Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics

Hyperbranched polymer dots enhance hair follicle regeneration via Wnt/β-catenin activation: A drug-free nanozyme-based approach to hair growth therapy

BACKGROUND

Hair loss affects millions worldwide, yet current pharmacological treatments remain limited in efficacy and long-term sustainability. The Wnt/β-catenin pathway plays a crucial role in hair follicle regeneration, providing a promising target for novel therapeutic interventions.

METHODS

This study investigates the potential of Hyperbranched Polymer Dots (HPD) as a novel nanotherapeutic for hair follicle regeneration. Using a C57BL/6 mouse model, we assessed the effects of topically applied HPD on hair growth, follicular proliferation, and key molecular markers of follicular activation. Optical coherence tomography (OCT), histological analysis, and immunofluorescence staining for Ki67 and β-catenin were performed to evaluate follicular activity at multiple time points.

RESULTS

HPD treatment significantly accelerated hair regrowth (p < 0.05) and enhanced follicular density compared to minoxidil-treated controls. Immunofluorescence analysis revealed upregulation of Ki67 and β-catenin, indicating enhanced follicular stem cell proliferation and activation of the Wnt/β-catenin pathway. Furthermore, HPD-treated mice exhibited increased melanin deposition, suggesting early follicular entry into the anagen phase.

CONCLUSION

Our findings demonstrate that HPD serves as a potent activator of hair follicle regeneration, surpassing the efficacy of conventional minoxidil treatment. By modulating Wnt/β-catenin signaling and enhancing follicular proliferation, HPD presents a promising nanomedicine-based approach for non-invasive hair restoration therapies. Future studies should focus on optimizing HPD formulations for clinical translation in treating androgenetic alopecia and related hair disorders.

A systematic review of erbium lasers in the treatment of androgenetic alopecia

Androgenetic alopecia (AGA) is the most common form of hair loss, affecting a significant portion of both men and women. Despite the availability of various treatments, challenges such as limited efficacy, ongoing treatment requirements, side effects, and high costs persist. We sought to evaluate the efficacy and safety of erbium lasers, specifically erbium-doped yttrium-aluminum-garnet (Er: YAG) and erbium: glass lasers, in the management of AGA. A comprehensive search of PubMed/Medline, Web of Science, and Ovid-Embase databases was conducted until November 18th, 2023, adhering to PRISMA guidelines. Clinical studies involving Er: YAG or erbium: glass lasers for AGA treatment were included. A total of 12 studies recruiting 344 patients were included in this study; six of them investigated Er: YAG and six others evaluated erbium: glass laser. As a result, both erbium lasers were effective in treating AGA with respect to hair density, growth rate, and hair thickness. Erbium: glass lasers were particularly effective with combination therapies, such as those with minoxidil or Platelet-rich plasma. Er: YAG lasers also showed promising results, although some studies reported variability in patient satisfaction and aesthetic outcomes. The safety profile of erbium lasers was generally favorable, with minimal adverse effects. Erbium lasers, especially when used in combination with other therapies, show considerable potential in managing AGA. However, variability in treatment protocols and patient responses highlights the need for further research.

Menopause and hair loss in women: Exploring the hormonal transition

Menopause, which is defined as the cessation of menstruation, may be preceded by hormonal fluctuations during the transition to menopause, up to 10 years prior. During this time, hormonal changes, including the relative increase in androgens and the cessation of ovarian estrogen production directly impacts the hair follicle, which is an estrogen-sensitive tissue. These hormonal fluctuations can lead to alterations in the hair shaft and hair cycle, including decreased density, decreased caliber, and changes in hair texture. Additionally, loss of estrogen after the onset of menopause may lead to sub-optimal metabolic and vascular functioning of the follicular unit. The overall decline in hair density, appearance and manageability can have significant emotional impact and affect overall mental health, with feelings of stress, anxiety, and diminished self-esteem. In addition to the physiologic changes that can occur in the hair follicle during menopause, certain hair disorders, including female-pattern hair loss, telogen effluvium, and frontal fibrosing alopecia, have been noted with higher frequency in post-menopausal women.

Real-World Efficacy and Safety of Cuticapil Stem Hair Serum as an Add-On to Minoxidil in Androgenetic Alopecia: A Prospective Observational Study

BACKGROUND

Androgenetic alopecia (AGA) is a common age-related hair loss condition influenced by genetics and androgen activity.

AIM

This study evaluated the safety and efficacy of Cuticapil Stem Hair Serum in improving hair loss in AGA patients.

METHOD

This multicenter, prospective, observational study assessed the real-world efficacy and safety of Cuticapil Stem Hair Serum in patients with androgenetic alopecia. A total of 60 subjects were evaluated, with the Cuticapil and Standard of Care groups compared using the Mann-Whitney and Wilcoxon signed-rank tests. Key assessments included the hair pull test, global photographic analysis, and hair shedding count. No adverse events were reported, reinforcing the serum's favorable safety profile.

RESULT

The Cuticapil + SoC treatment group consistently showed higher mean ranks across multiple parameters compared to the SoC-only group. The addition of Cuticapil Serum to SoC significantly reduced hair shedding (p = 0.0220). In the Hair Pull Test, the Cuticapil + SoC group had a lower mean rank (26.97) than SoC alone (34.03) (p = 0.0196), indicating greater efficacy. Global photography analysis showed a higher mean rank of 36.13 in the Cuticapil + SoC group compared to 24.87 in the SoC group (p = 0.0057), further supporting its effectiveness.

CONCLUSION

Cuticapil Stem Hair Serum, when used in addition to standard care, significantly enhances hair growth and reduces hair fall in patients with mild to moderate Androgenetic Alopecia and Female Pattern Hair Loss. It showed superior results in promoting hair growth, reducing shedding, improving hair density, appearance, and managing hair loss.

Mixture of Mastic Gum and Peppermint Extracts Promotes Hair Growth and Health in Vitro and in C57BL/6 Mice

PURPOSE

Hair disorders, which are often attributed to conditions associated with a shortened anagen growth phase, oxidative stress, and hormonal dysregulation, especially during aging, have profound psychological implications. Currently, only minoxidil has been approved as a topical hair growth solution; thus, alternative therapies for treating hair loss and promoting hair health are urgently needed. Herein, we aimed to develop and assess a novel method to promote hair growth and health using mastic (Pistacia lentiscus) gum and peppermint (Mentha piperita L.) extracts.

MATERIALS AND METHODS

After determining the optimal ratio of mastic gum and peppermint extracts, we performed in vitro and in vivo experiments to verify the efficacy of the 7:3 mastic gum-peppermint mixture (MP73; FHH-MG) for enhancing hair growth and health.

RESULTS

Mastic gum significantly promoted cell proliferation and demonstrated synergistic benefits when combined with peppermint extract. In vitro, FHH-MG increased human dermal follicle papilla cell proliferation and demonstrated anti-inflammatory and antioxidant effects. In vivo, treatment with FHH-MG dose-dependently enhanced hair growth and gloss and increased the expression of vascular endothelial growth factor, epidermal growth factor, β-catenin, and insulin-like growth factor-1 in C57BL/6 mice compared to the negative control.

CONCLUSION

The novel mixture exhibited hair growth-promoting effects in C57BL/6 mice; thus, FHH-MG may serve as a botanical alternative for hair growth and health promotion.

Novel Electrotrichogenic Device Promotes Hair Growth in Men With Androgenetic Alopecia: A Pilot Study

BACKGROUND

Androgenetic alopecia (AGA) is the most common cause of hair loss globally, affecting millions of people, particularly men. Current treatments include FDA-approved drugs and devices, but many patients experience side effects or suboptimal results. The niostem device is a new, wearable device that delivers low-level electrical stimulation to promote hair growth. This pilot study aims to evaluate the efficacy and safety of the niostem device in male AGA patients.

METHODS

A total of 21 male patients with AGA used the niostem device daily for 30 min over 6 months. Participants had not used any anti-hair loss products within the 6 months preceding the start of the study. Hair density, thickness, and terminal hair counts were assessed at baseline, 3 months, and 6 months using trichoscopic measurements. Patient-reported outcomes were recorded, and adverse events were monitored.

