Platelet-Rich Plasma: Advances and Controversies in Hair Restoration and Skin Rejuvenation

BACKGROUND

Platelet-rich plasma (PRP) and its combined therapeutic modalities have catalyzed new possibilities in dermatology; however, limitations in evidence and lack of consensus remain among clinicians regarding optimal composition, protocol, technique, and application.

OBJECTIVE

To provide an update and analysis of the evidence for PRP in hair restoration and skin rejuvenation through review of recent available data, highlighting controversies and expert insights to guide future studies, and stimulate discourse and innovations benefitting patients.

METHODS

A structured review and expert analysis of PubMed publications before October 2023, with a focus on recent literature from January 2020 through October 2023.

RESULTS AND CONCLUSION

Growing literature supports the utility and benefits of PRP and related autologous products for applications for skin and hair, with strongest evidence for androgenetic alopecia and skin rejuvenation. However, this is limited by lack of consensus regarding best practices and protocols. Randomized, controlled trials with uniform metrics comparing outcomes of various compositions of autologous blood products, preparation methods, dosimetry, and frequency of treatments are still required. This will allow the medical discourse to grow beyond the realm of expert opinion into consensus, standardization, and more wide spread adoption of best practices that will benefit patients.

Safety and Efficacy of Minoxidil Treatment in Scarring Alopecia: A Scoping Review

BACKGROUND

Topical minoxidil (TM) has been a cornerstone in treating various hair loss disorders, while low-dose oral minoxidil (LDOM) is emerging as an effective alternative. Despite their widespread use, there is a notable gap in the literature regarding their use in treating scarring alopecia.

OBJECTIVE

This study evaluates the efficacy and safety of TM and LDOM in managing scarring alopecia.

METHODS

A systematic literature search identified relevant studies on TM and LDOM use in central centrifugal cicatricial alopecia, frontal fibrosing alopecia, lichen planopilaris, and traction alopecia. Key metrics included disease stabilization, hair thickness improvement, hair regrowth, and side effect profiles.

RESULTS

Analysis of the selected studies revealed mixed outcomes. Most participants experienced benefits in terms of disease stabilization and hair regrowth with TM and LDOM. The majority of cases reported good tolerability of the treatment, although some side effects were noted.

CONCLUSION

TM and LDOM show promise in scarring alopecia treatment, demonstrating benefits in disease stabilization and hair regrowth. Despite these positive indications, the variability in results and reported side effects underline the need for further research to establish their consistent efficacy and safety profiles in scarring alopecia treatment. J Drugs Dermatol. 2024;23(3):     doi:10.36849/JDD.7743.

Photobiomodulation and alopecia: a crowdsourced survey study on patient preferences

Photobiomodulation is a treatment option for hair loss and is currently FDA cleared for androgenetic alopecia. There are a variety of photobiomodulation devices intended for at-home patient use. However, data examining user preferences is lacking. A social media-based, online survey study was completed to understand patient preferences when selecting a photobiomodulation device. Secondary outcomes examined patient experience with the device. Sixty participants responded to the 21-question survey. The majority of participants had never used a photobiomodulation device (n = 50; 86.2%). Most respondents (n = 40; 67.8%) felt the efficacy of the device was the most important aspect to consider when selecting a photobiomodulation device. Additionally, a majority of participants thought 15 (n = 22; 37.3%) or 20 minutes (n = 17; 28.8%) would be a reasonable treatment duration and would prefer a hand-free device (n = 51; 86.4%). Of the eight participants who had used a photobiomodulation device, only one was dissatisfied with the device and discontinued treatment.

An Analysis of the Content and Recommendations of 700 American Tattoo Aftercare Instructions

BACKGROUND

Tattoo aftercare instructions describe how to care for a new tattoo. Unfortunately, tattoo artists often base their advice on personal experience rather than best practices in medical wound management. The diversity of recommendations in these instructions is currently unknown.

OBJECTIVES

Our review was performed to determine current recommendations in tattoo aftercare instructions in the United States.

METHODS

Using a Google search, a total of 700 aftercare instructions from all 50 states and Washington D.C. were collected and their contents analyzed.

