Design, proof-of-concept of single robotic hair transplant mechanisms for both harvest and implant of hair grafts

The design and development of a prototype for a singular robotic hair transplant system capable of harvesting and implanting hair grafts were executed in this study. To establish a proof-of-concept for hair transplant procedures involving harvesting and implantation, a test system using a spherical phantom of the scalp was selected. The developed prototype of the robotic hair transplant system demonstrates the potential to reduce the duration that grafts remain without a blood supply, thereby minimizing hair graft damage. Additionally, the overall operation time for follicular unit extraction is comparatively shorter than that of conventional systems. Results from the robot vision tests indicate an 89.6% accuracy for hair graft detection with a 4 mm hair length phantom and 97.4% for a 2 mm hair length phantom. In the robot position control test, the root mean square error was found to be 1.268°, with a standard error of the mean of 0.203°. These outcomes suggest that the proposed system performs effectively under the conditions of a spherical phantom with a 2 mm hair length and a 5 mm distance between harvests.

Characteristics of hair loss in COVID-19 patients in Thailand

There is still a scarcity of data on hair loss caused by coronavirus disease 2019 (COVID-19) infection. This study aims to determine the characteristics of hair loss in Thai individuals after COVID-19 infection and to identify associated factors. From March to June 2022, a retrospective review of medical records and telephone interviews was conducted to determine the details of hair loss, the severity of infection, and the associated treatments of patients with an abrupt onset of hair loss after the diagnosis of COVID-19 infection at Siriraj Hospital in Bangkok, Thailand. This study included 43 patients who experienced hair loss within 4 months after COVID-19 infection. The mean age was 46.5 ± 14.5 years, predominantly women. Most had mild COVID-19 symptoms (59.3%), and 59.1% experienced weight loss, with a mean weight loss of 4.3 ± 2.0 kg per month. Preexisting hair loss was reported in 31.0% of participants, with approximately 3-quarters diagnosed with androgenetic alopecia. The median onset of hair loss after COVID-19 infection was 30 days (interquartile range 30-60). Telogen effluvium was the most common acute hair loss diagnosis, and topical minoxidil was the predominant treatment (95.3%). Female gender was correlated with a more severe shedding scale (adjusted odd ratio 24.76, 95% CI 1.67-168.86). Patients with a history of androgenetic alopecia tended to have a lower hair shedding scale (adjusted odd ratio 0.03, 95% CI 0.01-0.38). This study reviewed the characteristics of hair loss after COVID-19 infection during Omicron outbreaks in Thailand. The COVID-19-associated telogen effluvium, which is the primary cause in our patients, manifested with earlier onset at approximately 30 days.

Effect of Platelet-Rich Plasma and other Key Factors on Hair Follicle Preservation

Background

Hair graft preservation is an important factor that influences graft survival in hair transplantation.

Objective

To investigate the benefits of adding platelet-rich plasma (PRP), and the effect of different storage solutions and temperatures on hair follicle preservation.

Materials and Methods

This randomized-controlled study included 10 androgenetic alopecia patients who underwent hair transplantation. Forty-five hair grafts were collected from each patient and then randomized to 8 different culture conditions for 7 days. Hair grafts were cultured in Williams' Medium E or Ringer's lactate solution (RLS) at either 4°C or 37°C, and with or without 10% PRP supplementation.

Results

In vitro hair growth in Williams' Medium E was significantly greater than in RLS. The 37°C temperature condition was found to be significantly better than the 4°C condition. The growth of hair grafts cultured with PRP was not significance difference from those without PRP. However, immunofluorescence staining for cytokeratin 15 showed greater expression in hair graft cultured with PRP.

Conclusion

PRP may have a beneficial effect for preserving the viability of hair grafts. Williams' Medium E and 37°C temperature were found to be superior to RLS and 4°C relative to hair follicle growth in organ culture.

