Randomized control trial to study the efficacy and safety of platelet-rich plasma as intraoperative holding solution in hair restoration surgery: A pilot study

Background

Hair restoration surgery is a definitive surgical procedure undertaken for androgenetic alopecia (AGA). Platelet-rich plasma (PRP) therapy has gained importance in recent times as a valuable adjunct to therapy in hair restoration. However, the various beneficial effects of PRP as intraoperative holding solution hair restoration surgery remain to be objectively defined.

Methods

Twenty cases of AGA were allocated into two groups (PRP and non-PRP). The follicular grafts harvested were stored in platelet-rich plasma/chilled ringers lactate solution depending on subject/control and were implanted in receding hairline using hair implanters. Patients were reviewed at the end of 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months using clinical and folliculoscopic images. The analysis was performed using SPSS version 20.0.

Results

Follicular growth as assessed using the percentage of grafts in actively growing phase posttransplant showed faster recovery from 'shock effluvium' in the PRP group when compared with the non-PRP group from Week 4, through Week 8 and 3 months with the 'lead' increases of percentage growth difference being statistically significant(P = 0.02) between the two groups. At the end of 6 months, 100% of patients recorded a hair shaft length of >10 mm in the PRP group, whereas only 20% achieved >10 mm length. The difference in hair densities between PRP and the non-PRP group from 4 weeks up to 6 months in the non PRP group remained significant (P < 0.05).

Conclusion

Intraoperative PRP as a holding solution improves outcome in hair restoration surgery by a significant improvement in the mean density of the implanted follicular unit grafts at 6 months.

Advances in microneedles research based on promoting hair regrowth

Alopecia is the most common and difficult-to-treat hair disorder. It usually brings a significant psychological burden to the patients. With the growing popularity of alopecia, the study of alopecia has gained more attention. Currently, only minoxidil and finasteride have been approved by the FDA for the treatment of alopecia, but the efficacy has always been unsatisfactory. As a new form of transdermal drug delivery, microneedles have been widely used in the treatment of alopecia and have proven to be effective. Microneedles delivery can improve the efficiency of local drug delivery and patients' compliance, which can achieve better therapeutic effects on hair-related diseases. Therefore, microneedles have gained much attention in the field of alopecia and hair regrowth promotion in recent years. This review summarizes the last decade of research on the microneedles delivery design for the treatment of alopecia or promotion of hair regrowth and provides a comprehensive evaluation of this field.

Observation of the Expression of Vascular Endothelial Growth Factor and the Potential Effect of Promoting Hair Growth Treated with Chinese Herbal BeauTop

Despite minoxidil and finasteride already being approved by the Food and Drug Administration (FDA) for the treatment of hair loss, it is important to identify new and innovative treatments for hair loss, such as looking for a solution in Chinese herbal medicine. One such treatment to consider is BeauTop (BT), whose primary ingredients include Panax japonicus (T.Nees), C.A. Mey. (Araliaceae), Astragalus membranaceus (Fisch) Bunge (Fabaceae), Angelica sinensis (Oliv.) Diels (Apiaceae), Ligustrum lucidum W.T. Aiton (Oleaceae), Rehmannia glutinosa (Gaertn.) DC. (Plantaginaceae), and Eclipta prostrata (L.) L. (Compositae). The aim of this study was to evaluate whether BT can promote hair growth in C57BL/6 mice and to investigate hair coverage, the expression of vascular endothelial growth factor (VEFG), and the numbers of hair follicles in growth phase after oral administration. A total of 12 C57BL/6 mice were divided into two groups: control group and treatment group BT. BT was administered orally as an extract at a volume of 0.6 g/kg. The control group was treated with distilled water. Each group was treated once a day for 12 consecutive days. To observe the expression of VEGF distribution, the number of hair follicles and the hair coverage were examined on days 4, 8, and 12. By comparing the treatment group and control group, we found that VEGF in the BT group on day 8 presented with a higher area percentage than the control group (p value = 0.003). Hair follicle counting results showed that the BT group was significantly higher than the control group on day 8 (p value = 0.031). Furthermore, hair coverage was shown to be significantly increased in the treatment group BT on day 8 (p value = 0.013). Taken together, these results suggest that Chinese medicine (BT) possesses the potential effect of promoting hair growth through VEGF expression. VEGF is considered the most important mediator for the process of angiogenesis involved in hair growth development.