RESULTS

Most instructions encouraged washing new tattoos with antibiotic soaps, including chlorhexidine, and 14.9% encouraged using topical antibiotics. Few instructed individuals to wash their hands before touching a healing tattoo. A total of 70 moisturizers were recommended. Of these, 22 were niche products made specifically for tattoo aftercare. Only a subset of instructions provided parameters about when to contact the tattooist (49.9%) and/or a physician (19.4%) should there be a complication in the healing process.

CONCLUSION

The content and recommendations of the 700 instructions vary tremendously. Many lacked instructions on appropriate hygiene and when to seek medical care. As skin and wound care experts, there may be an opportunity for the dermatology community to partner with tattooists to create more useful evidence-based tattoo aftercare practices.

Medical and procedural treatment of androgenetic alopecia - Where are we?

Novel medical and procedural options for androgenetic alopecia have arrived. Low-dose oral minoxidil has made its clinical debut, while data on spironolactone, finasteride, and nutritional supplements have advanced. Minimally invasive technological advancements include photobiomodulation and platelet-rich plasma. Within hair transplantation, follicular unit extraction and robotics are now at the clinicians' fingertips.

Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

Systematic review of photodynamic therapy for the treatment of hidradenitis suppurativa

OBJECTIVE

To perform a systematic review of available literature regarding the use of 5-aminolevulinic acid (ALA) and ALA derivative photodynamic therapy (PDT) in the treatment of hidradenitis suppurativa (HS) and provide recommendations on its use.

METHODS

A systematic review was performed of all published studies up to September 1, 2019 from nine databases, including PubMed, that evaluated PDT in the treatment of HS. For each study, quality of evidence and risk of bias was evaluated. Recommendations from the body of evidence were created based on Strength of Recommendation and Taxonomy (SORT) criteria.

RESULTS

Eighteen studies met inclusion criteria. The majority of studies had a high risk of bias. Blue light PDT with 20% ALA and red light PDT with 16% methyl aminolevulinate (MAL) demonstrated some benefit based on a small number of poor-quality studies with a high risk of bias (Grade C, level III evidence). The most promising results were for 1%-5% ALA with intralesional diode, with good to complete response in 78%-94% of anatomic sites treated (Grade B, level II evidence).

LIMITATIONS

The majority of studies contained high levels of bias, with significant heterogeneity between studies. Conclusions are limited by small samples sizes, lack of randomized controlled trials, and differing protocols.

CONCLUSION

Further studies are needed to determine the clinical efficacy of 20% ALA with blue light and MAL with red light. Intralesional diode PDT shows the most promise and warrants further investigation in larger, randomized controlled trials.

Safety profile of laser-assisted drug delivery of vitamin C, E, and ferulic acid serum following ablative fractional resurfacing: A retrospective chart review

OBJECTIVES

The topical application of a combination Vitamin C, Vitamin E, and Ferulic acid serum following ablative fractional resurfacing has been reported to shorten post-procedure downtime and improve wound healing. However, transcutaneous drug delivery of cosmeceuticals initially meant for topical application have also been shown to have unintended side effects. The objective of our study was to report safety data from our single academic center experience consisting of patients treated with topical application of a vitamin C-containing cosmeceutical immediately following fractional ablative CO₂ laser treatment with a focus on reportable side effects.

METHODS

A retrospective chart review of all patients at the University of Minnesota M Health Cosmetic Center who had fractional ablative CO₂ (10,600 nm) laser procedure for any diagnosis followed by immediate one-time application of a combination serum containing 15% Vitamin C, 1% Vitamin E, and 0.5% Ferulic acid (C E Ferulic®, SkinCeuticals Inc., New York, NY) from Jan 1, 2015 to Dec 31, 2018 was performed. Pediatric and research opt-out patients were excluded. The medical records of these patients were manually reviewed for the following: age, sex, diagnosis, location, after-care instructions, antiviral and/or antibacterial prophylaxis use, and documentation of post-procedure side effects.

