Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version

Innovative strategies for the discovery of new drugs against androgenetic alopecia

INTRODUCTION

Androgenetic alopecia (AGA) is the most common cause of hair loss worldwide. The significant psychological and social impact of AGA continues to drive demand for more effective treatments beyond the limited options currently available.

AREAS COVERED

The authors review the key components of AGA pathogenesis, as well as current treatments, and therapeutic techniques under development. Innovative strategies for AGA drug discovery are still needed, given the significant unmet medical needs and the limited efficacy of both current and emerging treatments. The authors outline relevant preclinical models, such as hair follicle (HF) cell cultures, 3D spheroids, organoids, follicle explants, and animal models, highlighting their advantages and limitations in AGA research. Finally, they summarize the primary objectives in AGA treatment development, including direct hair growth promotion, interference with androgen signaling, and HF rejuvenation, identifying key pathogenesis intervention points for treatment development.

EXPERT OPINION

Developing better in vitro models, possibly using induced pluripotent stem cell (iPSC) systems, could greatly accelerate drug discovery. Similarly, a superior in vivo model could significantly expedite drug discovery. Near future development research should focus on drug delivery improvements. Longer term, treatments targeting AGA's underlying pathophysiology and promoting HF rejuvenation or true regeneration would provide the most benefit to prospective patients.

Differential association between cumulative dose of 5α-reductase inhibitors and mortality

The association between various cumulative doses of 5-ARIs and mortality remains unclear. To examine the absolute and time-averaged cumulative doses of 5-ARIs and their association with all-cause and cause-specific mortality among patients with benign prostatic hyperplasia (BPH) or androgenic alopecia (AGA). A nested case-control study was conducted. For each patient who died, up to five controls were matched, based on age, sex, follow-up duration, and date of BPH or AGA diagnosis. The cumulative 5-ARI dose was calculated as the cumulative defined daily dose (cDDD) for the absolute and time-averaged doses over the follow-up period. The study involved 3,084 cases and 14,630 controls. The < 365 cDDDs group and 365-730 cDDDs group had higher mortality rates, whereas the > 5840 cDDDs group had a significantly reduced mortality risk. A similar result was observed for the duration-averaged cumulative doses. Cause-specific analysis revealed higher suicide rates at lower cumulative doses and lower cardiovascular mortality rates at higher cumulative doses. Other cause-specific mortality rates were not statistically significant. The findings revealed a complex relationship between cumulative 5-ARI dosage and all-cause mortality, highlighting the need for careful monitoring of patients using 5-ARIs, particularly concerning the elevated risk of suicide.

Evaluating the efficacy and safety of combined microneedling therapy versus topical Minoxidil in androgenetic alopecia: a systematic review and meta-analysis

This study evaluates the efficacy and safety of the combined microneedling (CMNT) with minoxidil versus minoxidil monotherapy for the treatment of androgenetic alopecia (AGA), with a focus on the impact of microneedling parameters on treatment outcomes. We conducted a systematic review and meta-analysis (PROSPERO: CRD42024594487) of randomized controlled trials (RCTs) comparing CMNT versus minoxidil alone for AGA, following PRISMA guidelines. A comprehensive search across six databases was performed up to September 8, 2024. We identified 12 RCTs involving 631 AGA patients, with a total of 11 RCTs included in the meta-analyses. CMNT significantly improved hair count compared to minoxidil monotherapy (SMD 1.32, 95% CI 0.73-1.92, p < 0.01), with substantial heterogeneity (I² = 88%, p < 0.01). Subgroup analyses indicated no significant effect of microneedling (MN) depth (≤ 1 mm vs. >1 mm), duration (≤ 12 weeks vs. >12 weeks), or technique(device) (electrodynamic vs. rolling) on hair count outcomes. Additionally, A meta-analysis of six RCTs demonstrated a significant improvement in hair diameter with CMNT (SMD 0.34, 95% CI 0.11-0.58; p < 0.01), with no observed heterogeneity (I² = 0%). Investigators and patient's self-assessment scores were also improved. Adverse events were more frequent with CMNT (74 vs. 59 events), however they were generally considered mild or self-limiting. CMNT significantly enhances hair count and diameter in AGA patients with mild adverse events. MN parameters including depth, duration, and technique variations did not significantly affect hair count outcome, suggesting microneedling as a promising adjunctive AGA treatment.

A Scoping Review of Exosome Delivery Applications in Hair Loss

The objective of this scoping review was to understand the extent and type of evidence found in the current literature on the delivery mechanisms of exosome therapeutics and how these methods can work synergistically with existing treatments for alopecia. Alopecia is primarily characterized as non-scarring or scarring (cicatricial). In cicatricial alopecia, the hair follicles are irreversibly destroyed, causing permanent hair loss. In non-cicatricial alopecia, the hair follicles are undamaged, allowing for possible hair regeneration. Non-scarring alopecia includes androgenetic alopecia, telogen effluvium, and alopecia areata. Current treatments for non-scarring alopecia include oral minoxidil and spironolactone. Exosome therapeutics are a possible alternative treatment for non-scarring alopecia because of their regenerative properties in hair follicle stimulation, customizable size selection, and the potential to activate and down-regulate specific pathways that enhance hair growth. This review evaluates types and sources of exosome delivery as regenerative treatments for alopecia. A search of literature published in English from 2018 to 2023 was performed using the electronic databases EMBASE, Ovid MEDLINE, and Web of Science. Data from selected studies included specific details about the participants, concept, context, study methods, and key findings relevant to the review questions. Upon completion of the database search that yielded 1,087 citations, after removing 284 duplicates, 803 articles remained for assessment of eligibility. Finally, 16 studies were retained for inclusion. These studies explored one or more exosome delivery techniques, such as intradermal needle injection, microneedle patches, topical application, and topical application with a secondary assistive device. The therapeutic focus of these studies ranged from hair follicle regeneration and wound healing to spinal cord injury repair and collagen regeneration for cosmetic purposes. Most of the studies (14 out of 16) used exosomes derived from mesenchymal stem cells (MSCs), while others isolated exosomes from human adipose stem cells, macrophage cell lines, and dermal fibroblast cells. Of the 16 studies, all but two administered exosomes via microneedle patches. The findings suggest that intradermal microneedle patches are a promising method for delivering exosomes into tissues, particularly for the treatment of non-cicatricial alopecia. Exosome therapy shows strong potential for promoting hair follicle regeneration, supported by its proven efficacy in wound healing, spinal cord injury repair, and cosmetic applications. Among the various delivery methods explored, microneedle patches loaded with exosomes from MSCs emerged as the most effective for targeted delivery into tissues. These findings support exosome-based therapies for non-cicatricial alopecia.

The Pharmacokinetics of Topical Finasteride 0.25% Spray in Chinese Adult Male Volunteers with Androgenic Alopecia: A Phase I Study

INTRODUCTION

This study aimed to evaluate the pharmacokinetics (PK), safety, and local tolerability of local finasteride spray (0.25% solution in HPCH, once daily, volume 200 μL) after single and multiple doses in Chinese male volunteers with androgenetic alopecia.

METHODS

Twelve male patients with androgenetic alopecia received once-daily scalp application of the solution for 7 days. Blood samples were collected at specified time points (on day 1, days 3-6, and day 7 of the trial) and plasma finasteride concentrations were determined by HPLC-MS.

RESULTS

After single-dose administration, the Cmax of finasteride was 15.2 ± 5.54 pg/mL, Tmax was 11.00 (3.00, 20.00) h, AUC0-24h was 263 ± 76.6 h·pg/mL, t1/2 was 35.3 ± 47.7 h, and CL/F was 974 ± 518 L/h. After 7 days of multiple doses, Cmax,ss was 29.7 ± 12.9 pg/mL, Tmax,ss was 8.00 (3.00, 12.00) h, AUCtau,ss was 530 ± 251 h·pg/mL, AUC0-t,ss was 790 ± 464 h·pg/mL, t1/2,ss was 22.6 ± 10.7 h, and CL/Tss was 1080 ± 658 L/h. No clinically significant adverse events occurred during the study.