Evaluation of Hair Follicle Counts of Occipital Scalp Biopsies from Male Hair Transplant Patients in Thailand

Objective: To evaluate the average hair follicle count from the occipital scalp of Thai males with AGA who were candidates for hair transplantation. Materials & Methods: A cross-sectional study of 47 male with AGA undergoing hair transplantation surgery was conducted.  The 4-mm punch biopsies from the occipital scalp were evaluated for hair count parameters. The results were compared to prior studies. Results: The average counts of total hair follicles and the density of hair follicle per square millimeter were 18.6±1.2, and 1.5±0.1, respectively. The terminal-to-vellus ratio was 11.1, and the percent ratio of anagen-to-telogen ratio was 91.9:8.1. The hair count number is significantly lower than other ethnicities including Thais in general population (P < 0.001), but greater than the Thai males with AGA in the previous study. (P < 0.001). Conclusion: Our study showed a lower average hair density as compared to the other normal Asian population.  The total hair count in the occipital area from this study is less when compared to the previous studies conducted in Thai normal controls but higher than those with more advanced AGA. This result supported the evidence of hormonal effect involving the occipital scalp of male AGA.  

Diphenylcyclopropenone Treatment Outcomes for Alopecia Areata

Objective: To ascertain (1) Diphenylcyclopropenone (DCP)’s efficacy in treating alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) in Thai patients; and (2) prognostic factors. Materials & Methods: We retrospectively reviewed the medical records of patients with AA, AT, and AU who were administered DCP at Siriraj Hospital, Bangkok, Thailand. The median response and relapse times of the 3 groups were evaluated. Factors affecting outcomes were investigated. Results: Fifty-nine cases were enrolled (AA, 22; AT, 9; AU, 28), with women predominating in each group. The overall response was 61% (AA, 78.6%; AT, 66.7%; AU, 50%). The median response time was 58 weeks, with a significantly longer time for AU than AA (P = 0.006). Factors significantly influencing response to DCP, evaluated by multivariate analysis, were older age at onset (P = 0.02), disease duration before DCP initiation (P = 0.003), and treatment duration to initial hair regrowth (P = 0.001). The overall relapse rate was 63.9%, with a median of 39 weeks between response and relapse. The most common side effect was blistering (73.7%). Conclusion: DCP is effective and safe for treating extensive AA. Favorable prognostic factors are low disease severity, late disease onset, short duration before DCP treatment, and short duration to initial response. As the relapse rate is high, maintenance therapy should be considered.

Effects of Music on Preoperative Anxiety in Patients Undergoing Hair Transplantation: A Preliminary Report

Objective: To study the effects of music on anxiety in patients undergoing hair transplantation.Materials and Methods: This randomized controlled trial enrolled patients undergoing hair transplantation. The patients were randomized into a music group, who listened to music for 15 minutes during the preoperative period, and a control group, who were not exposed to music. Two scales were used to measure anxiety. One was the State-Trait Anxiety Inventory (STAI), comprised of a state anxiety scale (STAI-S) and trait anxiety scale (STAI-T). The other was the Visual Analog Scale for Anxiety (VASA). Demographic and physical parameters (blood pressure, heart rate, and respiratory rate) were recorded.Results: The 26 patients had a mean age of 40.8 ± 10.4 years. Twenty-three (88.5%) were men. The 2 groups had no significant differences in their STAI-S or VASA scores, or physical parameters before and after intervention. TheSTAI-S score of the control group significantly increased with time (P = 0.027). Additionally, a significant decrease in the VASA score was observed after the intervention for the music group (P = 0.039). No adverse events were noted.Conclusion: Listening to music is an easy, effective, and safe method of reducing preoperative anxiety in patients undergoing hair transplantation. The method should be employed during the preoperative period for patients undergoing hair transplantation. It may also be considered for use in similar procedures.

A New Universal Follicular Unit Excision Classification System for Hair Transplantation Difficulty and Patient Outcome

Introduction

The difficulty of the follicular unit excision (FUE) hair transplantation procedure is currently attributed to hair curliness and subsurface angulation. Patients possessing the curliest hair shafts are considered the most challenging. Consequently, patients with these features are often denied FUE. However, this practice does not consider intrapatient variation in the graft attrition rate and the rates themselves, which are frequently low in very curly hair where the skin firmness/thickness is average. To better aid practitioners in predicting FUE performance, we have developed a new scoring system (the Sanusi FUE Score Scale [SFS Scale]) based on two major donor variables (hair and skin characteristics).