Androgens in women: Hormone-modulating therapies for skin disease

Androgen-mediated cutaneous disorders (AMCDs) in women, including acne, hirsutism, and female pattern hair loss, can be treated with hormone-modulating therapies. In the second article in this Continuing Medical Education series, we discuss the hormone-modulating therapies available to dermatologists for the treatment of AMCDs, including combined oral contraceptives, spironolactone, finasteride, dutasteride, and flutamide. Available hormone-modulating treatments used for each AMCDs are reviewed, along with mechanisms of androgen modulation, safety profile, contraindications, monitoring parameters, and evidence of efficacy. Medications discussed include those that are approved by the US Food and Drug Administration for certain AMCDs and some that are used off-label. Despite the ubiquity of hormone-modulating therapies used for AMCDs, this review highlights the need for more rigorous studies to evaluate these therapies for acne, hirsutism, and female pattern hair loss.

Prescribing Habits for Androgenic Alopecia Among Dermatologists in Spain in 2017: A Cross-Sectional Study

BACKGROUND

Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA).

MATERIAL AND METHODS

Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain.

RESULTS

The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy.

CONCLUSIONS

The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

Understanding patient and physician perceptions of male androgenetic alopecia treatments in Asia-Pacific and Latin America

This survey aimed to explore patient and physician attitudes towards male androgenetic alopecia (AGA), satisfaction with currently available male AGA treatments and investigate the factors affecting treatment choice. The survey was carried out in five countries (Japan, South Korea, Taiwan, Mexico and Brazil) between November and December 2015 using a standard market research methodology. Questionnaires were completed by patients with male AGA or hair loss/thinning and practicing physicians who were responsible for prescribing AGA treatment. In total, 835 patients and 338 physicians completed the questionnaire. Overall, 37.6% of patients reported satisfaction with the treatments they had used. The highest patient satisfaction was reported for 5‐alpha‐reductase inhibitors (53.9% of patients satisfied). In all countries, physicians were more likely than patients to think that male AGA has a major impact on patient confidence (89.3% vs 70.4%, respectively). There was agreement by physicians and patients that male AGA patients who are involved in their treatment decisions have better outcomes. Patients who were satisfied with AGA treatments were more likely to have the level of involvement they desired in treatment decisions (69.1% of satisfied patients) than dissatisfied patients (56.4% of dissatisfied patients). This survey provides valuable insights into the attitudes of patients and physicians in Asia and Latin America about male AGA and its treatments. The survey identified areas of disconnect between physicians and patients regarding the impact of male AGA, treatment consultations and the importance of treatment attributes. It also highlights the need for physicians to spend sufficient time with patients discussing AGA treatment approaches.

A rapid and highly sensitive UPLC-MS/MS method using pre-column derivatization with 2-picolylamine for intravenous and percutaneous pharmacokinetics of valproic acid in rats

A rapid, highly sensitive and specific ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) for the detection of valproic acid (VPA) in rat plasma following the topical application was developed and validated. This method was carried out with pre-column derivatization using 2-picolylamine (PA) which reacts with the carboxylic acid group of VPA. The derivatization was completed in 10min and the resulting PA-VPA derivative enabled the sensitive detection of VPA in selected reaction monitoring (SRM) mode. Sample preparation was done with simple liquid-liquid extraction and chromatographic separation was achieved within 5min on a C18 column using a gradient elution with the mobile phase of 2mM ammonium formate containing 0.1% formic acid and methanol. The standard curves were linear over the concentration range of 0.07-200μg/mL with a correlation coefficient higher than 0.99. The limit of detection (LOD) and the lower limit of quantification (LLOQ) was 0.03 and 0.07μg/mL, respectively with 100μL of plasma sample. The intra- and inter-day precisions were measured to be below 10.7% and accuracies were within the range of 94.1-115.9%. The validated method was successfully applied to the pharmacokinetics of VPA in the rat following topical and intravenous applications.