CONCLUSION

Compared to single-dose administration, multiple-dose administration of finasteride resulted in a stable half-life, minimal changes in clearance rate, and approximately twofold accumulation in exposure over 7 days. Multiple-dose administration of finasteride spray was well tolerated in Chinese male volunteers with androgenetic alopecia.

Human Platelet Extract (Plated) Hair Serum for Hair Health Improvement: A Double-blind, Placebo-controlled Clinical Study

Background

The primary aim of this study was to demonstrate the benefits of topical human platelet exosome extract (HPE) (plated) hair serum for improving hair and scalp health in participants with self-perceived thinning hair.

Methods

This single-center, placebo-controlled, double-blind study enrolled 39 healthy men and women 18-65 years of age with self-perceived thinning hair. Participants applied either HPE for 9 months or a topical placebo for 6 months with the option to cross over to HPE at 6 months for an additional 3 months. End points included improvements in the global aesthetic appearance of hair, as assessed by a blinded live evaluator; participant-reported outcomes; hair trichoscopy; and independent physician photograph evaluations. Safety data included monitoring for adverse events.

Results

Blinded live evaluator assessments demonstrated statistically significant improvements in the global aesthetic appearance of hair for volume/fullness, density, scalp coverage, and appearance, with all P values less than 0.0001 within the HPE group and statistical improvement over the control at months 3 and 6 for volume/fullness, density, and scalp coverage. Participant-reported outcomes for within-group changes for HPE were statistically significant for all hair health parameters, including density, volume fullness, scalp coverage, scalp health, thickness, amount, quality, color, dryness, strength, and overall health of the hair. Hair trichoscopy analyses were significantly improved from baseline within the HPE group. Independent physician photography review demonstrated greater improvements within the HPE group. No adverse effects were observed.

Conclusions

This study demonstrates that topical HPE (plated) hair serum with Renewosome technology significantly improves hair and scalp health and is safe and well tolerated.

Serum Vitamin D levels in males with premature androgenetic alopecia: a prospective case-control study

INTRODUCTION

Androgenetic alopecia (AGA), the predominant form of hair loss, affects a significant global population. While emerging research suggests a potential correlation between serum vitamin D levels and AGA severity, the current body of evidence remains inconclusive, necessitating further investigation to elucidate this relationship and its clinical implications.

A Prospective and Comparative Study to Explore the Effects of Platelet-Rich Plasma in Hair Transplantation for Patients With Androgenetic Alopecia

BACKGROUND

Androgenetic alopecia (AGA) is the most prevalent type of hair loss. Traditionally, treatment for AGA has primarily involved the topical application of minoxidil in conjunction with oral finasteride or spironolactone. Recently, platelet-rich plasma (PRP) has emerged as a significant focus of research in hair loss treatment. However, many studies on PRP-assisted hair transplantation have encountered various limitations.

OBJECTIVE

This study aims to conduct a prospective, comparative clinical investigation to evaluate the therapeutic effects of combining PRP with minoxidil and finasteride/spironolactone as adjuncts to hair transplantation.

METHOD

From August 2019 to December 2022, we enrolled 30 patients with AGA in the study, randomly assigning them to an experimental group and a control group. The experimental group received drug therapy alongside hair transplantation and underwent PRP injections, whereas the control group received only drug therapy to assist with hair transplantation.

RESULTS

Prior to surgery, no significant differences in baseline data were observed between the two groups. Following treatment, the experimental group demonstrated significantly improved follicle survival rates, follicle growth rates, and hair strength compared with the control group.

CONCLUSION

This prospective, comparative clinical study demonstrated that the application of PRP in conjunction with pharmacological support during FUE treatment for AGA resulted in improved follicle survival rates, hair growth rates, and hair strength.

Evaluation of the safety and efficacy of concentrated growth factors for hair growth promotion in androgenetic alopecia patients: A retrospective single-centre, single-arm study

OBJECTIVE

This study was designed to evaluate the safety and efficacy of injections of concentrated growth factors (CGF) for hair growth promotion in androgenetic alopecia (AGA) patients.

METHODS

A retrospective review of AGA patients treated with injections of CGF at our center from October 2021 to April 2023 was performed. A total of 3 injections were administered every 3-4 weeks apart, and evaluation were performed before the first injection and at 3 months, 6 months later. The outcomes were assessed by trichoscopy photomicrographs and the Global Aesthetic Improvement Scale (GAIS).

RESULTS

At 3 months after the first injection, the hair density and hair growth ratio were significantly improved. Significant improvements were found in GAIS score by both patients and independent doctors and the hair growth promotion was sustained for 6 months after first treatment.

CONCLUSIONS

According to this tiny single-arm trial, the use of CGF injection may help AGA by increasing terminal hair density and hair density. No severe topical or systemic adverse events occurred during the treatment.

New Plant Extracts Exert Complementary Anti-Hair Loss Properties in Human In Vitro and Ex Vivo Models

BACKGROUND

Hair loss is linked to dysfunction of the growth (anagen), regression (catagen) and rest (telogen) phases of the hair follicle (HF) cycle.

AIMS

To evaluate the effects of a Silybum marianum extract (SME), manganese PCA (MnPCA), and a Lespedeza capitata extract (LCE) on markers of hair growth and anchorage in human follicle dermal papilla cells (HFDPCs), and to investigate the ability of a topical serum containing these active ingredients to improve HF growth in an ex vivo human scalp skin model.

METHODS

In HFDPCs, we assessed receptor tyrosine kinase phosphorylation and Wnt/β-catenin pathway activation; quantified versican, vascular endothelial growth factor (VEGF) and Dickkopf-1 (DDK1) secretion; and evaluated 5α-reductase (5αR) activity. Using scalp skin biopsies from two female donors, we measured hair shaft elongation, analyzed hair matrix keratinocyte proliferation and apoptosis, and determined HF cycle stage and score.

RESULTS

Compared to untreated HFDPCs, SME upregulated phosphorylation of growth factor receptors (EGFR:1.9 × and PDGFR: 2.8 ×) and their downstream effectors (ERK, GSK3, Akt, and STAT: 1.2-2.0 ×); MnPCA enhanced versican (33.0 ×) and VEGF (3.3 ×) secretion, and stimulated the Wnt/β-catenin pathway (+80%); and LCE reduced DKK1 secretion (-72%) and 5αR activity (dihydrotestosterone/testosterone ratio: -60%). Compared to untreated scalp skin biopsies, the serum enhanced hair shaft elongation (+102%), and significantly prolonged the anagen phase by improving hair cycle scores and stimulating hair matrix keratinocyte proliferation (+58%).

CONCLUSIONS

SME, MnPCA, and LCE displayed complementary anti-hair loss properties. The serum combining these active ingredients may be useful in hair loss treatment.

Advances in polymeric nano-delivery systems targeting hair follicles for the treatment of acne

Acne is a common chronic inflammatory disorder of the sebaceous gland in the hair follicle. Commonly used external medications cause skin irritation, and the transdermal capacity is weak, making it difficult to penetrate the cuticle skin barrier. Hair follicles can aid in the breakdown of this barrier. As nanomaterials progress, polymer-based nanocarriers are routinely used for hair follicle drug delivery to treat acne and other skin issues. Based on the physiological and anatomical characteristics of hair follicles, this paper discusses factors affecting hair follicle delivery by polymer nanocarriers, summarizes the common combination technology to improve the targeting of hair follicles by carriers, and finally reviews the most recent research progress of different polymer nanodrug-delivery systems for the treatment of acne by targeting hair follicles.

Restoration of follicular β-catenin signaling by mesenchymal stem cells promotes hair growth in mice with androgenetic alopecia

BACKGROUND

The use of mesenchymal stem cells (MSCs) is recognized as a promising strategy for the treatment of androgenetic alopecia (AGA). However, the underlying mechanism remains to be explored. Here, we evaluated the therapeutic effects and potential mechanisms of the use of human umbilical cord mesenchymal stem cells (hUCMSCs) in dihydrotestosterone (DHT)-induced AGA models in vivo and in vitro.