Material and Method

The scale assigns scores to each of three hair subtypes (straight-wavy, curly, and coily-kinky) and each of three skin subtypes (thick/firm, soft/thin, and medium thickness/firmness). The scores were weighted based on the assessment of 13 experienced FUE practitioners from around the globe, who were asked to score each of the three skin and hair characteristics for their contribution to FUE difficulty.

Results

On the contribution of skin characteristics to FUE difficulty, 12/13 (92%) practitioners assigned the highest (most difficult) score to thick/firm skin, with medium skin thickness/firmness being the least challenging. The same percentage of practitioners gave the highest difficulty score to coiled-kinky hair subtypes regarding the contribution of hair characteristics to FUE difficulty. All agreed that straight-wavy hair presents the least challenge to FUE performance. Tallying the scores of the skin and hair variables generates a final score range of 2–9, which is associated with five grades/classes of challenge in the FUE procedure, influencing the need for a specialized skill/nuanced approach or equipment.

Conclusion

We developed a universal FUE donor scoring scale that accounts for the diversity of human hair and skin types. Further evaluation to determine the validity of this new classification system in predicting and grading FUE difficulty and patient outcomes is warranted.

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Topical diphenylcyclopropenone plus topical 0.5% anthralin versus topical diphenylcyclopropenone alone for the treatment of chronic extensive alopecia areata: A split-scalp, double-blind, controlled study

Background:

The combination of diphenylcyclopropenone (DCP) and anthralin may demonstrate synergistic effects in the treatment of chronic extensive alopecia areata (AA).

Objective:

The objective of the study was to compare the efficacy of the combination therapy of topical DCP and topical 0.5% anthralin versus topical DCP alone for the treatment of chronic extensive AA.

Materials and Methods:

Ten patients were included in the study. Of these, 1, 2, and 7 patients were diagnosed with alopecia totalis, severe AA (>50% hair loss), and alopecia universalis, respectively. For each patient, one side of the scalp was treated with a DCP solution and 0.5% anthralin for 6 months, while the other side was treated with DCP and a cream base for the same duration. The clinical responses were assessed at baseline and then monthly until the end of the 6-month study period using the Severity of Alopecia Tool score. The side effects were evaluated at each follow-up visit.

Results:

The difference in the efficacies of the combination treatment and DCP alone was not statistically significant (P = 0.59). Regarding the side effects, DCP plus 0.5% anthralin caused significantly more excessive dermatitis than DCP alone (7 patients vs. 2 patients; P = 0.02). Eight patients reported temporary hyperpigmentation at the combination-treatment site, whereas no hyperpigmentation was reported at the DCP-alone site of any patient (P < 0.001).

Conclusions:

The combination of DCP and 0.5% anthralin was not superior to DCP alone for the treatment of chronic extensive AA. An increase in side effects – excessive dermatitis and hyperpigmentation – was observed in the combination-treatment group.

Clinical Characteristics of Female Patterned Hair Loss in Patients Attending Hair Clinic in Thailand

Objective: To study the clinical features and associated factors of female pattern hair loss (FPHL) in premenopausal and menopausal women patients. Materials and Methods: This is a retrospective chart review of FPHL patients visited hair clinic, Siriraj Hospital from June 2012 to May 2015. Demographic data, family history and history of hair loss were evaluated. Factors associated with FPHL were analysed. Results: There were 267 patients (180 premenopausal women and 87 menopausal women) in this study. The mean age of onset of patients was 35.5±12 years (premenopausal FPHL) and 60.5±7 years (menopausal FPHL). Positive family history of androgenetic alopecia (AGA) was 48.3%, mainly in first-degree relatives. The data showed an increased incidence of FPHL with advancing age. The most common presentation is Ludwig grade I. The study showed that patients also have dyslipidemia (16.9%), hypertension (16.5%), diabetes mellitus (10.9%), hypothyroidism (4.9%), anemia (3.7%), and hyperthyroidism (2.9%). In multivariate analysis, significant associations were found between low ferritin level < 70 µg/L and premenopausal FPHL (OR 5.51, 95% CI 2.26-15.14, P = 0.01). Conclusion: Maternal family history of AGA seems to have a greater influence on premenopausal FPHL. Low serum ferritin levels < 70 µg/L were significantly associated with FPHL in premenopausal women.

Use of facial care products and frontal fibrosing alopecia: Coincidence or true association?