The contribution of endogenous and exogenous factors to female alopecia: a study of identical twins

BACKGROUND

In this study, the authors investigated the potential contribution of environmental factors and testosterone levels on androgenic alopecia in women.

METHODS

Ninety-eight identical female twins were recruited from 2009 to 2011. Subjects were asked to complete a comprehensive questionnaire, provide a sputum sample for testosterone analysis, and pose for standardized digital photography. Frontal, temporal, and vertex hair loss were assessed from the photographs using Adobe Photoshop. Hair loss measures were then correlated with survey responses and testosterone levels between twin pairs. Two independent, blinded observers also rated the photographs for hair thinning.

RESULTS

Factors associated with increased frontal hair loss included multiple marriages (p = 0.043); longer sleep duration (p = 0.011); higher severity of stress (p = 0.034); positive smoking history (p = 0.021); higher income (p = 0.023); absence of hat use (p = 0.017); and history of diabetes mellitus (p = 0.023), polycystic ovarian syndrome (p = 0.002), and hypertension (p = 0.001). Factors associated with increased temporal hair loss included divorce or separation (p = 0.034), multiple marriages (p = 0.040), more children (p = 0.005), longer sleep duration (p = 0.006), and history of diabetes mellitus (p = 0.008) and hypertension (p = 0.027). Lack of sun protection (p = 0.020), consuming less caffeine (p = 0.040), history of skin disease (p = 0.048), and lack of exercise (p = 0.012) were associated with increased vertex hair loss. Higher testosterone levels were associated with increased temporal and vertex hair loss patterns (p < 0.039). Increased stress, increased smoking, having more children, and having a history of hypertension and cancer were all associated with increased hair thinning (p < 0.05).

CONCLUSION

This study implicates several environmental risk factors in the pathophysiology of female alopecia.

Genetik der androgenetischen Alopezie

Die androgenetische Alopezie (AGA, erblich- bzw. hormonbedingter Haarausfall [MIM 109200; MIM 300710; MIM 612421]) ist die häufigste Form des Haarverlusts beim Menschen, wobei die Prävalenz stark altersabhängig ist. Im Alter von über 70 Jahren sind über 80% der europäischen Männer betroffen, bei Frauen liegt die AGA-Häufigkeit mit 30–40% deutlich niedriger. Die AGA führt, v. a. bei betroffenen Frauen, zu einer erheblichen psychologischen Belastung und entfaltet dabei Krankheitswert. Der Haarverlust geht auf einen veränderten Haarzyklus und eine Miniaturisierung des Haarfollikels zurück. Die Pathogenese ist androgenabhängig, und die genetische Anlage ist wesentliche Voraussetzung für den Phänotyp. In mehreren Studien konnten der Androgenrezeptor-/Ektodysplasin-A2-Rezeptor(EDA2R)-Locus auf dem X-Chromosom als stärkster beitragender Faktor und durch genomweite Assoziationsuntersuchungen ein weiterer Locus auf Chromosom 20p11 identifiziert werden. Das zum Assoziationssignal nächstgelegene in der Kopfhaut exprimierte Gen ist „paired box 1“ (PAX1). Zwischen PAX1 und dem Androgensignalweg gibt es keine offensichtliche Verbindung, jedoch sind die dem Assoziationssignal auf Chromosom 20p11 zugrunde liegenden pathophysiologischen Prozesse noch nicht geklärt. Bis heute ermöglichen die zur Verfügung stehenden medikamentösen Therapien der AGA bestenfalls ein Aufhalten des Haarverlusts. Mit der Identifizierung der AGA-assoziierten Gene und der Aufklärung ihrer Funktionen wird man die biologischen Ursachen der AGA schrittweise erschließen. Damit ist die Hoffnung auf die Entwicklung neuer Therapien verbunden.