RESULTS

The niostem device resulted in significant increases in hair count, with a 12% increase in total hair density at 3 months and a 19.3% increase at 6 months. Hair thickness also increased by 8.8% in 6 months. Terminal hair density improved significantly over time, with visible hair growth observed in the participants. No adverse events were reported.

CONCLUSIONS

The niostem device demonstrated a significant increase in hair density and hair thickness in male AGA patients, with no adverse effects. Further large-scale studies are warranted.

Efficacy, safety and tolerability of drugs for alopecia: a comprehensive review

INTRODUCTION

Alopecia, encompassing non-scarring and scarring types, presents therapeutic challenges requiring individualized approaches based on pathophysiology and treatment responses. A comprehensive literature search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science (2015-2024) focused on randomized controlled trials, meta-analyses, and observational studies.

AREAS COVERED

This review evaluates pharmacological strategies for androgenetic alopecia (AGA), alopecia areata (AA), and scarring alopecias, emphasizing efficacy and safety. Treatments for non-scarring alopecia include finasteride, minoxidil, JAK inhibitors, and antiandrogens like spironolactone. JAK inhibitors, such as baricitinib, show promise for AA but require monitoring due to immune suppression risks. Scarring alopecias, including lichen planopilaris and discoid lupus erythematosus, are managed with systemic agents like hydroxychloroquine and corticosteroids, alongside adjunctive topical and laser therapies.

EXPERT OPINION

The future of alopecia treatment is poised for transformation, particularly for AA and AGA. Emerging targeted therapies, such as JAK inhibitors for AA, represent significant advancements. Additionally, innovations in regenerative medicine and delivery systems for AGA treatments, alongside nanotechnology and 3D bioprinting, promise enhanced efficacy and personalization. This shift toward mechanism-targeted and individualized therapy is expected to improve outcomes for various alopecia subtypes.

Formulation and evaluation of repurposed ketoconazole‐loaded transferosomal gel for enhanced trichogenic effects

This study was focused to formulate and optimize transferosomes encapsulating ketoconazole (KTZ) for its repurposed use as a hair growth promoting agent. Ketoconazole exerts trichogenic effect in patients with androgenic alopecia androgen by acting on receptors present in keratinocytes and sebocytes of the scalp. This necessitates the penetration of ketoconazole into deep epidermal and dermal layers for exerting trichogenic effect. Transferosomes have been reported to improve drug penetration owing to their deformable vesicular structure. Thus, in the present work, transferosomal gel loaded with ketoconazole was developed with the intention to enhance drug permeation and improved hair proliferation activity. Solvent evaporation method has been adopted for the formulation of transferosomes and then optimized by quality by design approach. KTZ‐TF (ketoconazole‐transferosomes) were assessed for particle size, entrapment efficiency (%EE), surface charge, and morphology. The optimized KTZ‐TF formulation demonstrated particle size of 151.22 ± 1.3 nm, PDI index of 0.191 ± 0.034, and ζ potential of –33.05 ± 01.3 mV, respectively. The developed formulation was further added into gel and compared with commercially available product. It was concluded that KTZ‐TF gels showed control drug release (89.1 ± 2.12%) for 9 h. The in vivo skin irritation test demonstrated that the gel formulation caused minimal irritation and was well accepted by the scalp. In vivo qualitative hair growth activity demonstrated improved hair growth with the developed formulation in comparison to marketed KTZ. Histopathological studies also corroborated the findings through demonstrating increase in number of hair follicles. Hence, this study concluded that ketoconazole‐loaded transferosomes are efficacious in hair growth activity.

Anti-androgenetic effect of diphlorethohydroxycarmalol on testosterone-induced hair loss by inhibiting 5α-reductase and promoting Wnt/β-catenin signaling pathway in human dermal papilla cells

Diphlorethohydroxycarmalol (DPHC), a marine phlorotannin compound derived from the brown alga Ishige okamurae, has been known to have a variety of biological effects. Recently, marine resources have been highlighted by their effects on ameliorating alopecia and related hair loss. Therefore, this study aimed to investigate the potential of DPHC isolated from I. okamurae as a hair loss treatment through examination of its anti-androgenic alopecia effects. Molecular docking analysis predicted that DPHC can be used as a 5α-reductase inhibitor superior to finasteride, which has traditionally been used as an anti-androgenic alopecia agent. In addition, DPHC significantly inhibited 5α-reductase activity in dihydrotestosterone (DHT)-treated human dermal papilla (HDP) cells, and downregulated hair growth inhibitor proteins such as AR, DKK1, TGF-β1, and IL-6. Moreover, DPHC treatment remarkably upregulated both the phosphorylation levels of GSK3β and expression levels of β-catenin in DHT-treated HDP cells, confirming the effects of DPHC on activating the Wnt/β-catenin signaling pathway. Therefore, these findings suggest that DPHC has a significant potential to prevent androgenic alopecia by promoting hair growth and preventing hair loss.

Can oral minoxidil be the game changer in androgenetic alopecia? A comprehensive review and meta-analysis comparing topical and oral minoxidil for treating androgenetic alopecia

Androgenetic alopecia (AGA) is a hair disorder seen in both sexes. Its aetiology is multifactorial. Treating AGA has always been a challenge for dermatologists. Only a few drugs such as topical minoxidil and finasteride are U.S. Food and Drug Administration-approved for treating AGA. Thus, looking for new and more effective treatment options for AGA is imperative. This review was conducted to compare the efficacy of oral with topical minoxidil in treating AGA. Only clinical trials that compared oral with topical minoxidil in treating AGA were included in this review. PubMed, Cochrane, Scopus and ClinicalTrials.gov were searched. A total of 2063 studies were retrieved from the databases. Four studies met the inclusion criteria and were included in this systematic review. Outcomes such as hair density, terminal hair density, hair count, global photographic assessment and negative hair pull were studied in this review. The results showed that there was no significant difference between oral and topical minoxidil in terms of improving the hair density of patients with AGA (overall mean difference 0.95, 95% confidence interval -24.98 to 26.87). Two studies showed that the mean difference in terminal hair density was greater in patients treated with oral minoxidil, but there was no significant difference between the two treatments in terms of improving terminal hair density. The efficacy of oral minoxidil is comparable to that of topical minoxidil in terms of improving hair density and terminal hair density in patients with AGA. Oral minoxidil can be used as an adjunct or as a second-line treatment option for AGA.

Kyoh® Rocket Leaf Extract Regulates Proliferation and VEGF and FGF7 Expression in Human Dermal Follicle Papilla Cells

Androgenetic alopecia is the most common cause of hair loss for women and men. Current treatments for androgenetic alopecia, such as those based on drugs like Minoxidil, Finasteride, or Dutasteride, have been associated with a variety of side effects, such as irritation, contact dermatitis, scalp pruritus, burning, etc. In this regard, plant extracts have emerged as promising alternatives to available chemical-based treatments for androgenetic alopecia given their efficacy, customer acceptability, and potentially minimized side effects. In this study, we evaluated the efficacy of Kyoh®, an extract from rocket leaves, as a treatment to improve the signs of androgenetic alopecia. We found that Kyoh® contained 2.1% total flavonoids, with kaempferol, quercetin, and isorhamnetin diglucosides being the most abundant. Additionally, Kyoh® showed a stimulating effect on the growth of human dermal follicle papilla cells in laboratory conditions. Most importantly, Kyoh® enhanced the gene expression of the hair growth-associated growth factors VEGF (Vascular Endothelial Growth Factor) and FGF7 (Fibroblast Growth Factor 7). Specifically, VEGF expression increased by 60.7% after 4 h and 267.3% after 24 h, while FGF7 expression increased by 50.3% after 4 h and 244.3% after 24 h, indicating both a rapid induction of gene expression and a sustained effect lasting at least one day. Moreover, Kyoh® increased the gene expression of NRF2 (Nuclear factor erythroid 2-related factor 2) by 71.2%, which encodes for a protein participating in the antioxidant response. Overall, our study shows that flavonol-rich rocket extract (Kyoh®) is a promising treatment for promoting hair growth, demonstrated by its proliferation-promoting effect, potential antioxidant priming, and induction of the expression of growth factors associated with hair growth and health.