The increasing incidence of frontal fibrosing alopecia (FFA) suggests that environmental factors may be related to the pathogenesis. Recent studies reported potential association between the use of facial care products and FFA. The aim of this study was to investigate the possible association between the use of facial care products and FFA in Asian females. A total of 250 females (50 FFA patients, 100 pattern hair loss [PHL] patients, and 100 normal controls) were recruited and completed a questionnaire to obtain information approximately facial care products and various environmental factors. Our study revealed the use of moisturizer to be significantly higher in the FFA group compared to normal controls (p < 0.001), and sunscreen use was significantly higher in the PHL group than in the control group (adjusted p < 0.001). Subjects with FFA or PHL reported significantly higher use of both sunscreen and moisturizer compared to normal controls (p < 0.001). This study focused on Asian populations. Our results revealed a high frequency of moisturizer and sunscreen use in both FFA and PHL among Asian females. Therefore, the use of facial care products appears not to be linked to the true disease mechanism of FFA, but rather to appearance-related concerns of patients.

Synthetic hair reactions and treatment of complications: Case reports

BACKGROUND

Synthetic hair fiber implantation first achieved widespread use in the 1970s, but in 1983, the US Federal Drug Administration banned the fibers due to its complications. Currently available synthetic fibers consist of polyamide material, which has been claimed to be effective and safe. Nevertheless, its use for hair restoration is controversial because of complications such as recurrent infections; the rejection and the faster-than-anticipated loss of fibers; frequent allergic reactions; fears about carcinogenicity; cicatricial alopecia; granulomatous hypersensitivity; and cyst formation.

AIMS

To report complications of synthetic hair implantation and treatments.

METHODS

We report the clinical data, pathological studies, and treatment outcomes of two patients who developed complications after a synthetic hair implantation.

RESULTS

Our case reports showed significant moderate-to-severe adverse events, including recurrent folliculitis, scalp crusting, scarring, the matting and breakage of fibers, and granulomatous reactions. The onset of the reactions varied between 1 and 8 weeks. Pathological studies showed that the implantation of the synthetic hair into the scalp produced a hyperplastic proliferation of epidermal cells, foreign body granuloma, and persistent acute inflammation due to bacterial infections. In our study, definitive treatment was ineffective until the synthetic fibers were removed from the scalp.

CONCLUSION

These significant adverse reactions may limit the benefits of synthetic hair fiber implantation for some patients. Although the inflammations were initially controlled by oral and topical antibiotics, a variety of antibiotics were unable to control the folliculitis. The fibers were ultimately removed, following which, the inflammations improved.

Generation of an integration-free human induced pluripotent stem cell line MUSIi010-A from occipital scalp fibroblasts of a male patient with androgenetic alopecia

An induced pluripotent stem cell (iPSC) line, MUSIi010-A, was established by Sendai virus (SeV) transduction of scalp fibroblasts from a 59-year-old male with androgenetic alopecia (AGA). Pluripotency of the iPSC line was verified by immunofluorescence staining of pluripotent markers and by in vitro trilineage differentiation. The MUSIi010-A line was shown to retain normal karyotype and free of SeV vectors at passage 17. This iPSC line can be used for studying pathological mechanisms of AGA.

Comparison of salicylic acid 30% peel and pneumatic broadband light in the treatment of mild to moderately severe facial acne vulgaris

Acne patients experience not only a medical disease but also an aesthetic condition, and this latter complication greatly motivates patients to seek out the best treatment regimen to hasten improvement in their appearance. The available clinical procedures for acne treatment include salicylic acid 30% peel and pneumatic broadband light (PBBL). The objective of this study was to compare the efficacy of salicylic acid 30% peel and PBBL treatments in patients with mild to moderately severe facial acne vulgaris. Twelve patients were recruited for a 12-week prospective, single-blind, randomized, split-face study. Patients were treated with a salicylic acid 30% peel on one side of the face and PBBL treatment was administered on the opposite side of the face for 6 consecutive weeks without other acne treatments. At every visit, treatment evaluations were performed using a modified Global Acne Grading Score (mGAGS), acne quality of life (QOL) questionnaire, Wong-Baker FACES Pain Rating Scale (WBPRS) assessments, and clinical photography. Improvement in acne symptoms was observed for both treatment procedures without significant differences and with minimal side effects. Salicylic acid 30% peel and PBBL were well tolerated in our study, and both clinical procedures were efficacious and well-tolerated by the patients.