A alopecia androgenética na consulta de tricologia do Hospital Geral de Santo António (cidade do Porto, Portugal) entre 2004 e 2006: estudo descritivo com componente analítico

FUNDAMENTOS: A alopecia androgenética é a causa mais comum de perda progressiva de cabelo. Geralmente ocorre em doentes com predisposição hereditária para esse tipo de alopecia e com androgénios circulantes. OBJETIVO: Avaliar aspectos epidemiológicos e clínicos de pacientes com alopecia androgenética pertencentes ao sexo feminino. MÉTODOS: Realizou-se estudo clínico transversal e descritivo em grupo de mulheres com alopecia androgenética observadas na consulta de tricologia entre 2004 e 2006. Os dados foram analisados com base na estatística descritiva e no teste do qui-quadrado. RESULTADOS: Foram estudadas 200 mulheres com diagnóstico clínico de alopecia androgenética. Em 68% das pacientes foi detectada história familiar e, na maioria das mulheres, a alopecia era frontobiparietal. De acordo com os dados analíticos estudados, 17% delas tiveram níveis baixos de zinco e 9% de albumina e ferritina. Em 20% foi detectada alteração no estudo hormonal. CONCLUSÃO: A alteração analítica mais detectada nas mulheres estudadas com alopecia androgenética foi a alteração hormonal.

Assessment of hair and scalp disorders

The diagnosis and management of hair and scalp disorders in the clinic or office presents a unique challenge for the physician. In addition to identifying and treating the underlying cause of the disorder, the physician also needs to take into account the impact of these disorders on the patient's self-esteem and quality of life. The first stage in determining the correct treatment strategy is to evaluate the underlying cause of the condition; and to that end, there are a number of invasive and non-invasive methods available to the office physician. These methods range from traditional biopsy and microscopic techniques to new optical methods such as videodermoscopy. Once the type and cause of the condition have been identified, the next stage is to determine the most appropriate holistic treatment strategy. In addition to any prescribed medical treatment, the use of cosmetic hair care products can often play an important role in improving the patient's quality of life. These products (particularly conditioners and styling aids) have been shown to provide the patient with improvements in hair feel, appearance, behavior, and protection against damage. Many of these cosmetic benefits can be measured directly on the hair fiber, using a variety of techniques.

Polycystic Ovary Syndrome and Its Differential Diagnosis

Polycystic ovary syndrome (PCOS) is a common disorder of reproductive-aged women. It affects between 3.4-6.8% of this population. Common clinical symptoms of PCOS include menstrual irregularities, hirsutism, and often obesity. Long-term sequelae include anovulatory infertility, endometrial carcinoma, and an increased risk for cardiovascular disease due to type II diabetes mellitus, dyslipidemia, and systolic hypertension. The diagnosis of PCOS is one of exclusion and is defined by the Rotterdam criteria which were established in 2004. However, several other endocrine disorders can closely resemble PCOS. It is important for practitioners to recognize and distinguish PCOS from other disorders in its differential.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to summarize the short-term reproductive and long-term metabolic consequences of polycystic ovary syndrome (PCOS), point out the importance of meeting the current criteria for diagnosis, and recall the recommended treatment related to the clinical presentation of the patient.

The psychosocial impact of hair loss among men: a multinational European study

OBJECTIVE

Hair plays an important role in determining self-image, social perceptions, and psychosocial functioning. The objectives of this survey were to identify the impact of hair loss on the self-image of men in five European countries and their level of concern about hair loss with regard to image and personal attractiveness. Moreover, we evaluated participants' use of treatments for hair loss and whether treatment success was associated with psychological benefit.