A Prospective Study of Exosome Therapy for Androgenetic Alopecia

BACKGROUND

Androgenetic alopecia (AGA) is a prevalent condition that significantly impacts patients' psychological well-being and quality of life. Traditional treatments, such as minoxidil and finasteride, have limited efficacy and undesirable side effects. Exosome therapy, which uses extracellular vesicles to promote tissue regeneration, offers a promising alternative. This study evaluates the effectiveness of exosome therapy combined with microneedling (MTS) for treating AGA.

OBJECTIVE

To assess the efficacy of exosome therapy in promoting hair regrowth in patients with AGA following microneedling treatment.

METHODS

This prospective, open-label study included 16 male patients aged 36-45 years with mild to moderate AGA. Microneedling was performed on the scalp followed by the application of exosome topical therapy (ZISHEL XOMAGE, Zishel Bio Inc., Seoul, Republic of Korea). Hair density and patient satisfaction were evaluated through clinical assessments and photographic documentation at 1, 3, 6, and 12 months after treatment. Side effects were also monitored.

RESULTS

At the 12-month follow-up, the average increase in hair density was 35 hairs/cm2, with a standard deviation of 6.5 hairs/cm2. Baseline hair densities ranged from 75 hairs/cm2 to 95 hairs/cm2, with improvements observed in all patients. Patient satisfaction was high, with 80% of participants reporting noticeable improvements in hair regrowth and 87% indicating satisfaction or high satisfaction with the results. Mild side effects, including scalp tenderness and slight irritation, were reported but resolved within 48 hours.

CONCLUSION

Exosome therapy, in combination with microneedling, offers a promising non-surgical treatment for AGA, demonstrating significant improvements in hair regrowth and patient satisfaction. Further studies with larger samples and longer follow-up periods are needed to confirm the long-term efficacy of this approach.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Botulinum Toxin in the Treatment of Hair and Scalp Disorders: Current Evidence and Clinical Applications

Botulinum toxin (BoNT) is well-recognized throughout dermatology for its cosmetic indications and growing therapeutic value. Recent studies have trialed BoNT in the treatment of hair and scalp disorders, many of which lack long-term effective treatments and significantly impact quality of life. In this review, we summarize the current clinical literature on this topic to comprehensively evaluate the efficacy, safety, and clinical value of BoNT in treating hair and scalp conditions. A literature search on PubMed/MEDLINE and Scopus identified 40 articles reporting the use of 25-200 units of BoNT-A or B in 689 patients with hair loss (79.5%), scalp seborrheic dermatitis/hyperseborrhea (10%), craniofacial hyperhidrosis (9%), folliculitis decalvans/dissecting folliculitis (0.86%), scalp pain (0.43%), or linear scleroderma (0.29%). Most studies on BoNT therapy for androgenetic alopecia (AGA) reported mild or non-significant hair growth; however, considerable variability in outcome measures complicates the ability to draw definitive conclusions or justify the use of BoNT over established AGA therapies. BoNT-A and B showed consistent efficacy in treating craniofacial hyperhidrosis with minimal side effects. Additional scalp conditions may benefit from BoNT therapy, but the evidence is limited, and larger, controlled studies are needed to better understand BoNT's clinical value in these conditions.

The 100 most cited articles in androgenetic alopecia: A bibliometric analysis

Androgenetic alopecia (AGA) is a condition with a rapidly evolving research landscape. The expanding volume of AGA research necessitates synthesis to identify trends and gaps. Bibliometric analysis can be used to quantify the characteristics of a body of literature, and this technique has not been previously applied to AGA. We aimed to evaluate the bibliometric characteristics of the top 100 most cited AGA articles over the past 50 years. This includes the analysis of contributing authorship, institutional affiliation, journal representation, publication years, citation counts, country productivity, and funding sources, among other characteristics. We used the Web of Science to identify and characterize the 100 most cited AGA publications between 1975 and 2024. A secondary analysis was performed to identify and characterize the top 20 most cited AGA articles from 2020 to 2024. The top 100 articles amassed 24,289 citations. Authors from the United States contributed the most articles (n = 56). The University of Pennsylvania contributed the most articles (n = 11). Dr Elise A Olsen and Dr George Cotsarelis were the most frequent contributors. The Journal of the American Academy of Dermatology published the most number of articles. From 1975 to 2024, most studies primarily discussed pathophysiology (45%) and treatment (35%). However, from 2020 to 2024, 75% of the top articles focused on the treatment options. This bibliometric analysis provides an overview of influential AGA research over the last 50 years, highlighting shifting trends toward treatment optimization and emerging therapies.

A Pilot Randomized Controlled Trial (RCT) Evaluating the Efficacy of an Exosome-Containing Plant Extract Formulation for Treating Male Alopecia

Background/Objectives: Hair loss affects self-esteem, confidence, and psychological well-being. Exosomes, as molecular carriers of growth factors and active compounds, offer a promising treatment. This study evaluates the efficacy of an exosome formulation containing extracts from two known hair-regenerating plants, Ecklonia cava and Thuja orientalis (ECPE), for male pattern alopecia. Methods: A randomized controlled trial included 20 male participants with Norwood grade 2-3 androgenetic alopecia who were randomly assigned into two groups, placebo (0.9% sodium chloride) and ECPE, administered bi-weekly across four sessions. Evaluations included hair density measurements, adverse effect tracking, and self-assessments. Results: Most participants (55%) were aged 18 to 35, with 75% reporting hair loss for over a year and 80% noting scalp thinning. The hair counts showed no significant change in the placebo group from baseline to week 16 (Wilcoxon signed-rank test: V = 13.5, p = 0.163), while a significant increase was observed in the ECPE group (V = 0, p = 0.002). Between-group analysis revealed a significant difference in the hair count changes (Wilcoxon rank-sum test: W = 86.5, p = 0.006) with a large effect size (Cliff's Delta: & = 0.73, 95% CI: 0.41-0.89), with the ECPE group showing higher median hair growth (9.5, IQR = 16.88) compared to the placebo group (1.5, IQR = 3.00). A Bayesian ANCOVA, adjusted for covariates (the father's scalp hair condition, baseline hair count, and Norwood classification), showed no significant effect of these factors on the outcomes. Conclusions: These findings suggest that ECPE significantly improves hair regrowth compared to the placebo, with no notable adverse effects.

Efficacy and safety of topical finasteride spray solution in the treatment of Chinese men with androgenetic alopecia: A phase III, multicenter, randomized, double-blind, placebo-controlled study

BACKGROUND

Topical finasteride is a novel treatment for men with an androgenetic alopecia (AGA). This study aimed to evaluate the efficacy and safety of topical finasteride spray solution in Chinese men with AGA.

METHODS

This randomized, double-blind, placebo-controlled, phase III trial enrolled 270 individuals with AGA from 16 sites across China between December 2021 and March 2023. The participants were randomized at a ratio of 2:1 to receive either topical finasteride or placebo treatment once daily for 24 weeks. The primary endpoint was the change from baseline in target area (0.903 cm2 area) hair count at week 24. The secondary endpoints were change from baseline in target area hair count at week 12, target area terminal hair count at weeks 12 and 24, target area terminal hair width at week 24, and target area hair width at week 24; an improvement of vertex hair growth assessed by the investigator at week 24; and the patient-assessed scores on the Male Hair Growth Questionnaire at week 24.

RESULTS

A total of 270 individuals were enrolled and randomized and 251 completed the study. Compared with the placebo group, in the topical finasteride group, the change from baseline in target area hair count was significantly higher at week 24 (P <0.05), although it was only numerically higher at week 12 (P = 0.0688). Significant differences favoring topical finasteride over placebo were observed for change from baseline in target area terminal hair count at weeks 12 (P <0.05) and 24 (P <0.01). The improvement of vertex hair growth assessed by the investigator was significantly greater in the topical finasteride group vs. the placebo group at week 24 (P <0.01). Topical finasteride was generally safe and well-tolerated.

CONCLUSIONS

In Chinese men with AGA, topical finasteride spray solution increased hair growth and showed good safety and tolerability profile during a 24-week treatment period.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT05135468.