METHODS

Intradermal transplantation of hUCMSCs was performed in AGA model mice and therapeutic effects were evaluated using histological and immunofluorescence staining. Transwell assays were used for co-culture of hUCMSCs and dermal papilla cells (DPCs), and communication was assessed using RT-qPCR, immunofluorescence, and apoptosis analysis. Interactions between DPCs and hair follicle stem cells (HFSCs) were investigated using RT-qPCR, EdU assays, and cell cycle analysis.

RESULTS

Treatment of AGA mice with hUCMSCs promoted hair growth, HFs density, skin thickness, and anagen phase activation, while inhibiting DPCs apoptosis, and promoting HFSCs proliferation. In vitro, hUCMSCs activated Wnt/β-catenin signaling in DPCs via Wntless (Wls), while stimulating growth factor secretion and HFSCs proliferation. Blocking β-catenin degradation with MSAB increased DPCs apoptosis, reduced growth factor secretion, and retarded HFSCs proliferation.

CONCLUSION

hUCMSCs promoted hair regeneration in AGA model mice. This was found to be dependent on reducing DPCs apoptosis, thereby relieving the inhibitory effects of DPCs on the growth of HFSCs. The activation of the Wnt/β-catenin signaling pathway was shown to play a crucial role in the promotion of hair growth by hUCMSCs in AGA mice.

Repurposing prescribed hydromorphone: Alternative uses of safer supply and tablet-injectable opioid agonist treatment to meet unaddressed health needs

BACKGROUND

In response to the ongoing overdose crisis in Canada, a number of opioid agonist treatment and safer supply programs provide people at high overdose risk with daily-dispensed tablet hydromorphone, with some requiring witnessed ingestion and others providing take-away doses. While these programs are intended to reduce overdose events by limiting people's use of the contaminated drug supply, the experiences of people receiving hydromorphone vary. In this article we explore the ways people repurpose hydromorphone to address unmet needs.

METHODS

This article draws on in-depth qualitative interviews from two studies evaluating hydromorphone tablet distribution programs in British Columbia, Canada. We used thematic analysis to identify themes related to repurposing hydromorphone. We compared themes across the two studies to identify any similarities or differences in relation to the ways study participants discussed repurposing hydromorphone tablets. We utilize vignettes - snapshots of participant experiences - to analyse and represent the data.

RESULTS

Four vignettes demonstrate how hydromorphone tablets are often being used to address and resolve unmet needs of people who use drugs. While most participants reported reducing their use of illicit drugs, a variety of instrumental uses of tablet hydromorphone were also discussed, including reducing anxiety, addressing sleep issues, withdrawal management, and managing chronic pain.

CONCLUSION

Our findings demonstrate how people who use drugs are maximizing the benefits of tablet hydromorphone distribution to address unmet needs. Hydromorphone distribution programs represent a public health and harm reduction intervention that is usefully addressing experiences related to structural vulnerabilities (such as inadequate pain management), which are often overlooked amongst stigmatized groups.

Small molecule agents against alopecia: Potential targets and related pathways

Alopecia has emerged as a global concern, extending beyond the middle-aged and elderly population and increasingly affecting younger individuals. Despite its growing prevalence, the treatment options and effective drugs for alopecia remain limited due to the incomplete understanding of its underlying mechanisms. Therefore, it is urgent to explore the pathogenesis of alopecia and discover novel and safer therapeutic agents. This review provided an overview of the prevailing clinical disorders of alopecia, and the key pathways and targets involved in hair growth process. Additionally, it discusses FDA-approved drugs and clinical candidates for the treatment of alopecia, and explores small molecule compounds with anti-alopecia potential in the drug discovery phase. These endeavors are expected to provide researchers with valuable scientific insights and practical information for anti-alopecia drug discovery.

Efficacy of Platelet-Rich Plasma versus Mesotherapy with Recombinant Growth Factors and Stem Cell-Conditioned Media in Androgenetic Alopecia: A Retrospective Study

Introduction

Androgenetic alopecia (AGA) is the most common type of hair loss. Platelet-rich plasma (PRP) and mesotherapy (MZT) injections of various solutions fortified with growth factors are popular treatment options for AGA. The aim of this study was to compare the efficacy of RPP and MZT products in the treatment of AGA.

Methods

This retrospective study included 72 AGA patients treated with two PRP formulations and two MZT products, administered manually or with a gun injector. Hair parameters (hair thickness, hair density, and hair count) on frontal and vertex areas were measured before and after 6 months.

Results

Over 6 months, trichoscopic parameters showed significant intragroup and intergroup variability. MZT1 and PRP2 groups exhibited statistically significant improvement in most parameters, while MZT2 significantly increased vertex hair density. Hair thickness changes differed significantly between PRP1 and PRP2 groups (unadjusted p value <0.001) and possibly between MZT1 and PRP1 groups (unadjusted p value = 0.049) in both regions.

Discussion

Injections of PRP and MZT formulations can significantly enhance trichoscopic parameters in AGA patients within a 6-month period, but the extent of improvement varies among different PRP and MZT products.

"Effectiveness of minimally invasive injectable modalities in the management of androgenetic alopecia among adults-A systematic review"

BACKGROUND

Androgenetic alopecia is the most common cause of hair loss that affects over 50% of the world population. It is a condition that is multifactorial in origin, with no specific causative factor, making treatment an enervating experience for the patient as well as the doctor. In recent times, a number of modalities have been introduced for the treatment of alopecia. However, the evidence supporting them is unstructured and sparse. Therefore, this article aims to explore the current trends in minimally invasive treatments for the management of androgenetic alopecia.

METHODS

An in-depth literature search on injectables used in the treatment of alopecia in PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane Library, and Cochrane Skin databases between January 2000 and May 2023 was performed. The studies included were randomized controlled trials, non-randomized trials, quasi trials, single arm interventions, and cohort studies.

RESULTS

Sixteen of the 1071 studies that were found during the original search were accepted in accordance with the inclusion criteria. Twelve studies assessed the effectiveness of the injectable group by comparing it to a control group consisting of saline, distilled water, and topical minoxidil. In the treatment of alopecia, dutasteride and injectable growth factor formulations achieved clinically significant results.

CONCLUSION

The usage of injectables and topical medicines to treat hair loss has increased in the recent years. Overall results from clinical investigations, pilot studies, and trials looking at the efficacy and safety of these growth factors in the AGA show satisfactory efficacy.

The 100 Most Cited Androgenetic Alopecia Articles: An Analysis of Altmetrics Data from 2015 to 2022

Introduction

Androgenetic alopecia is the most common type of hair loss, and with increasing media integration in medicine, understanding social media consumption of literature is invaluable. Altmetric Attention Score analysis can quantify factors impacting article distribution on media platforms.

Methods

To determine factors influencing literature dissemination and reader demographics, a bibliometric analysis was performed on the 100 most cited androgenetic alopecia articles.

Results

Articles with top 25th percentile Altmetric Attention Scores were cited more frequently (41.76 vs. 24.59, p < 0.05). Open-access articles had lower odds of being read by healthcare professionals (aOR = 0.16, p < 0.05), while funded studies and journal impact factor increased odds of readership (aOR = 5.80; aOR = 1.55; p < 0.05 for both). Scientists and healthcare professionals showed interest in publications addressing 5α-reductase inhibitors (aOR = 26.08; aOR = 6.13; p < 0.05 for both). Articles with high social media viewership were also highly cited in academic literature.

Conclusion

Healthcare professionals appeared more discerning about article readership compared to the public. With many outlets for consumption of media, members of the public not involved in dermatology may have difficulty in identifying reliable sources of material. Overall, Altmetrics can help quantify readership trends and public interest in dermatology research.

The psychosocial impact of alopecia in men: A mixed-methods survey study

Background

The most common forms of hair loss in men, alopecia areata (AA) (an autoimmune condition) and androgenetic alopecia (AGA) (pattern baldness), alter individuals' appearance in ways that may impact psychological and social wellbeing. We currently have a limited understanding about this impact of alopecia in men, their support needs, and preferences.