RESEARCH DESIGN AND METHODS

A structured questionnaire of closed-ended questions was administered by telephone in major cities in Germany, France, Italy, Spain, and the United Kingdom. Random sampling was used, and eligible respondents were men from 18 to 45 years old.

RESULTS

Of the 1536 men responding to the telephone survey, 729 (47%) reported hair loss; these men are the subject of this report. Over 70% of these men reported hair to be an important feature of image, and 62% agreed that hair loss could affect self-esteem. The realization that they were losing hair was linked to concern about losing an important part of personal attractiveness (43% of men), fear of becoming bald (42%), concern about getting older (37%), negative effects on social life (22%), and feelings of depression (21%). Reduced self-confidence in personal attractiveness was also reported by 38% of men who were not in stable romantic relationships. Less than 10% of men were currently pursuing treatment for hair loss, and three out of four had never pursued treatment for hair loss, either at present or in the past. Those few men who pursued treatment and reported success (n = 73) also reported psychosocial benefits as a result: from 43% to 59% experienced improvements in parameters of self-esteem and perception of personal attractiveness. Reliance on self-reporting of hair loss and use of nonvalidated instruments to measure psychological outcomes are important study limitations.

CONCLUSIONS

The results of this survey indicate a gap between the need for treatment of hair loss and initiation of such treatment among men in five European countries. Further research is needed into the factors affecting men's willingness to seek treatment for hair loss.

Androgenetic alopecia: combining medical and surgical treatments

BACKGROUND

Medical treatment or surgical reconstruction is used separately to treat androgenetic alopecia. Two drug molecules (5% minoxidil solution and oral finasteride 1 mg) have proven efficacy to stabilize hair loss and promote hair regrowth. Microtransplant of one to three hair follicular unit grafts can provide a definitive hair restoration with a natural appearance.

OBJECTIVES

Aesthetic results can be optimized with a combination of drugs and transplantation of follicular unit grafts. The Dynamic Multifactorial Classification is used to select suitable candidates for this combined approach and also to assess follow-up results.

RESULTS

Dynamic Multifactorial Classification assists the evaluation of the natural history of androgenetic alopecia evolution and also the effects of treatment. Regression of male androgenetic alopecia from Hamilton type V to type III can be achieved by combining drugs with hair grafts.

CONCLUSION

Improvement of investigative methods and especially the Dynamic Multifactorial Classification makes it easier for a patient to follow the results of treatment adapted to their case.

Phototrichogram analysis of Japanese female subjects with chronic diffuse hair loss

Hair growth patterns of 101 Japanese female subjects with diffuse, chronic hair loss and 58 healthy Japanese female volunteers were categorized into subgroups using noninvasive quantitative methods after determining the key parameters of hair growth. Phototrichogram was performed at 0 and 48 h after clipping hairs in the parietal region of the scalp. Shaft diameters of the excised hairs were then measured. Multiple regression analysis indicated that hair densities, hair diameters, short hair ratios, and hair growth rates, but not anagen hair ratios, were significant, in order of decreasing importance, for grading female diffuse alopecia. Using cluster analysis, hair growth patterns among subjects complaining of diffuse hair loss were divided into six abnormal groups (n=60), two borderline groups (n=21), and one normal group (n=20). The control subjects judged to be normal by macroscopic observation, actually included two subjects with borderline hair growth patterns and one abnormal subject. Most of the abnormal groups shared features of female androgenetic alopecia. Hair patterns showing a decrease in hair density but without vellus hair change, however, emerged as the most prevalent and distinct pattern of chronic diffuse hair loss among the Japanese female subjects. The phototrichogram, combined with the measurement of hair diameters, is an accurate tool for assessing hair growth patterns, especially in detecting the slight changes indicative of the early phase of diffuse alopecia.