Assessment of androgenic hormones and other risk factors in Egyptian males with early onset androgenetic alopecia: a case control study

Early-onset androgenetic alopecia (AGA) is a common, hereditary hair loss condition in men, often starting in the early twenties. It involves gradual thinning of hair, influenced by genetics, hormones, and other factors like smoking and family history. Early identification of these risks could support timely intervention. This case control study aimed to evaluate androgen levels, specifically the free androgen index(FAI) and dehydroepiandrosterone sulfate ( DHEA-S), in males with early-onset AGA versus healthy age and sex matched controls. It also determined risk factors contributing to premature AGA in Egyptian males. This study included 40 male patients between 18 and 30 years with early-onset AGA and 40 age-matched healthy male controls. Risk factors and hormonal profiles including sex hormone binding globulin (SHBG), total testosterone (TS), DHEA-S as well as calculated FAI were compared between both groups using ELISA kit. Our study found that early-onset AGA is linked to a strong family history, smoking, coffee intake, hair straightener use, fast-food diets, and recent weight gain. Early-onset AGA patients also showed statistically significant lower SHBG levels and higher TS, DHEAS and FAI compared to healthy controls. These findings suggest that early-onset AGA is shaped by a complex interaction of different factors, highlighting the importance of a comprehensive approach and advice to patients as regards different risk factors.

Hair Longevity-Evidence for a Multifactorial Holistic Approach to Managing Hair Aging Changes

Loss of hair density-hair thinning and balding- is typically referred to as male and female pattern alopecia. Causes include genetic predisposition and links to the impact of dihydrotestosterone on the follicle dermal papilla, which are typically characterized by an increase in the number of vellus follicles. Links to chronological aging are unclear. Proven treatments remain few in number and are still targeting and tested on those experiencing classical pattern hair loss. The way hair changes with aging, especially in women, can be considered as having a much broader scope. Trends in managing changes to hair density, length, and fiber quality with aging now mostly include cocktail approaches-whether topical, injected, or oral-recognizing that solutions are more likely to require a multifactorial strategy. This review examines the evidence for the more holistic approach to addressing unwanted hair loss, which includes nutrition, lifestyle, stress management, and scalp and hair care, as well as co-morbidities with other health concerns. We discuss the strengths and limitations of clinical study design to investigate efficacy using multifactorial holistic approaches. We propose that this strategy will contribute to the emerging concept of hair longevity in which follicle, scalp, and fiber are targeted and that maintaining anagen is the most appropriate route to achieving healthy hair with aging. Finally, we discuss the problem facing patients and consumers regarding the quantity of misinformation and how it influences choosing from a fast-growing market of solutions that bypass a pharmaceutical approach to hair thinning.

Natural phenylethanoid glycoside forsythoside A alleviates androgenetic alopecia by selectively inhibiting TRPV3 channels in mice

Dihydrotestosterone (DHT), an androgen derivate, is known to be a key factor involved in androgenetic alopecia. DHT suppresses the growth of outer root sheath cells and induces apoptosis of hair keratinocytes, thereby causing hair follicle miniaturization and hair regrowth inhibition. Forsythoside A, a natural substance derived from Forsythia suspensa, has been shown to reduce DHT-induced apoptosis in human hair cells and suppress hair regrowth inhibition induced by DHT in mice. However, the molecular mechanism underlying the action of forsythoside A remains unclear. Here, we report that the alleviation of androgenetic alopecia by natural phenylethanoid glycoside forsythiaside A involves the selective inhibition of warmth-sensitive Ca2+-permeable transient receptor potential vanilloid-3 (TRPV3) channels. TRPV3 mRNA and protein expressions are upregulated in the skin of a mouse model of androgenetic alopecia induced by DHT. Ablation of the Trpv3 gene or subcutaneous injection of forsythoside A alleviates DHT-induced hair regrowth inhibition. In whole-cell patch clamp recordings, forsythoside A selectively inhibits macroscopic TRPV3 currents in a concentration-dependent manner with an IC50 value of 40.1 ± 4.8 μM. At the single-channel level, forsythoside A also reduces the channel open probability and open frequency without significantly altering the channel unitary conductance. Molecular docking combined with site-directed mutagenesis reveals two residues T636 and T665 critical for forsythoside A-mediated inhibition of TRPV3. Taken together, our findings demonstrate that TRPV3 inhibition is an important a mechanism by which natural forsythoside A ameliorates DHT-induced hair regrowth. Topical TRPV3 inhibitors may hold promise as a new therapeutic approach for treating androgenetic alopecia.

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.

Hair regeneration in androgenetic alopecia using secretome of adipose-derived stem cells (ADSC) and minoxidil: a comparative study of three groups

Androgenetic alopecia is one of the most common cause of hair loss disorder. This hereditary and androgen-dependent disorder tends to progress into partial or even complete baldness Several therapeutic options are now available for AGA, including conventional medications such as finasteride, dutasteride, and minoxidil. However, side effects of these medications are also commonly reported. The use of adipose derived stem cells and their secreted bioactive molecules, "secretome" has gained attention which could produce many effects for hair growth promotion and has been proven in clinical trials. This study aims to compare the effectiveness and safety of with minoxidil in androgenetic alopecia cases. 60 subjects were divided into three treatment groups (minoxidil only, secretome only, and combination of both) and were given intervention on week 0, 4, and 8. All subjects were evaluated by physical examination, photography, trichoscopy, and trichoscan until week 12. All groups showed a statistically significant improvement (p < 0.05) on hair growth parameters with the best improvement observed on week 12. The combination group had the best improvement substantially on hair growth parameters. Side effects are minimum and reported by the subjects in minoxidil group. Clinicaltrials.gov, NCT06066827. Registered 05 October 2023, Retrospectively. https://register.clinicaltrials.gov/prs/app/template/Home.vm?uid=U0004ES6_ts=7_sid=S000DOK9_cx=-igh2d .

Male androgenetic alopecia

Male androgenetic alopecia (MAA) is quite common and worsens with age, with a significant impact on quality of life, and is increasingly a reason for consultation with a dermatologist. The etiopathogenesis of MAA is multifactorial and genetic and hormonal influences stand out. MAA starts with the process of follicular miniaturization in diverse phenotypic patterns. The diagnosis of MAA is basically clinical and currently corroborated by well-established trichoscopic findings. Despite this, therapeutic options are limited, especially when one considers medications with a high level of scientific evidence. This review aims to help the general dermatologist towards a better understanding of MAA providing a basis for good individualized and judicious therapeutic decisions.

Epidemiological landscape of androgenetic alopecia in the US: An All of Us cross-sectional study

BACKGROUND

Androgenetic alopecia (AGA) is extremely prevalent with a multifactorial etiology.

MATERIALS

We conducted a cross-sectional study using the All of US (AoU) dataset Sept 2024 to better understand the epidemiology, social determinants and management of AGA.

RESULTS

Most males were 20-39 years old and females 60-69 years old. Men typically have an earlier onset of AGA than females. Male AGA is generally managed with finasteride; oral minoxidil is prescribed in younger males. Females are prescribed spironolactone and oral minoxidil with finasteride in post-menopausal females. There was very little dutasteride prescribed. Topical minoxidil is available over the counter and was not evaluated. Early in 2011 there were reports of the Post-Finasteride Syndrome (PFS); subsequently, the finasteride prescription rate fell to about 10-20% of the pre-PFS prescription rate. There was increased reporting for AGA in those who drink, have an annual household income ≥$75,000, and those with a higher level of education. There was also higher reporting of female AGA in those with anxiety and depression. Patients with higher income and education may have less pressing medical concerns enabling them to bring their AGA to the physician's attention. Females in whom the AGA affects their anxiety and depression may seek help for the AGA as a way to address their underlying disorder.

CONCLUSIONS

This study provides a snapshot of the epidemiology and management of AGA in the USA. AGA is linked to the social determinants of health; addressing the AGA may help better manage the underlying mental and physical state.

Black phosphorus nanosheets encapsulated microneedle for multifunctional therapy for androgenic alopecia

BACKGROUND

Androgenetic alopecia (AGA), a chronic and progressive disease, significantly impacts the patients' social, emotional, and mental well-being. Current treatment for AGA are mainly limited by drug side effects and the stratum corneum (SC) barrier of scalp.