A Comparative Study between the Efficacy and Safety of 5% Minoxidil Solution and 5% Minoxidil Milky Lotion in the Treatment of Male Androgenic Alopecia

BACKGROUND

5% minoxidil solution is approved for the treatment of male androgenetic alopecia (AGA). However, there have been occasional reports of adverse events that were caused mostly by propylene glycol sensitivity. As an alternative treatment, Siriraj hair team developed a proprietary preparation referred to as “minoxidil milky lotion” that uses butylene glycol as a substitute for propylene glycol.

OBJECTIVE

To compare the efficacy and safety of 5% minoxidil solution with 5% minoxidil milky lotion in the treatment of male AGA.

MATERIALS AND METHOD

Twenty males with AGA were recruited for this prospective randomized study. Subjects were randomly treated with 5% minoxidil solution or 5% minoxidil milky lotion. Clinical outcomes and adverse events were recorded at 8, 16, and 24 weeks.

RESULTS

The mean age of subjects was 43.5±12.5 years (range, 26-65 years). Percentage increase in hair density at 8 weeks after receiving 5% minoxidil solution and 5% minoxidil milky lotion was 8.8% and 37.4%, respectively (p = 0.01). However, there was no statistically significant difference between the two preparations at the 16 and 24 week visits. Mild irritation was reported in 1 case in the 5% minoxidil milky lotion group.

STUDY LIMITATION

Small sample size.

CONCLUSION

Both formulations were found to be effective and safe in the treatment of male AGA. 5% minoxidil milky lotion may be an alternative treatment in propylene glycol-sensitive patients, with efficacy that is comparable to that of 5% minoxidil solution.

Multi-Concentration Level Patch Test Guided Diphenyl Cyclopropenone (DPCP) Treatment in Alopecia Totalis or Alopecia Universalis

BACKGROUND

Diphenylcyclopropenone (DPCP) has proved to be effective in alopecia areata. The present study aimed to shorten the treatment duration of DPCP for achieving optimal outcomes.

OBJECTIVE

To evaluate the efficacy of multi-concentration level patch test guided DPCP treatment against conventional protocol by measuring percentage of hair regrowth and duration of treatment.

MATERIAL AND METHOD

The scalp was divided into experimental and control sites. Conventional DPCP sensitization and experimental patch test with multi-level of DPCP concentration were applied in 20 alopecia totalis or universalis patients. The percentages of hair regrowth were evaluated.

RESULTS

Five patients achieved complete response within 34 weeks. Mean duration of the experimental sites was shorter although there was no significant difference. Reported complications of both groups were vesicle formation, generalized eczema and folliculitis.

CONCLUSION

Patch test guided DPCP therapy may be a new regimen for alopecia areata treatment because of shortening treatment duration without increasing complications.

A light-emitting mouse to image skin inflammation

BACKGROUND

The mouse ear swelling test is a well-accepted method for quantitating the inflammatory response to contact irritants and sensitizing agents. However, this assay measures edema rather than the cellular component of skin inflammation.

OBJECTIVE

To develop a quantitative and noninvasive assay of inflammatory cell infiltration in contact dermatitis.

METHODS

We bred a transgenic bioluminescent mouse that emits light proportional to cutaneous infiltration of inflammatory cells. We characterized this model by correlating luminescence with edema and histologic analysis of affected skin. A mouse strain expressing cyclization recombinase enzyme (cre) recombinase exclusively in myeloid cells was crossed with a reporter strain containing an inactivated form of the luciferase gene. In progeny mice, cre-mediated recombination repaired the luciferase gene, causing light emission from myeloid cells. Light emission and swelling from the inflamed ear was quantitated and compared to the contralateral ear.

RESULTS

Light intensity correlated with the inflammatory cell infiltration in the dermis. In sensitized mice challenged with squaric acid, luminescence increased about 2.2-fold while swelling increased about 1.5-fold.

CONCLUSION

Our model may serve as a useful screening assay for topical antiinflammatory molecules. Moreover, this approach allows real-time imaging of skin infiltration by specific inflammatory cell lineages in living animals.