Objectives

We sought to investigate and explore the psychosocial impact of alopecia on men, alongside their experiences of treatment and support.

Methods

The study used a mixed methods cross-sectional online survey with 177 men aged 17-79: 83 with AGA and 94 with AA. Quantitative questions included purpose-made rating scales of men's support experiences, and standardised measures of wellbeing and appearance-focused anxiety. Qualitative data comprised participants' answers to an open-ended question asking about their subjectively salient experiences related to their alopecia.

Results

The combined findings indicate that while participants in both subsamples had sought minimal support for psychosocial concerns, such concerns were in fact commonplace. Over half of participants (56%-57%) shared qualitative accounts of depleted confidence, while wellbeing scores were on average lower than matched norms. Participants identifying as sexual minority also reported greater appearance-focused anxiety compared to those identifying as straight.

Conclusions

The apparent contrast between participants' minimal help-seeking and accounts of affected wellbeing suggests an unmet support need for men with alopecia. Masculine norms may impede men from accessing psychosocial support, both by discouraging help-seeking behaviours and by encouraging minimisation of appearance concerns. The findings also suggest sexual minority status may pose a greater risk of distress in affected men.

Patient-reported outcomes of topical finasteride/minoxidil treatment for male androgenetic alopecia: A retrospective study using telemedical data

BACKGROUND

Oral finasteride and topical minoxidil are the current standard of care for male androgenetic alopecia and a combination of the two treatments can be considered for greater efficacy. Clinical trials of topical finasteride have also yielded promising results, but routine care data are lacking.

AIMS

To examine patient-reported outcomes of men with androgenetic alopecia who received topical finasteride admixed with minoxidil compared to the current standard of care (oral finasteride).

METHODS

Retrospective, cross-sectional study with data from a German direct-to-consumer teledermatology platform between December 2021 and January 2023. Patient-reported outcomes were collected through voluntary follow-up questionnaires provided after 6 weeks on topical finasteride/minoxidil or oral finasteride treatment.

RESULTS

A total of 1545 patients who received topical finasteride/minoxidil treatment were included; 238 (15.4%) participated in the follow-up questionnaire. At week six, 62.2% (148/238) reported positive changes in their hair appearance, and 44.1% (105/238) reported an improvement of self-esteem. Treatment-related adverse events were reported in 11.8% (28/238). Full treatment adherence was observed in 74.4% (177/238). Comparing the topical treatment group to those receiving oral finasteride, lower treatment adherence was reported, along with higher rates of local adverse events; no difference was found in the incidence of sexual adverse events.

CONCLUSION

Based on patient-reported outcomes, topical finasteride/minoxidil seems to be effective and well tolerated, but not superior to oral finasteride. Lower treatment adherence for topical usage must be considered when considering treatment options. Additional real-world data are needed to further evaluate the efficacy and safety of topical finasteride/minoxidil.

Long-term Treatment with a 5-Alpha-Reductase Inhibitor Alleviates Depression-like Behavior in Obese Male Rats

Several studies have reported side effects of finasteride (FIN), such as anxiety/depression in young men. Obesity is also positively associated with anxiety/depression symptoms; however, the impacts of long-term FIN treatment and FIN withdrawal in young obese individuals are still elusive. The present study aimed to investigate the effect of long-term treatment and its withdrawal on anxiety/depression and brain pathologies in lean and obese adult male rats. Forty-eight male Wistar rats were equally divided into two groups and fed either a normal or high-fat diet. At age 13 weeks, rats in each dietary group were divided into three subgroups: 1) the control group receiving drinking water, 2) the long-term treatment group receiving FIN orally at 5 mg/kg/day for 6 weeks, and 3) the withdrawal group receiving FIN orally at 5 mg/kg/day for 2 weeks followed by a 4-week withdrawal period. Anxiety/depression-like behaviors, biochemical analysis, brain inflammation, oxidative stress, neuroactive steroids, brain metabolites, and microglial complexity were tested. The result showed that lean rats treated with long-term FIN and its withdrawal exhibited metabolic disturbances, depressive-like behavior, and both groups showed increased neurotoxic metabolites and reduced microglial complexity. Obesity itself led to metabolic disturbances and brain pathologies, including increased inflammation, oxidative stress, and quinolinic acid, as well as reduced microglial complexity, resulting in increased anxiety- and depression-like behaviors. Interestingly, the long-term FIN treatment group in obese rats showed attenuation of depressive-like behaviors, brain inflammation, and oxidative stress, along with increased brain antioxidants, suggesting the possible benefits of FIN in obese conditions.

Clinical and preclinical approach in AGA treatment: a review of current and new therapies in the regenerative field

Androgenetic alopecia (AGA) is the most prevalent type of hair loss. Its morbility is mainly psychological although an increased incidence in melanoma has also been observed in affected subjects. Current drug based therapies and physical treatments are either unsuccessful in the long term or have relevant side effects that limit their application. Therefore, a new therapeutic approach is needed to promote regenerative enhancement alternatives. These treatment options, focused on the cellular niche restoration, could be the solution to the impact of dihydrotestosterone in the hair follicle microenvironment. In this context emerging regenerative therapies such as Platelet-rich plasma or Platelet-rich fibrine as well as hair follicle stem cells and mesenchymal stem cell based therapies and their derivatives (conditioned medium CM or exoxomes) are highlighting in the evolving landscape of hair restoration. Nanotechnology is also leading the way in AGA treatment through the design of bioinks and nanobiomaterials whose structures are being configuring in a huge range of cases by means of 3D bioprinting. Due to the increasing number and the rapid creation of new advanced therapies alternatives in the AGA field, an extended review of the current state of art is needed. In addition this review provides a general insight in current and emerging AGA therapies which is intented to be a guidance for researchers highlighting the cutting edge treatments which are recently gaining ground.

LncRNA RP11-818O24.3 promotes hair-follicle recovery via FGF2-PI3K/Akt signal pathway

A previous study indicated that patients with androgenic alopecia (AGA) have significantly reduced levels of LncRNA RP11-818O24.3. This study investigates whether LncRNA RP11-818O24.3 promotes hair-follicle recovery and its possible mechanism. Hair alteration and cutaneous histopathological changes induced by testosterone propionate were observed by H&E and bromodeoxyuridinc (BrdU) stain to evaluate the therapeutic effect of LncRNA RP11-818O24.3 in C57BL/6 J mice. The cellular viability was analyzed in LncRNA RP11-818O24.3-transfected human hair-follicle stem cells (HFSCs) in vitro. The signaling pathways and pro-proliferative factors were investigated by transcriptomic gene sequencing and qRT-PCR. LncRNA RP11-818O24.3 transfection successfully recovered hair growth and hair-follicle cells in AGA mice. In a series of HFSC studies in vitro, LncRNA RP11-818O24.3 transfection greatly promoted cellular proliferation and decreased cellular apoptosis. Transcriptome gene sequencing suggested that the phosphatidylinositol 3-kinase (PI3K)-Akt pathway was upregulated by LncRNA RP11-818O24.3. The qRT-PCR results showed that fibroblast growth factor (FGF)-2 was 14-times upregulated after LncRNA RP11-818O24.3 transfection. Hair-follicle recovery activity of LncRNA RP11-818O24.3 may involve the upregulation of FGF2 and PI3K-Akt to promote follicle stem cell survival. These data not only provide a theoretical basis for AGA development but also reveal a novel therapeutic method for AGA patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-024-00624-3.

Efficacy and safety of microneedling radiofrequency in patterned hair loss

Objectives

We aimed to assess the improvement of patterned hair loss with microneedling radiofrequency (MNRF) and its adverse effects in patients.

Material and Methods

An open-label study was conducted to evaluate the efficacy and safety of MNRF for the treatment of androgenetic alopecia. Patients diagnosed with patterned hair loss received three MNRF treatment sessions once monthly. Efficacy was assessed by comparing before and after photographs and trichoscopy.

Results

Twenty-four patients were recruited. Excellent improvement in hair growth was observed in 14 patients, fair improvement in seven patients, and no improvement in three patients without significant adverse effects. Slight pain lasting for a day was the most common adverse event following MNRF.