RESULTS

To address these issues, we developed a microneedle (MN) system loaded with black phosphorus nanosheets (BP) encapsulating baicalin (BA), a natural ingredient, for effective treatment of AGA. We first fabricated BP-BA based on the BP properties of high drug loading capacity and excellent photothermal conversion efficiency. Upon 635 nm laser irradiation, BP-BA demonstrated efficient photothermal conversion to mild thermal of ~ 42 °C. This mild thermal effect controlled BA's stimuli-responsive release, enhanced cellular uptake, and effectively modulated gene expression in dihydrotestosterone-treated human dermal papilla cells, downregulating negative regulators such as SRD5A2, AR, DKK1, and TGFB1, while upregulating positive regulators like CTNNBIP1 and VEGFA. Furthermore, we encapsulated BP-BA to MN fabricating BP-BA@MNs to overcome the SC barrier. Compared with BP-BA@MNs without laser irradiation, BP-BA@MNs with laser irradiation significantly enhanced drug penetration into the subcutaneous area and accumulation at the follicular site. Importantly, BP-BA@MNs demonstrated synergistic efficacy against testosterone-induced AGA in vivo through combining BA chemotherapy, BP-mediated mild photothermal therapy, and MN delivery, as well as good biocompatibility and biosafety, and the underlying synergistic mechanism was elucidated in terms of follicular microenvironment reconstruction.

CONCLUSIONS

This combining BP mild photothermal and MN system is a promising approach for follicular targeted drug delivery, providing a multifunctional strategy for addressing the clinical needs of anti-AGA.

Changes and Correlation Between Hormones, Immunoglobulins, and Minerals in Blood Serum and Hair of Tianzhu White Yaks of Different Ages and Gender

(1) Background: Hair growth can function as an indicator of an animal's health and nutritional status, furnishing a valuable means for early diagnosis and timely modifications to management practices, and is influenced by hormones, the immune system, and the levels of minerals within the animal's body. (2) Methods: In this study, a total of 81 yaks were selected and divided into three groups according to their ages (1-2 years, 3-4 years, 5-6 years), and the concentrations of melatonin, dihydrotestosterone, IgA, IgG, and IgM in their blood serum and the levels of Ca, Mg, Zn, Fe, and P in both their blood serum and hair were detected. (3) Results: The levels of melatonin and dihydrotestosterone in yaks aged 1-2 years were significantly higher than those of other age groups (p < 0.001). In addition, the concentration of melatonin in male yaks was markedly greater than that in female yaks (p < 0.05). When it came to immunoglobulins, the IgA level in 1-2-year-old yaks was strikingly higher than those in yaks aged 3-4 years and 5-6 years (p < 0.05). In terms of mineral elements, the concentrations of calcium, magnesium, zinc, and iron in the blood serum of 1-2-year-old and 5-6-year-old yaks were significantly elevated compared to those in 3-4-year-old yaks. However, there was no notable difference between the 1-2-year-old and 5-6-year-old groups. The correlation analysis showed that there was a significant correlation between DHT and the levels of melatonin and IgA in yaks. Additionally, a significant correlation was observed between IgA and IgG, as well as between IgA and the levels of Fe, Mg, and Ca. It is likely that they jointly regulate the hair growth and immune processes of yaks. (4) Conclusions: There are positive correlations among melatonin, dihydrotestosterone, and IgA in the blood serum and the content of Fe and Mg in the hair to varying degrees, implying these indicators may jointly regulate yak hair growth and immune status. These research findings provide data support for applied research into evaluating the overall health status of yaks through the growth status of hair or by measuring the mineral content in hair in a non-invasive way.

Application of platelet-rich plasma lysate combined with hyaluronic acid microneedles for the treatment of alopecia

Androgenetic alopecia (AGA) continues to pose a significant challenge due to the paucity of effective therapeutic options. Upon lysis, platelet-rich plasma (PRP) releases numerous growth factors (GFs), which facilitate tissue reconstruction and hair regeneration. However, concerns such as infection, bleeding, local erythema, and patient anxiety associated with injections have substantially diminished patient acceptance. To address these issues, we developed a microneedle (MN) system loaded with PRP lysate (PL), termed PL-MN, designed to deliver GFs transdermal to sites of hair loss without inducing significant discomfort. The PL-MN not only exhibits a well-defined needle structure but also demonstrates excellent in vivo penetration and external transdermal efficacy. Upon skin penetration, the needle matrix rapidly dissolves, releasing GFs directly to the target site. In animal tests, the PL-MN shows synergistic effects by orchestrating an upregulation in the expression of Ki67 and CD31, which collectively foster cell proliferation and migration, thereby facilitating the expedited progression of hair follicles (HFs) into the anagen phase and promoting peripheral angiogenesis. Compared with minoxidil, the first-line clinical drug for treating AGA (administered once per day, 20 times in total), the PL-loaded MN could induce hair regeneration in mice with a lower frequency of administration (once every 3 days, 5 times in total). Consequently, such a safe and GFs-releasing MNs patch shows great potential for clinical AGA treatment.

Therapeutic Potential of Gynostemma pentaphyllum Extract for Hair Health Enhancement: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Hair health critically influences both aesthetic appearance and psychological well-being. Existing treatments often show limited efficacy and may cause side effects. Gynostemma pentaphyllum (GP), known for its antioxidant and anti-inflammatory properties, has emerged as a promising botanical agent, although clinical evidence regarding its hair health benefits remains limited. Purpose: This study aimed to evaluate the efficacy and safety of GP extract in improving hair parameters through a randomized controlled trial. Methods: This randomized, double-blind, placebo-controlled trial involved 100 eligible adults aged 19-60 years who were randomly allocated to either the GP or placebo group. Participants consumed 340 mL/day of the test product for 24 weeks. The primary outcomes included hair elasticity, density, diameter, glossiness, and subjective satisfaction. Safety was evaluated through laboratory tests and adverse event monitoring. Results: After 24 weeks, the GP group showed a threefold increase in hair elasticity and density and a fourfold increase in hair diameter compared to the placebo group. The subjective satisfaction scores corroborated these findings: the GP users reported better outcomes in terms of reducing hair damage and dryness. No significant differences in hair glossiness were observed based on the instrumental and visual assessments (p > 0.05). The safety evaluations revealed no severe adverse events. All the safety evaluation metrics demonstrated no significant abnormalities. Conclusions: This study provides compelling evidence of the efficacy of GP extract in enhancing hair health, demonstrating both significant functional improvements and an excellent safety profile. These findings substantiate its potential as a promising functional food ingredient for comprehensive hair care interventions.

Effect of Patient Age on Platelet-Rich Plasma (PRP) and Fibrin Treatments for Skin Density and Thickness: A Single-Center Ultrasound Study

OBJECTIVE

This study aimed to establish a reproducible protocol for obtaining four plasma fractions (autologous platelet-rich plasma (C-PRP, PRP LCC) and platelet-rich fibrin (I-PRF, F-PRF)) from a single blood draw and to evaluate their effectiveness in enhancing skin density and thickness in facial aesthetic treatments across different age groups.

METHODOLOGY

Twenty participants aged 30-60 years received three treatments at 4-6 week intervals, with C-PRP, PRP LCC, I-PRF, and F-PRF injections in targeted facial areas. Ultrasound measurements provided an objective method to assess the outcomes, and statistical analysis evaluated the changes in skin density and thickness. A comprehensive literature review contextualized our findings within the broader scientific discourse on PRP and PRF applications in aesthetic medicine.

RESULTS

The protocol successfully yielded four distinct plasma fractions from a single blood draw. Ultrasound and statistical analyses demonstrated significant improvements in skin density and thickness, particularly in the lower eyelid area. These improvements were consistent across all the age groups, suggesting that the therapy's effectiveness is independent of age. The findings also align with previous research, underscoring PRP's and PRF's roles in stimulating fibroblast activity, promoting collagen synthesis, and enhancing skin quality.

