 40s group. Terminal/vellus hair ratio tended to increase with age and peak on 50-60s group.

CONCLUSION

Reduced hair density and hair diameter, and miniaturization of hair follicles are the characteristics of FPHL in Southern Chinese women. Occipital and temporal sites are also affected in FPHL. Age-associated changes might have an influence on the hair condition. The values of hair parameters obtained in this study will help to establish reference data for better evaluation of hair disorders.

Recycling of Previously Transplanted Hair: A Novel Indication for Follicular Unit Extraction

BACKGROUND:

Hair transplantation has enhanced the realm of procedural dermatology. Before the advent of follicular transplantation, androgenetic alopecia was a difficult disease to manage, as there is a limited armamentarium of topical and systemic pharmaceuticals. However, as with other novel surgical procedures, there is a steep learning curve, that may result in poor transplantation or cosmesis.

CASE REPORT:

We present a case of androgenetic alopecia, where previously, poorly implanted hairs were recycled by follicular unit extraction to increase hair density at the vertex of the scalp, which resulted in improved cosmesis and patient satisfaction.

CONCLUSION:

We have demonstrated that re-transplantation is not only feasible but is effective; therefore redesigning of previous transplantations should be considered as a possible indication follicle unit extraction, particularly in the setting of scarce follicular reserves. The utility of our recycling method may also inspire hope in patients that have undergone failed or unsatisfactory hair transplantations.

Platelet-rich plasma, the ultimate secret for youthful skin elixir and hair growth triggering

The clinical application of platelet-rich plasma (PRP) is based on the increase in the concentration of growth factors that are released from alpha-granule of the concentrated platelets and in the secretion of proteins which are able to capitalize on the healing process at the cellular level. It has been invented to restore the natural beauty by starting the natural rejuvenation process of the skin and aiming to make it function as a younger one and to keep the skin youthful and maintain it. Besides that, it is also emerged to include hairs as a new injectable procedure to enable stimulating hair growth locally and topically; preventing its fall; improving hair shaft, hair stem, and its caliber; increasing its shine, vitality, and pliability; and declining hair splitting and breakage. Thus, youth is in your blood as it has a magical power imposed in the platelet factors. There is, however, no standardization of the techniques besides insufficient description of the adopted procedures. Not long, autologous platelet-rich plasma (PRP) has surfaced strongly in diverse medical specialties including plastic, wound healing and diabetic ulcers, orthopedic, trauma, ocular surgery, dry eye for eyelid injection, urology for urinary incontinence, sexual wellness, cutaneous surgery, sport medicine, dentistry and dermatology, and aesthetic applications. PRP proved to promote wound healing and aid in facelift, volumetric skin, skin rejuvenation, regeneration, and reconstruction; improve wrinkling; stimulate hair growth; increase hair follicle viability and its survival rate; prevent apoptosis; increase and prolong the anagen hair growth stage; and delay the progression to catagen hair cycle stage with increased density in hair loss and hair transplantation. The aims of this extensive review were to cover all PRP application aspects that are carried out in aesthetic dermatology and to assess the literature on platelet-rich plasma outcomes on main aesthetic practices of general dermatology. A literature review was conducted by searching through PubMed, Biomedical Library database, Google Scholar, and Research Gate for the terms PRP, platelet-rich plasma, platelet-rich fibrin matrix, platelet preparations, platelet application therapy, platelet growth factors, platelet facial, platelet facial rejuvenation, platelet hairs, and platelet wound healing, from inception till 2017, and they were combined using Boolean operators. All those retrieved articles in English language were looked at and explored thoroughly.

Diversity in human hair growth, diameter, colour and shape. An in vivo study on young adults from 24 different ethnic groups observed in the five continents

Based on previous findings, from a worldwide study, classified the shapes of human hair into 8 major types, from straight to highly curly. This clearly extended the usual classification of hair into African, Asian or Caucasian types. However, determinations of hair growth parameters and hair density were excluded from such studies. To measure and compare the hair growth profiles of young adults without alopecia living in the five continents. 2249 young adults (18-35 years, females and males) without alopecia, originating from 24 various human ethnic groups were included in the study. Total hair density, telogen percentage and growth rate on three different scalp areas were measured, using non-invasive validated techniques. Natural hair colour level, curliness and hair diameter were additionally recorded, when practically possible. Diversity in hair growth parameters among the entire cohort was a key finding, with differences linked to scalp area, gender and geographic origin. Statistical approaches depicted African hair as having lower density and a slower growth rate. Asian hair showed a thicker diameter, with faster growth. Caucasian hair showed a high total hair density. On the one hand, this inter-continental study of hair growth parameters provides initial valuable base-line data on hair in young adults without alopecia, and on the other hand, further extends our knowledge of this unique human appendage, with some mosaic features, observed worldwide.