Conclusion

Overall, significant improvement was observed in the majority of the patients without significant side effects.

Higher percentage of CD34+ stem cells and elevated efficacy in androgenetic alopecia treatment observed in CGF prepared from 640 nm laser-pretreated blood: A preliminary study

BACKGROUND

Concentrated growth factor (CGF) injection has proven effective in treating androgenetic alopecia (AGA). The primary mechanism of CGF in treating AGA is thought to be the CD34+ stem cells and platelets-associated growth factors being injected into the scalp. CGF efficacy in treating AGA may rely on the activation level of these stem cells and platelets. The 640 nm laser is a United States Food and Drug Administration approved AGA treatment that activates follicle stem cells. Therefore, we hypothesize that pretreating CGF with a 640 nm laser may further activate CD34+ stem cells and platelets, thereby improving the efficacy of CGF in treating AGA.

OBJECTIVE

This study aims to investigate whether 640 nm laser pretreated CGF (640CGF) has a greater effect in treating AGA than 640 nm laser non-pretreated CGF (N640CGF) and evaluate whether 640 nm laser pretreatment changed CD34+ cell percentage.

METHODS

This study enrolled 10 patients (8 male, 2 female) with AGA aged 18-60 years who received CGF injections. The 640CGF group was pretreated with a 640 nm laser at an energy density of 4 J/cm2, with a 30 cm irradiation distance for 30 min. Half of the scalp was treated with 640CGF, whereas the other half was treated with N640CGF. The injection was prepared by a doctor who did not know which blood tube had been pretreated. The treatment efficacy was evaluated using a trichoscope 1 month after injection.

RESULTS

All 10 (100%) patients participated in the follow-up visit, and a higher quantity of new hairs was observed on the side injected with 640CGF than N640CGF (p = 0.019). Additionally, fewer malnourished hairs were observed on the 640CGF pretreated side (p = 0.015). No serious adverse events were reported.

CONCLUSIONS

A higher percentage of CD34+ stem cells and improved efficacy in AGA treatment could be observed with CGF prepared from 640 nm laser-pretreated blood.

Safety of Antiandrogens for the Treatment of Female Androgenetic Alopecia with Respect to Gynecologic Malignancies

The most common type of alopecia in women is female androgenetic alopecia (FAGA), characterized by progressive hair loss in a patterned distribution. Many oral therapies, including spironolactone (an aldosterone antagonist), androgen receptor blockers (e.g., flutamide/bicalutamide), 5-alpha-reductase inhibitors (e.g., finasteride/dutasteride), and oral contraceptives, target the mechanism of androgen conversion and binding to its respective receptor and therefore could be administered for the treatment of FAGA. Despite significant advances in the oral treatment of FAGA, its management in patients with a history of gynecological malignancies, the most common cancers in women worldwide, may still be a concern. In this review, we focus on the safety of antiandrogens for the treatment of FAGA patients. For this purpose, a targeted literature review was conducted on PubMed, utilizing the relevant search terms. To sum up, spironolactone seems to be safe for the systemic treatment of FAGA, even in high-risk populations. However, a general uncertainty remains regarding the safety of other medications in patients with a history of gynecologic malignancies, and further studies are needed to evaluate their long-term safety in patients with FAGA and risk factors to establish an optimal risk assessment and treatment selection protocol.

Effectiveness and safety of the ablative fractional 2940-nm Er: YAG laser for the treatment of androgenetic alopecia

Laser sources have established their potential effect in inducing hair regrowth. No large cohort study has evaluated the effect of ablative fractional 2940-nm erbium yttrium aluminum garnet (Er: YAG) laser in the treatment of androgenetic alopecia (AGA). To investigate the efficacy and safety of the ablative fractional 2940-nm Er: YAG laser in combination with medication therapy for the treatment of AGA. We performed a retrospective study between first July 2021 to 30th December 2021. All included patients received oral finasteride and topical minoxidil, or combined with six sessions of Er: YAG laser at 2-week intervals. Patients were divided into medication or combined therapy groups. The efficacy of the two therapies was evaluated by the investigator's Global Assessment (IGA) scores and the patient's Likert satisfaction scale at week 12 and week 24. Changes in total, terminal and villous hair count, total and terminal hair diameter, and AGA grade were also recorded. Adverse events were evaluated at each follow-up. A total of 192 male patients with AGA were included, including 67 receiving combination treatment, and 125 receiving medication treatment. At week 24, the combination treatment afforded superior outcomes in the IGA score, patient's global assessment, total and terminal hair counts, and diameters (all P<0.05). No severe adverse events were reported in both groups. The combined therapy of ablative fractional Er: YAG laser and medication was superior in treating male AGA than single medication therapy without serious adverse effects.

Lasers in the management of alopecia: a review of established therapies and advances in treatment

Alopecia, also known as hair loss, is a highly prevalent condition affecting millions of men and women in the United States and worldwide, making it one of the most common complaints by patients presenting to a dermatologist. The symptomology on the presentation of alopecia can be highly variable, ranging from diffuse thinning of hair, discrete and localized patches completely absent of hair, or noticing significant shedding when brushing and showering. Although alopecia does not have a direct negative health impact on patients, it is nonetheless a debilitating disease as it can profoundly impact an individual's self-image and psychosocial well-being. There are multiple treatment options available to patients with alopecia, and they are typically tailored to the patient's needs and preferences. The most common of these is the Food and Drug Administration-approved drugs for alopecia, minoxidil, and finasteride. However, both of these are known to be partially efficacious for all patients, so clinicians often use different modalities in conjunction with them, in particular laser-based therapies. This review article will provide a comprehensive assessment of lasers and other light therapies that may be used to manage the two most common types of alopecia: androgenetic alopecia and alopecia areata.

[Translated article] Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Hair Disorders Group of the Spanish Academy of Dermatology and Venererology (AEDV)

Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Hair Disorders Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.

Psychosocial impact of androgenetic alopecia on men: A systematic review and meta-analysis

The adverse psychosocial impact of androgenetic alopecia (AGA) is often framed as an essential motivation for developing efficacious treatments to halt hair loss or promote regrowth, especially since AGA is common among men but does not result in physically harmful or life-limiting consequences. Yet, empirical evidence documenting the impact of AGA on men's psychological wellbeing and quality of life is patchy and has not previously been subject to systematic review. This systemic review and meta-analyses aim to integrate and evaluate evidence regarding the psychosocial impact of AGA on men. A database and manual reference search identified English-language articles which reported: 1) empirical research; of ii) psychosocial distress (mental health, depression, anxiety, self-esteem, or quality of life); and iii) data separately for male AGA participants. Screening of 607 articles resulted in 37 (6%) for inclusion. PRISMA guidelines, the (modified) AXIS quality assessment tool, and independent extraction were deployed. Heterogeneity in measures and study aims, moderate study quality (M = 7.37, SD = 1.31), probable conflicts of interest (78%) and biased samples (68%) suggest that results should be treated cautiously. Meta-analyses revealed no impact on depression (pooled M = 8.8, 95% CI = 6.8-10.8) and moderate impact on quality of life (pooled m = 9.12, 95% CI = 6.14-12.10). Men with AGA were found to have average or better mental health compared to those without AGA. Overall, there was limited evidence of a severe impact on mental health and quality of life for men experiencing hair loss, with most studies evidencing (at best) a moderate impact. Good dermatological care includes accurately educating about the psychosocial impact of AGA on men, taking care not to overstate levels of distress, and screening for distress using validated measures which have clear clinical thresholds.

Diagnostic and grading criteria for androgenetic alopecia using dermoscopy

OBJECTIVES

To establish accurate and objective dermoscopic diagnostic criteria and grading standards for males and females with androgenetic alopecia (AGA).