Caffeine as an Active Ingredient in Cosmetic Preparations Against Hair Loss: A Systematic Review of Available Clinical Evidence

Background/Objectives: Hair loss (alopecia or effluvium) can significantly affect the self-esteem and psychosocial well-being of patients, resulting in a reduced quality of life. It may herald a systemic disease, nutritional deficiency, or side effects of pharmacotherapy. Current therapeutic options for hair loss are not always satisfactory and may be associated with considerable side effects; therefore, new solutions are still sought. Caffeine seems to be an effective agent against hair loss thanks to its stimulating effects on cell growth and good penetration into the hair follicle. The aim of this study was to systematically review published clinical trials of topical caffeine preparations against hair loss. Methods: We searched PubMed, Scopus, and Web of Science for clinical trials investigating the efficacy of topical caffeine products in hair loss, published until 29 November 2024. The quality of evidence was assessed using the GRADE classification. Results: The query returned 1121 articles, of which 9 ultimately met the inclusion criteria. In total, 684 people with androgenetic alopecia, excessive hair loss, or hair thinning were included in these trials. In all studies, conclusions were in favor of topical caffeine treatment; however, the level of scientific evidence was medium in 3 studies, low in 1, and very low in the remaining 5. Their major flaws included the lack of randomization and placebo and control groups, as well as the lack of information on the caffeine concentration in the topical products. Conclusions: Results from studies published to date suggest that topical caffeine preparations are safe and effective against hair loss. Nevertheless, better-designed clinical trials of well-defined caffeine products are required for an ultimate statement. Commercial hair products with caffeine offered on the market nowadays may be worth a try, but due to incomplete scientific data and product information, satisfactory outcomes are not guaranteed.

Advancing Hair Regrowth Assessment: Development and Standardization of Methods for Evaluating New Hair Growth, Hair Keratin Levels, and Scalp Health in Androgenetic Alopecia Patients

Introduction Androgenetic alopecia (AGA) is a prevalent and progressive hair disorder affecting both men and women. It is characterized by the miniaturization of hair follicles, reduced hair density, and alterations in scalp conditions. Accurate assessment of hair growth parameters is crucial for understanding the progression of AGA and evaluating the efficacy of treatment interventions. This study aimed to develop and validate robust methodologies for assessing critical endpoints related to hair growth and scalp health. These standardized methods provide a reliable framework for future efficacy studies targeting AGA and similar hair disorders. Methods This method development and standardization study utilized an observational, non-interventional, open-label design and included 25 subjects diagnosed with AGA. Non-invasive techniques were employed to evaluate various hair parameters, including hair regrowth (vellus hair count), hair density, thickness, and total hair count, using the CASLite Nova phototrichogram software (Catseye Systems & Solutions Pvt Ltd, Navi Mumbai, India) and Image-Pro software (Media Cybernetics, Inc., Rockville, MD, USA) for precise analysis. Hair length was assessed using a calibrated ruler, while hair tensile strength was measured with the Testronix tensile hair tester (TX TST C, Testronix, Inc., Manila, PHL) instrument. Additional parameters, such as quantitative hair keratin levels and scalp keratin levels, were analyzed to provide an understanding of hair health. Baldness severity was evaluated using the Norwood-Hamilton scoring system for male participants and the Ludwig scoring system for female participants. Furthermore, a detailed visual hair distribution analysis was conducted. To minimize inter-evaluator variability, standardized training sessions were conducted, ensuring consistency across assessments. The reliability of the scoring systems was confirmed using the Fleiss Multirater Kappa test. This study received ACEAS Independent Ethics Committee (EC) approval on July 10, 2024. Results The vellus hair count, indicative of new hair growth, was found to be higher in AGA-affected areas, averaging 12.4 compared to 3.92 in the standardized area. Terminal hair counts were lower in AGA-affected areas, with 9.88 compared to 21.84 in the standardized area. Hair density (count/cm²) and thickness (µm) were significantly less in AGA-affected areas, with averages of 209.84 (count/cm²) and 6.64 µm, compared to 246.12 (count/cm²) and 9.16 µm in the standardized areas (p < 0.0001). Tensile strength was measured at an average of 344.14 MPa across samples. The Fleiss Multirater Kappa analysis showed high agreement between evaluators for Norwood-Hamilton (0.894) and Ludwig scores (0.957). Conclusion This standardization and validation study underscores the importance of developing and utilizing standardized methodologies in clinical research, particularly in hair and scalp health studies. The implementation of these accurate and reproducible techniques will enhance the reliability of efficacy data for both current and future AGA treatments while establishing a benchmark for advancing research in hair restoration and scalp health. These methodologies provide a reliable and scientifically grounded approach to studying hair regrowth, paving the way for evidence-based treatments that can address the diverse needs of individuals with AGA and other hair-related disorders.

Dual Wavelength LEDs Induce Reactive Oxygen Species and Nitric Oxide That Inhibit the Production of Dihydrotestosterone by 5-α Reductase

Androgenetic alopecia (AGA) causes balding in approximately 50% of adults. One primary cause of AGA is synthesis of dihydrotestosterone from testosterone by 5-α reductase. Systemic pharmaceutical interventions have potentially serious side effects, necessitating development of localized interventions. One such approach is administration of red light via low level light therapy (LLLT), which has promising clinical data. However, the LLLT mechanism of action remains unclear. We investigated the ability of LLLT to stimulate nitric oxide (NO) and the role of NO in inhibition of DHT synthesis. Our results show that red and red-orange light induce NO release in a cell-free platform. In A549 and HEK293T cells, we demonstrate 620 and 660 nm LED-emitted light stimulates the production of NO, reactive oxygen species (ROS), and decreases DHT synthesis. These results provide a plausible mechanism of action for LLLT employing LED-emitted red and red-orange wavelengths of light to treat AGA.

Oral Supplementation with l-Cystine, Serenoa repens, Cucurbita pepo, and Pygeum africanum in Chronic Telogen Effluvium and Androgenetic Alopecia: A Double-Blind, Placebo-Controlled, Randomized Clinical Study

Introduction

Chronic telogen effluvium (TE) and androgenetic alopecia represent two prevalent forms of hair loss that can significantly impact individuals' quality of life. Insufficiency of essential micronutrients has been associated with hair loss. The objective of this study was to evaluate the safety and efficacy of an oral supplement containing l-Cystine, Serenoa repens, Cucurbita pepo, Pygeum africanum, vitamins, and micronutrients in chronic TE (CTE) and androgenetic alopecia (AGA).

Methods

Eighty patients of both sexes aged 18-60 years with CTE or AGA were randomized to receive one capsule daily of the oral supplement or placebo for 6 months. Dermatological evaluations, clinical pictures and phototrichograms were done at baseline, 3 months and 6 months. The overall hair volume and appearance were assessed before and after treatment as well as subject's self-assessment via standardized questionnaire.

Results

Hair density increased by 9.9 hairs/cm2 after 3 months and 12.3 hairs/cm2 after 6 months in the oral supplement group and it is statistically significant when compared to placebo. Overall hair volume after 1, 3, and 6 months is better in the supplement group than in the placebo group. The oral supplement was well tolerated. No moderate or severe adverse events were reported.

Conclusion

Oral supplementation can increase hair density, anagen hairs, and overall hair appearance in patients with AGA or CTE.

A Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Safety and Efficacy of a Nutraceutical Supplement With Standardized Botanicals in Males With Thinning Hair

BACKGROUND

Hair thinning in men is a prevalent issue for which treatment oftentimes consists of a multi-modal approach. Targeting key root causes of hair thinning, such as hormones, stress, and metabolism through vitamins, minerals, and botanicals, has been shown to be effective in improving hair growth and quality in women. This approach could also be effective in improving hair growth and quality in men with thinning hair.

AIMS

This study investigates the safety and efficacy of a nutraceutical in improving hair growth and quality in men with thinning hair.

METHODS

This was a 6-month multi-center, double-blind, randomized, placebo-controlled trial. Men aged 21-61 years old with confirmed hair thinning were included. Subjects were randomized to receive the oral supplement or placebo. The study end points included changes in blinded Global Investigator Ratings for hair growth and quality, the Men's Hair Growth Questionnaire (MHGQ), and changes in the Arizona Sexual Experience Scale (ASEX) in the active group compared to baseline and placebo.