METHODS

Twenty patients each with AGA, diffuse alopecia areata, telogen effluvium, and healthy controls were enrolled in the current study. In addition, 60 patients with grades F1/V1, F2/V2, and F3/V3 AGA (20 cases each) were enrolled. The patients underwent dermoscopic examinations. The sensitivity and specificity of the diagnostic criteria were based on the 60 AGA and 60 non-AGA. In addition, 150 patients diagnosed with AGA clinically and by dermoscopy were enrolled to calculate the accuracy of the grading criteria.

RESULTS

The diagnostic criteria included primary, secondary, and exclusion criteria. The grading criteria included three indices, which divided the severity of AGA into grades 1, 2, and 3. The sensitivity and specificity of the diagnostic criteria were 98.3% and 96.7% respectively. The accuracy of grade 1, 2, and 3 dermoscopic grading criteria were 96%, 92%, and 100% respectively, with a total accuracy of 96%.

LIMITATIONS

To test the diagnostic and grading criteria, more patients need to be collected.

CONCLUSIONS

The dermoscopic diagnostic and grading criteria are objective with good accuracy, which could provide a reasonable basis for the early diagnosis, grading treatment, and improved prognosis for AGA.

Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Trichology Group of the Spanish Academy of Dermatology and Venererology (AEDV)

Androgenetic alopecia can be challenging to treat due to the wide range of available treatments, most of which are not based on evidence from clinical trials. In addition many of the options do not include androgenetic alopecia among the approved indications according to their summaries of product characteristics. A panel of 34 dermatologists from the Spanish Trichology Society of the Spanish Academy of Dermatology and Venereology (AEDV) used the Delphi method to develop a consensus statement on the management of androgenetic alopecia. Over a 2-round process the experts agreed on 138 (86%) of the 160 proposed items, which were structured into 4 blocks of recommendations: general considerations, pharmacologic treatment, procedures and hair transplant, and special cases. The resulting consensus statement based on expert opinion of the scientific evidence can guide professionals in the routine management of androgenetic alopecia.

Safety and efficacy of REGENDIL™ infused hair growth promoting product in adult human subject having hair fall complaints (alopecia)

BACKGROUND

Hair serum is recommended therapy for the management of hair fall problems. People of all ages suffer from hair fall.

AIM

To evaluate safety and efficacy of hair growth promoting product in healthy adult subjects with hair fall complaints (Alopecia).

METHODS

In this safety and efficacy clinical study, 32 healthy individuals (aged 18-45 years) experiencing hair loss were enrolled. Participants applied 0.5 mL of the product to the affected scalp area daily for 60 days. The study evaluated various factors, including hair growth rate, thickness, density, scalp condition using CASLite-Nova, anagen-to-telogen ratio, hair fall reduction, overall hair and scalp appearance, hair strength, and participants' subjective perceptions of the product.

RESULTS

Highly statistically significant improvement was observed in hair growth rate, thickness, and density at Day 30 and Day 60. Hair growth rate increased (p-value <0.01) by 10.52% in 30 days and 31.62% in 60 days after test product application. Average hair growth increased by 424.21 μm/day and 487.31 μm/day at Day 30 and 60 respectively. The hair growth improved by up to 1.5 times after 60 days of usage in healthy subjects with hair fall complaints. No adverse events or product-related adverse events were reported.

CONCLUSION

Hair serum containing REGENDIL™ (Redensyl, AnaGain, Procapil, Capilia longa), and 5 kDa hyaluronic acid was efficacious and well tolerable in reducing hair fall (Alopecia). Hair serum significantly improved hair growth, hair density, hair thickness, and hair strength within 60 days of usage, thereby demonstrating it worth as a beneficial inclusion as a daily haircare product.

Cosmetic Dermatology Concerns in Older Adults

It is important to understand that each layer of facial tissue, from the underlying facial skeleton to the overlying skin, undergoes significant changes during the aging process. Bony support is lost along the mandible and maxilla and the orbital aperture widens. Superficial and deep fat pads undergo volume loss and migration and the overlying skin begins to reveal signs of both intrinsic aging with skin laxity and fine rhytids as well as extrinsic aging in the form of coarse, deeper rhytids and dyspigmentation.

Efficacy of the association of topical minoxidil and topical finasteride compared to their use in monotherapy in men with androgenetic alopecia: A prospective, randomized, controlled, assessor blinded, 3-arm, pilot trial

PURPOSE

Topical minoxidil (MNX) 2%-5% and oral finasteride (F) 1 mg/day are the only two pharmacological treatments authorized for androgenetic alopecia (AGA). Recently, a 2.2 mg/mL topical formulation of F was developed to minimize the systemic adverse effects associated with the oral formula. MNX and F act through different mechanisms; therefore, their association could improve clinical efficacy. To evaluate the efficacy of the association of 5% MNX and 0.25% topical F compared to their use in monotherapy, a 6-month, prospective, randomized, assessor-blinded trial was conducted.

PATIENTS AND METHODS

Forty-two males, mean age 24 ± 3 years, with AGA (I-VII of Norwood-Hamilton Grading Scale), treatment naive or free from any therapy for at least 6 months, were enrolled and randomly assigned to three arm treatment groups (2:1:1): group A (n = 19, the subjects applied 5% MNX in the morning and F spray in the evening), group B (n = 12, the subjects applied F spray in the evening), and group C (n = 11, the subjects applied 5% MNX twice daily). The efficacy of treatments was evaluated at baseline and after 3 and 6 months using a global photography score (GPAS; from -3 to +3) and trichoscopy evaluation and assessed by an investigator unaware of treatment allocation. At baseline and after treatments, the serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEA-S), and testosterone were also evaluated.

RESULTS

All treatments resulted in an increase in hair density compared to baseline. However, this improvement was significant only for group A (MNX + F), both at three (+56 density/cm2 , p < 0.05) and six (+81 density/cm2 , p < 0.001) months. The mean change from baseline in hair density was higher for group A compared to other groups and statistically different compared to group B (F) (p < 0.01), both after 3 and 6 months. Group A showed a global photographic assessment score (GPAS) significantly higher compared to group B (p < 0.001) and group C (p < 0.05) both at 3 and 6 months (2.0 ± 0.7 vs. 0.6 ± 0.8 and 1.3 ± 0.6; respectively). A significantly greater percentage of subjects in Group A achieved a GPAS score of ≥2 in comparison with Groups B and C both after 3 and 6 months (79% vs. 8% and 41%, respectively). No significant differences were observed in mean hair diameter and hormonal levels between the three groups. Good tolerability was observed in all treated groups.

CONCLUSION

The association of 5% MNX lotion and 0.25% F in spray formulation in patients with AGA showed a significantly higher clinical and instrumental efficacy compared to the monotherapies, with comparable tolerability and safety profile.

Cyanidin-3-O-glucoside and its derivative vitisin A alleviate androgenetic alopecia by exerting anti-androgen effect and inhibiting dermal papilla cell apoptosis

Androgenetic alopecia (AGA), one of the most common forms of hair loss, lacks satisfactory treatment methods in modern society. This study employed an experimental design combining in vitro and in vivo approaches to explore the effects of Cyanidin-3-O-glucoside (C3G) and Carboxypyranocyanidin-3-O-glucoside (Vitisin A) on AGA. In human dermal papilla cells (HDPCs), both anthocyanins demonstrated inhibitory effects on androgen receptors, significantly reduced dihydrotestosterone (DHT) induced apoptosis of HDPCs, and regulated the secretion of Fibroblast growth factor 7 and Transforming growth factor beta 1. In vitro transdermal experiment revealed that both C3G and Vitisin A could penetrate mice skin, aided by the application of cream. Furthermore, in vivo experiments with mice indicated that application of C3G or Vitisin A cream effectively improved hair follicles miniaturization, regression, and apoptosis caused by DHT. The repression of Wnt10b and β-catenin expression induced by DHT was prevented by C3G and Vitisin A in both cell and mouse model. Consequently, these findings suggest that C3G and Vitisin A could be considered as alternative methods for alleviating AGA.

Evaluation of Follicular Unit Extraction Technique as a Method for Hair Restoration Problems

Context

Androgenetic alopecia, traction alopecia, and primary cicatricial alopecia can cause distressing scalp hair loss problems affecting a large number of both sexes. Follicular unit extraction (FUE) is one of the best ways to achieve improving conditions of those cases.

Aims

The aim of this study was to evaluate the FUE technique as a method for permanent hair restoration problems.

Settings and Design

Channels for the grafts were created through pieces of hand-cut razor blades.

Subjects and Methods

Twenty patients suffering from alopecia were eligible to participate in the study. They were subjected to FUE.

Results

On comparing different types of alopecia, we found that cicatricial alopecia was significantly more common among younger patients, unlike traction and traction types which were relatively more common among older patients (P = 0.043). There was no significant difference between alopecia types concerning the duration of operation. However, the number of implants was significantly higher among patients with androgenic alopecia when compared with cicatricial and traction subtypes (P < 0.001). Concerning patients' satisfaction, we found that there was no significant difference between alopecia types concerning patients, observers, or doctor satisfaction with an overall satisfaction rate ranging between 3.67 and 4.

Conclusions

Till now, there is no specific algorithm for treating patients with hair loss. However, there is a general preference of patients toward surgical options being less time-consuming and achieve better results. Whatever the cause is FUE showed good results concerning postpatients satisfaction concerning their appearance and visual age.

Duo-role Platelet-rich Plasma: temperature-induced fibrin gel and growth factors' reservoir for microneedles to promote hair regrowth

INTRODUCTION

Alopecia concerns more than half our adult population. Platelet-rich plasma (PRP) has been applied in skin rejuvenation and hair loss treatment. However, the pain and bleeding during injection and the troublesome for fresh preparation of each action limit PRP's in-depth applying dedication to clinics.

OBJECTIVES

We report a temperature-sensitive PRP induced fibrin gel included in a detachable transdermal microneedle (MN) for hair growth.

RESULTS

PRP gel interpenetrated with the photocrosslinkable gelatin methacryloyl (GelMA) to realize sustained release of growth factors (GFs) and led to 14% growth in mechanical strength of a single microneedle whose strength reached 1.21 N which is sufficient to penetrate the stratum corneum. PRP-MNs' release of VEGF, PDGF, and TGF-β were characterized and quantitatively around the hair follicles (HFs) for 4-6 days consecutively. PRP-MNs promoted hair regrowth in mice models. From transcriptome sequencing, PRP-MNs induced hair regrowth through angiogenesis and proliferation. The mechanical and TGF-β sensitive gene Ankrd1 was significantly upregulated by PRP-MNs treatment.

CONCLUSION

PRP-MNs show convenient, minimally invasive, painless, inexpensive manufacture, storable and sustained effects in boosting hair regeneration.

Injectable platelet-rich fibrin for treatment of female pattern hair loss

This case series evaluated use of injectable platelet rich fibrin (termed i-PRF+) for the treatment of female pattern hair loss (FPHL). Eleven individuals underwent 3-monthly intradermal injections of i-PRF+ using a mesotherapy gun. The mean number of hair follicles containing hairs per unit area improved at 3- and 6-months follow-up (p < .001), and all participants had a negative hair pull test. Hair volume and thickness, and patient-reported outcome scores also improved at follow-up (p < .001). Adverse effects were minor and self-limited. A series of three i-PRF+ injection sessions were effective for the treatment of FPHL, as shown by improved hair analysis parameters and patient self-assessment scores.

The Current Status and Future Direction of Extracellular Nano-vesicles in the Alleviation of Skin Disorders

Exosomes are extracellular vesicles (EVs) that originate from endocytic membranes. The transfer of biomolecules and biological compounds such as enzymes, proteins, RNA, lipids, and cellular waste disposal through exosomes plays an essential function in cell-cell communication and regulation of pathological and physiological processes in skin disease. The skin is one of the vital organs that makes up about 8% of the total body mass. This organ consists of three layers, epidermis, dermis, and hypodermis that cover the outer surface of the body. Heterogeneity and endogeneity of exosomes is an advantage that distinguishes them from nanoparticles and liposomes and leads to their widespread usage in the remedy of dermal diseases. The biocompatible nature of these extracellular vesicles has attracted the attention of many health researchers. In this review article, we will first discuss the biogenesis of exosomes, their contents, separation methods, and the advantages and disadvantages of exosomes. Then we will highlight recent developments related to the therapeutic applications of exosomes in the treatment of common skin disorders like atopic dermatitis, alopecia, epidermolysis bullosa, keloid, melanoma, psoriasis, and systemic sclerosis.

Herpes zoster ophthalmicus (HZO) secondary to platelet-rich plasma (PRP) therapy - A case report

Androgenetic alopecia (AGA) is a common and benign cause of chronic hair loss that affects both males and females. Platelet-rich plasma (PRP) is a safe and minimally invasive technique with promising outcomes in patients with AGA, alongside other therapeutics use. The currently available data in the literature assures that the rate of side effects is low but includes infection and localized reaction (Stevens and Khetarpal, Feb. 2019) [1]. This article describes a case of herpes zoster ophthalmicus (HZO) following PRP treatment for androgenic alopecia, while shedding light on the importance of respecting the guidelines when injecting PRP therapy to ensure a safe outcome with no complications.

Clinical study on the efficacy and tolerability of a topical regenerative treatment in patients with telogen effluvium and mild androgenetic alopecia

Hair loss may change the quality of life since modern society considers hair an essential element in beauty definition. The most common causes of hair loss are androgenetic alopecia (AGA) and telogen effluvium (TE). AGA requires a lifetime use of minoxidil or finasteride (and sometimes they lose efficacy over the years), whereas TE has no standardized therapy available. Our study focuses on a novel topical regenerative preparation that, by mimicking autologous PRP, can safely and efficiently improve hair loss in patients affected by TE and AGA.

Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.

Favorable effect of herbal extract on androgenic alopecia: A case report

RATIONALE

Androgenic alopecia (AGA) is a prevalent condition with progressive miniaturization of hair follicles. Currently, reliable treatments have remained limited, and complementary medications for AGA are still being investigated. Traditional Chinese medicine formulas have conspicuous advantages in the treatment of AGA with good development prospects. Zimmer aqueous spray (ZAS) is a water spray containing Zimmer herbal extract powder (ZMWP), which consists of Ligustri lucidi Fructus, Ecliptae Herba, Fallopia multiflora (Thunb.) Harald. and Polygonatum sibiricum Delar. ex Redoute, etc. ZMWP is an active ingredient in the prevention of hair loss. Our aim is to provide evidence for the effectiveness of ZAS in the treatment of AGA.

PATIENT CONCERNS

A 41-year-old man had suffered from hair loss for 8 years.

INTERVENTIONS

The patient with moderate AGA received 3 to 4 mL ZAS daily or every other day for 3 months.

OUTCOMES

The hair density obviously increased after 3 months of therapy. The improvement of hair diameter, vellus hair rate, and 1 hair pilosebaceous unit rate were observed with a trichoscopy and quantitatively analyzed. Besides, honeycomb pigment pattern mitigated and arborized red lines.

LESSONS

The results suggested that ZMWP might have the capability of improving hair growth and attenuating AGA, which can be a promising alternative treatment of AGA.

Dissolving microneedles for alopecia treatment

Alopecia is a treatable benign disease, however, approximately 15-30% of women and 50% of men suffer from alopecia, which greatly affects patient's self-esteem and quality of life. Currently, commercial products for alopecia treatment include topical minoxidil solution, oral finasteride tablets and oral baricitinib tablets. However, the barrier of stratum corneum, systemic adverse effects and poor cure rate limit the application of commercial products. Therefore, researchers investigated the mechanism of alopecia, and developed new drugs that could target lactate dehydrogenase-related pathways, remove excessive reactive oxygen in hair follicles, and reduce the escape of hair follicle stem cells, thus injecting new strength into the treatment of alopecia. Moreover, starting from improving drug stratum corneum penetration and reducing side effects, researchers have developed hair loss treatment strategies based on dissolved microneedles (MNs), such as drug powders/microparticles, nanoparticles, biomimetic cell membranes, phototherapy and magnetically responsive soluble microneedles, which show exciting alopecia treatment effects. However, there are still some challenges in the practical application of the current alopecia treatment strategy with soluble microneedles, and further studies are needed to accelerate its clinical translation.