RESULTS

Daily intake of the nutraceutical resulted in significantly more subjects in the active group compared to the placebo rated as improved for hair growth and quality in the blinded investigator global assessments. Overall changes and responses to the MHGQ also corroborated blinded investigator ratings. There were no trends in either treatment group for changes in sexual function on the ASEX questionnaire, and the supplement was well tolerated.

CONCLUSIONS

Ingestion of a nutraceutical targeting key root causes of male hair thinning significantly improves hair growth and quality in men with no changes in sexual function.

Retinoic acid drives hair follicle stem cell activation via Wnt/β-catenin signalling in androgenetic alopecia

BACKGROUND

Depletion or permanent quiescence of the hair follicle stem cell (HFSC) pool underlies pathogenesis in androgenetic alopecia (AGA). Reactivation of quiescent HFSCs is considered an efficient treatment strategy for hair loss. The retinoic acid (RA) is critical to ensure stem cell homeostasis and function. However, little is known about whether RA regulates HFSC homeostasis. We aimed to investigate the impact of RA on HFSC homeostasis and the underlying mechanisms, in order to provide new potential targets for medical therapies of AGA.

METHODS

Microdissected hair follicles from the occipital and frontal scalp in AGA were obtained for RNA sequencing analysis and test. The C57BL/6 mice model in telogen was established to investigate the effect of exogenous RA. Miniaturized hair follicles from frontal scalp were incubated with or without RA in hair follicle organ culture to test the effects on hair shaft elongation, hair cycling and HFSC activities. A strategy to characterize the effect of RA on HFSC in primary culture was developed to identify novel mechanisms that control HFSC activation. A clinical study was performed to test the efficacy of RA treatment in AGA patients.

RESULTS

RA signalling was inhibited in the course of AGA pathogenesis along with HFSC dysfunction. Hair regeneration was retarded in AGA miniaturized hair follicles with RA deficiency, but they tended to recover after treatment with RA. In addition, RA treatment during the telogen phase facilitated HFSC anagen entry and accelerated hair growth. Mechanistically, RA promoted hair growth by stimulating stem cells via Wnt/β-catenin signalling and accelerating the transition from a dormant to an activated state. Furthermore, a clinical study suggested that RA has obvious advantages in the early intervention of AGA by reactivating HFSCs.

CONCLUSIONS

Our study provides insights into the reactivation of HFSCs in AGA and provides potential targets for medical therapies.

Designing, Optimising, and Assessing a Novel Emulgel Containing Minoxidil for Controlled Drug Release, Incorporating Marine-based Polymers

OBJECTIVE

This study aimed to develop an emulgel containing minoxidil as a drug for hair growth promotion in diseases, such as androgenetic alopecia, using gelling agents, such as chitosan and fucoidan.

METHODS

In this study, gelling agents were selected for the emulgel formulation. By various evaluation tests and through optimization, the chitosan-fucoidan combination was selected as the gelling agent for the preparation of emulgel using various evaluation parameters.

RESULTS

X2, the best emulgel formulation, contained 2.54 % chitosan and 0.896 % fucoidan. Chitosan prolonged the duration of drug release, and controlled release was obtained. Fucoidan increased the gelling activity, water absorption rate, and stability of the formulation. In this study, the X2 formulation showed the highest percentage of drug release at the 12th hour. It was found to be 99.7%, which followed the zero-order release model.

CONCLUSION

Owing to the wide range of biological activities of fucoidan, the loaded active substance can be protected, and at the same time, its potency can be improved, resulting in effective treatment. Because fucoidan has diverse properties and potential, it will be widely used in the biomedical and pharmaceutical industries in the future.

The Role of Mesenchymal Stem Cell-Derived Exosomes in Skin Regeneration, Tissue Repair, and the Regulation of Hair Follicle Growth

Skin regeneration, repair, and the promotion of hair growth are intricate and dynamic processes essential for preserving the overall health, functionality, and appearance of both skin and hair. These processes involve a coordinated interplay of cellular activities and molecular signaling pathways that ensure the maintenance and restoration of skin integrity and hair vitality. Recent advancements in regenerative medicine have underscored the significant role of mesenchymal stem cell (MSC)-derived exosomes as key mediators in these processes. Exosomes, emerging as a promising cell-free therapy in tissue engineering, hold substantial potential due to their ability to influence various biological functions. This review explores the mechanisms by which MSC-derived exosomes facilitate skin regeneration and repair, and hair growth, their therapeutic applications, and the future research directions in this emerging field.

Exosomes in stroke management: a promising paradigm shift in stroke therapy

Effective treatment methods for stroke, a common cerebrovascular disease with a high mortality rate, are still being sought. Exosome therapy, a form of acellular therapy, has demonstrated promising efficacy in various diseases in animal models; however, there is currently insufficient evidence to guide the clinical application of exosome in patients with stroke. This article reviews the progress of exosome applications in stroke treatment. It aims to elucidate the significant potential value of exosomes in stroke therapy and provide a reference for their clinical translation. At present, many studies on exosome-based therapies for stroke are actively underway. Regarding preclinical research, exosomes, as bioactive substances with diverse sources, currently favor stem cells as their origin. Due to their high plasticity, exosomes can be effectively modified through various physical, chemical, and genetic engineering methods to enhance their efficacy. In animal models of stroke, exosome therapy can reduce neuroinflammatory responses, alleviate oxidative stress damage, and inhibit programmed cell death. Additionally, exosomes can promote angiogenesis, repair and regenerate damaged white matter fiber bundles, and facilitate the migration and differentiation of neural stem cells, aiding the repair process. We also summarize new directions for the application of exosomes, specifically the exosome intervention through the ventricular-meningeal lymphatic system. The review findings suggest that the treatment paradigm for stroke is poised for transformation.

Efficacy and safety of compound glycyrrhizin combined with topical minoxidil for alopecia areata: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Alopecia areata (AA) is a common autoimmune skin disease. Our study aimed to systematically evaluate the efficacy and safety of compound glycyrrhizin (CG) combined with topical minoxidil therapy in treating AA.

METHODS

We searched the PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases. Randomized controlled trials (RCTs) on CG combined with topical minoxidil therapy compared with topical minoxidil therapy alone for AA were included. The Cochrane Collaborative Network Tool was used to assess the risk of bias. Statistical analysis was completed using RevMan5.3 software and Stata 15.0 software. The GRADE system was used to evaluate the quality of evidence for outcomes.

RESULT

11 RCTs and 1189 patients were included. Compared with topical minoxidil therapy alone, CG combined with topical minoxidil therapy was more effective at improving the clinical efficacy (RR = 1.36, 95% CI [1.27, 1.45], p < 0.00001). The SALT score (MD = -10.09, 95% CI [-12.89, -7.30], p < 0.00001), serum TNF-α levels (MD = -0.99, 95% CI [-1.19, -0.39], p < 0.00001), serum IL-12 levels (MD = -8.84, 95% CI [-11.20, -6.47], p < 0.00001) and serum IFN-γ levels (MD = -7.44, 95% CI [-11.51, -3.37], p = 0.0003) were reduced, and the serum TGF-β1 levels (MD = 2.40, 95% CI [1.24, 3.57], p < 0.0001) were increased. There were no significant differences in reported adverse events, including irritant contact dermatitis (RR = 0.51, 95% CI [0.25, 1.01], p = 0.05),' gastrointestinal reactions (RR = 2.47, 95% CI [0.49, 12.55], p = 0.28), lower limb edema (RR = 2.60, 95% CI [0.61, 11.06], p = 0.20), facial edema (RR = 2.33, 95% CI [0.61, 8.93], p = 0.22), or localized itching (RR = 0.56, 95% CI [0.18, 1.75], p = 0.32), between the two groups.

CONCLUSION

The current evidence indicates that CG combined with topical minoxidil therapy is effective and safe for AA. However, owing to the suboptimal quality of the included studies, more high-quality and large-scale RCTs are needed for comprehensive analysis and further validation.

Conductive Bio-Harvesting Tonic (CBT) with an Anti-Dandruff Effect Enhances Hair Growth by Utilizing Naturally Generated Electric Energy during Human Activities

Alopecia, while not life-threatening, significantly impacts mental health, identity, and self-esteem of those afflicted. Current pharmacological and surgical treatments often have side effects and are limited in their ability to regenerate hair follicles (HF). Therefore, effective solutions for alopecia remain elusive. We developed an innovative hair tonic capable of stimulating HF regeneration by harnessing abandoned electric energy generated during human activities, such as the frictional electric field from walking and the electric fields from electronic devices. We devised a convenient, non-volatile, and conductive hair tonic to capture these naturally occurring electric fields. We identified 6-pentyl-α-pyrone (6PP) from Trichoderma gamsii as an antifungal agent effective against the dandruff-associated fungus Malassezia that can influence alopecia and adopted it into our conductive bio-harvesting tonic (CBT). Testing on hair follicle dermal papilla cells (HFDPC) and SKH1 mice showed that CBT significantly enhanced HF proliferation and increased growth factors in vitro and in vivo. In SKH1 mice, application of CBT under electric stimulation visibly increased hair shaft length and follicle counts. Additionally, tests on actual human hair follicles demonstrated delayed hair follicle regression when electric stimulation and 6PP were applied. In conclusion, our innovative CBT offers a promising and convenient approach for improving hair growth and combating alopecia.

Using the follicular unit extraction technique in treatment of male androgenetic alopecia

BACKGROUND

The incidence of androgenetic alopecia in males is on the rise annually, with hair transplantation using follicular unit extraction (FUE) gaining increasing acceptance as an appropriate treatment for these individuals.

METHODS

A retrospective study was undertaken, involving 158 male patients diagnosed with androgenetic alopecia, who underwent treatment between January 2016 and December 2020 at the Medical Cosmetology Department of the First Affiliated Hospital of Xi'an Medical University. Demographic data and treatment characteristics were documented and analyzed. Clinical efficacy, operation-related complications, patient satisfaction rates, and quality of life scores were assessed and analyzed.

RESULTS

Following FUE hair transplantation, over 90% of the hair follicles survived in 158 patients, with more than 85% of patients achieving a hair follicle survival rate exceeding 95% at 12 months post-operation. Patient satisfaction rates exceeded 98%, while the complication rate was below 6%.

CONCLUSION

Our findings demonstrate that FUE is a minimally invasive hair transplant technique associated with a high hair follicle survival rate and optimal hair density. This approach proves effective in treating male androgenetic alopecia and merits further clinical application.

Efficacy of topical minoxidil in enhancing beard growth in a group of transgender assigned female at birth individuals on gender affirming hormone therapy

PURPOSE

Testosterone therapy represents the cornerstone of gender affirming hormone therapy (GAHT) among t-AFAB (transgender Assigned Female At Birth) people. Minoxidil is a vasodilator drug approved for topical use for the treatment of androgenetic alopecia. The aim of the present study was to evaluate the efficacy of topical minoxidil in enhancing beard growth in a group of t-AFAB people on GAHT.

METHODS

Sixteen t-AFAB individuals with an incomplete beard development, on GAHT for at least 6 months, were enrolled. Topical minoxidil was applied to the interested facial areas. Before starting (T0), after 3 (T3) and 6 (T6) months, we evaluated facial hair growth using the Ferriman-Gallwey modified score (FGm).

RESULTS

Subjects were 26 (2.7) years old and on GAHT for 18.5 [15-54] months; using a paired match evaluation, a statistically significant facial hair growth was observed over time, in particular at T6 (median upper lip FGm 3.5 [3-4] vs 2 [1-2] at T0 and chin FGm 4 [3.25-4] vs 1 [1-2] at T0; p ≤ 0.002). Comparing the minoxidil group with a control group (n = 16) matched for age and BMI who developed a full-grown beard only with GAHT, a logistic multivariable analysis identified hirsutism before GAHT was independently positively associated with the development of a full beard [OR 15.22 (95% CI 1.46-158.82); p = 0.023].

CONCLUSIONS

This is the first study demonstrating the efficacy of topical minoxidil in enhancing facial hair growth among t-AFAB people on GAHT. Further studies will be necessary to assess whether the obtained improvements will persist after discontinuing the medication.

Comparative proteomic analysis of male and female androgenetic alopecia: elucidating gender-specific molecular patterns

This study presents a comprehensive comparative proteomic analysis aimed at elucidating the molecular mechanisms underlying male androgenetic alopecia (AGA) and female AGA. Scalp samples from both male AGA and female AGA patients, along with their respective normal controls, were subjected to proteomic analysis, followed by bioinformatics investigations. Our findings revealed distinct proteomic profiles between male AGA and female AGA, with a total of 68 differentially expressed proteins identified in male AGA and 84 in female AGA. Among these, specific proteins were altered in male AGA and female AGA, highlighting the sex-specific molecular pathways involved in the pathogenesis of pattern hair loss. Protein-protein interaction network analyses further delineated the most impacted biological processes, including cytoskeleton organization, stress response, and metabolic pathways, with particular emphasis on the differing altered stress responses and metabolic states associated with hair loss between sexes. Our study not only uncovered the complex molecular landscape of male AGA and female AGA but also identified potential biomarkers and therapeutic targets, offering new insights into the sex-specific pathogenesis of pattern hair loss.

Hair Growth Effect and the Mechanisms of Rosa rugosa Extract in DHT-Induced Alopecia Mice Model

Rosa rugosa is a medicinal plant known for its potential anti-inflammatory, antioxidant, anti-cancer, and antimicrobial benefits. The pharmacological effects of Rosa rugosa extract on hair loss have not yet been documented. This research sought to assess the inhibitory effects and mechanisms of action of Rosa rugosa water extract (RWE) in a mouse model of dihydrotestosterone (DHT)-induced alopecia. The study was conducted using C57BL/6 mice, which were assigned to five groups: control, DHT-treated, Rosa rugosa water extract (RWE) at doses of 25 mg/kg and 100 mg/kg body weight, and bicalutamide-treated. To induce hair loss, dihydrotestosterone (1 mg/day per body weight) was administered via intraperitoneal injections, and dorsal hair removal was timed to align with the telogen phase. Each group received oral treatments for a period of 23 days. In this study, we assessed hair growth activity, examined histological changes, and performed immunoblot analysis. We noted improvements in hair length and thickness. Additionally, the protein expression of growth factors associated with hair growth, including vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and insulin-like growth factor-1 (IGF-1), showed significant increases in the group treated with RWE. Additionally, treatment with RWE suppressed the protein expression of hair growth inhibitory factors, including dickkopf WNT signaling pathway inhibitor 1 (DKK1) and interleukin (IL)-6. Moreover, hair growth regulatory pathway related factors, including ERK, AKT, and GSK-3β, were activated. These findings indicate that RWE could serve as a promising natural therapy for preventing hair loss by enhancing the production of factors that promote hair growth while inhibiting those that suppress it.

Dermal Papilla Cells: From Basic Research to Translational Applications

As an appendage of the skin, hair protects against ultraviolet radiation and mechanical damage and regulates body temperature. It also reflects an individual's health status and serves as an important method of expressing personality. Hair loss and graying are significant psychosocial burdens for many people. Hair is produced from hair follicles, which are exclusively controlled by the dermal papilla (DP) at their base. The dermal papilla cells (DPCs) comprise a cluster of specialized mesenchymal cells that induce the formation of hair follicles during early embryonic development through interaction with epithelial precursor cells. They continue to regulate the growth cycle, color, size, and type of hair after the hair follicle matures by secreting various factors. DPCs possess stem cell characteristics and can be cultured and expanded in vitro. DPCs express numerous stemness-related factors, enabling them to be reprogrammed into induced pluripotent stem cells (iPSCs) using only two, or even one, Yamanaka factor. DPCs are an important source of skin-derived precursors (SKPs). When combined with epithelial stem cells, they can reconstitute skin and hair follicles, participating in the regeneration of the dermis, including the DP and dermal sheath. When implanted between the epidermis and dermis, DPCs can induce the formation of new hair follicles on hairless skin. Subcutaneous injection of DPCs and their exosomes can promote hair growth. This review summarizes the in vivo functions of the DP; highlights the potential of DPCs in cell therapy, particularly for the treatment of hair loss; and discusses the challenges and recent advances in the field, from basic research to translational applications.