Growth Factor Cocktail Including Fibroblast Growth Factor 9 (Cellcurin) in the Treatment of Androgenetic Alopecia in Men and Women: A Randomized Controlled Trial

Objectives

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women, affecting about 30% of men and 15% of women at 30 years and 80% and 48% at 70 years, respectively. This study aims to assess the effectiveness of growth factor cocktail therapy including fibroblast growth factor 9 (FGF9) (Cellcurin) in men and women with AGA.

Materials and Methods

This is a single-center randomized controlled trial, conducted with 10 men and 10 women with AGA. Eight men participated in the therapeutic group and two men in the control group. Eight women participated in the therapeutic group and two women in the control group. All were classified by sex, age, duration, and degrees of progression of AGA. The study obtained approval from the Research Ethics Committee (REC) of the Federal University of Uberlandia at approval number: 36918620.8.0000.5152. Six microneedling sessions were performed with an electromedical pen with an interval of 15 days between sessions. In the therapeutic group, sterile injectable Cellcurin was used and, in the control group, injectable sterile minoxidil 5 mg/ml 2 ml, both through the drug delivery system. Trichoscopic photos were taken before and after 12 weeks in the frontal and vertex regions. Descriptive statistics were performed using the t-test with the IBM SPSS-25 software.

Results

Men and women showed an expressive and significant increase in the amount of hair per cm2 after Cellcurin therapy, as well as an increase in the amount of terminal hair, vellus hair, sum of the terminal hair diameters, and mean of the terminal hair diameters in both regions, frontal and vertex.

Conclusions

In this study, we demonstrated that the use of Cellcurin in the treatment of AGA in men and women is associated with an increase in the amount of hair per cm2, in the amount of terminal hair per cm2, in the amount of vellus hair per cm2, in the number obtained by the sum of the terminal hair diameters per cm2, as well as an increase in the mean diameter of the terminal hairs.

Noninvasive Hair Rejuvenation

Both nonsurgical and surgical modalities for the treatment of hair loss are being used by providers at an increasing rate worldwide. Men and woman are affected by hair loss, but the pathophysiology of the hair loss is thought to be different between sexes; therefore, gender must play a role in treatment decisions. Currently, there are 3 Food and Drug Administration-approved nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy. Platelet-rich plasma injections are showing promise as a single modality and as an adjunct to other nonsurgical and surgical treatments of androgenetic alopecia.

Platelet Rich Plasma Combination Therapies for Treatment of Androgenetic Alopecia: A Systematic Review

Androgenetic alopecia (AGA) is the most common cause of alopecia in males and females. Minoxidil and finasteride are the only FDA-approved treatments for AGA. New treatments including Platelet Rich Plasma (PRP) and microneedling have shown promising results. The purpose of this literature review was to highlight recent studies examining the effects of topical minoxidil combined with PRP to minoxidil or PRP monotherapy. The method used for this paper includes a systematic review of the literature from 2010 to 2022 using the PubMed, EMBASE, and MEDLINE databases examining studies evaluating combination therapies for AGA. Three randomized control trials compared combination PRP + topical 5% minoxidil to either no treatment, 5% minoxidil, or PRP only. Two studies found increased hair growth at five months and at six months following combined therapy. Another study found an increase in hair density and improved patient satisfaction with combination therapy compared to monotherapy. A prospective study revealed that patients treated with combined 5% minoxidil, PRP, and microneedling reported the highest patient and physician satisfaction compared to minoxidil monotherapy. An observational study evaluating topical 5% minoxidil with PRP reported an increase in hair diameter after one year of combination treatment compared to minoxidil monotherapy. PRP therapy combined with minoxidil and microneedling in a retrospective study was shown to increase hair growth compared to PRP with minoxidil as well as PRP or minoxidil monotherapy. In conclusion, a variety of studies demonstrated superior treatment response with a combination of PRP and minoxidil therapy in patients with AGA. Limitations to this study include different PRP preparation protocols, few randomized control studies, and small sample sizes.

Female Pattern Hair Loss: An Overview with Focus on the Genetics

Pattern hair loss can occur in both men and women, and the underlying molecular mechanisms have been continuously studied in recent years. Male androgenetic alopecia (M-AGA), also termed male pattern hair loss, is the most common type of hair loss in men. M-AGA is considered an androgen-dependent trait with a background of genetic predisposition. The interplay between genetic and non-genetic factors leads to the phenotype of follicular miniaturization. Although this similar pattern of phenotypic miniaturization can also be found in female pattern hair loss (FPHL), the corresponding genetic factors in M-AGA do not account for the phenotype in FPHL, indicating that there are different genes contributing to FPHL. Therefore, the role of genetic factors in FPHL is still uncertain. Understanding the genetic mechanism that causes FPHL is crucial for the future development of personalized treatment strategies. This review aims to highlight the differences in the ethnic prevalence and genetic background of FPHL, as well as the current genetic research progress in nutrition, Wnt signaling, and sex hormones related to FPHL.

Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs

Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women. Traditionally, topical minoxidil and oral finasteride have been the standard of care yielding mixed results. New treatments such as Low-Level Laser Therapy (LLLT), microneedling, platelet-rich plasma (PRP), and others have been extensively studied in the literature, and the purpose of this review is to provide a comprehensive discussion of the latest treatment methods and their efficacy in treating AGA. Novel therapies such as oral minoxidil, topical finasteride, topical spironolactone, botulinum toxin, and stem cell therapy offer interesting alternatives to standard of care therapies for patients. In this review, we present data from recent studies on the clinical efficacy of these treatments. Furthermore, as new treatments have emerged, clinicians have tested combination therapies to assess whether there may be a synergistic relationship between multiple modalities. While there has been a great increase in the treatments available for AGA, the quality of evidence varies greatly and there is still a great need for randomized double blinded clinical trials to adequately assess the clinical efficacy of some treatments. While PRP and LLLT have demonstrated encouraging results, standardized treatment protocols are needed to adequately inform clinicians on how to use such therapies. Given the abundance of new therapeutic options, clinicians and patients must weigh the benefits and risks of each treatment option for AGA.

Prospective Efficacy and Safety Study of an Innovative Kerascalp Hair Growth Serum in Mild-to-Moderate Alopecia in India: Regrowth Study

BACKGROUND AND AIM

Male and female pattern baldness, commonly known as androgenetic alopecia is the most common type of alopecia, often predetermined genetically, which generally affects the scalp and is characterized by progressive terminal hair loss, known as miniaturization. This study aimed to assess the safety and efficacy of Kerascalp hair serum, a unique combination of esculin, ximenynic acid, and lauric acid, extracted from natural sources in subjects with mild to moderate androgenetic alopecia.

METHODS

An open-label, single-arm clinical study was conducted on healthy males and females aged 18-60 years. Each subject applied the hair serum once daily for 90 days. The efficacy of hair serum was evaluated in terms of the following outcome variables: anagen and telogen ratio (A:T ratio), hair thickness, hair density, hair fall, and hair strength assessment. Subjects were assessed on day 0, day 30, day 60, day 90, and on follow-up day 120.

RESULTS

Thirty subjects completed all assessment visits. After using the hair serum for 90 days, statistically significant (p<0.0001) improvement was observed in A:T ratio, hair density, hair thickness, and hair strength; a statistically significant reduction (p<0.0001) in hair fall was also observed. Moreover, improvement in general appearance of hair (in terms of hair volume and density) and scalp (in terms of itchiness, redness, roughness, and dryness) was recorded through dermatological assessment at each treatment visit and at follow-up visit compared to baseline. No adverse event was recorded during the study period, and on follow-up.

CONCLUSIONS

The results of this clinical study suggest that a 90 days treatment with a phyto-ingredient-based Kerascalp hair serum is safe and effective in significantly improving A:T ratio, hair density, hair thickness, and hair strength, while reducing hair shedding. The improvement in the test parameters persists, even 30 days after stopping the usage of the serum.