RESULTS

Thirty-three patients, encompassing a total of 45 treatment encounters, met inclusion criteria. There were ten cases of expected side effects: erythema (6), erythema with tenderness (1), erythema with mild bumpiness (1), skin peeling with pattern marking (1), and pain with slight bleeding (1). These were attributed to the normal post-procedure course and resolved without complications. There were no reported side effects related to the topical application of Vitamin C, Vitamin E, and Ferulic acid serum.

CONCLUSIONS

The topical application of a Vitamin C, Vitamin E, and Ferulic acid serum immediately following fractional ablative CO₂ laser therapy did not result in associated complications. However, these results may not be generalizable to longer application courses beyond the immediate post-procedure time period, nor to other cosmeceutical formulations. More studies examining the safety profile of topical cosmeceutical serums in laser-assisted drug delivery are needed.

The Use of the Video, "Dear 16-Year-Old Me," as a Melanoma Education Tool in Ambulatory Dermatology

BACKGROUND

Skin cancer continues to be the most common cancer in the United States. The rise of social media platforms and internet use offers an opportunity to present health information through video-based education. The video "Dear 16-Year-OldMe," addresses the risks associated with tanning and sun exposure, the importance of practicing sun protection, and shares stories from melanoma survivors.

OBJECTIVE

To evaluate the video "Dear 16-Year-Old Me," as a patient education tool in dermatology clinics and to investigate whether viewing a short educational video can change knowledge about skin cancer risks and intention to improve skin cancer prevention behavior.

PATIENTS AND METHODS/MATERIALS AND METHODS/METHODS

English-speaking clinic patients between the ages of 14 to 45 years old were recruited. Exclusion criteria include both a personal or family history of skin cancer, dysplastic nevi, or other medical comorbidities. Forty-five participants agreed to participate; 38 were eligible for analysis.

RESULTS

Comparison of prevideo and postvideo responses demonstrated a statistically significant reduction in participants reporting they were likely to tan outdoors (p-value = .001). A significant increase was observed in the reported likelihood to have a professional skin examination (p-value < .001) or self-examination (p-value < .001) in the future.

CONCLUSION

and Relevance: Viewing "Dear 16-Year-Old Me," resulted in reported participant changes in intention to tan outdoors and participate in skin surveillance. Although these are encouraging results, future studies with a comparison group are needed to elucidate whether these results correspond to changes in behavior. In the age of viral videos and readily accessible health information via the internet, continued investigation of video media on patient health behaviors should be pursued.

Effectiveness of an Educational Intervention to Improve Medical Student Comfort and Familiarity With Providing Gender-Affirming Hormone Therapy

BACKGROUND AND OBJECTIVES

Gender-affirming hormone therapy (GAHT) is a key component in the primary care of transgender and gender-nonconforming (TGNC) people. However, physicians are hesitant to initiate GAHT, citing a lack of knowledge. We developed an educational program for medical students and sought to investigate whether medical students' comfort and familiarity with GAHT could increase after a short interactive program.

METHODS

Second-year medical students (N=54) at the University of Minnesota were recruited to attend an hour long interactive lecture on GAHT. We calculated mean change in pre- and postintervention 5-point Likert scale scores from a survey assessing comfort and familiarity with key concepts of GAHT to assess the effectiveness of the intervention.

RESULTS

Mean response score change increased significantly after the intervention around the use of chosen names (0.4±0.13, P&lt;.017), the use of informed consent to initiate GAHT (1.8±0.20, P&lt;.001), initiating and managing GAHT in the primary care setting (1.4±0.19, P&lt;.001), medications used in GAHT (2.3±0.21, P&lt;.001), and dosing (2.5±0.60, P&lt;.001).

CONCLUSIONS

GAHT can be initiated and managed in a primary care setting. There is a push to introduce GAHT in the preclinical years. After participating in a short interactive lecture on GAHT, second-year medical students reported increased comfort and familiarity with GAHT. Inclusion of GAHT in the preclinical curriculum does not require significant teaching time and is important knowledge for all future physicians.

Energy-based Devices for Hair Loss

Treatment options for hair loss have traditionally been limited to topical and systemic therapies. Systemic therapies for inflammatory hair disorders are often immunosuppressive, and systemic treatment of androgenetic hair loss can cause undesired effects on sexual and reproductive health. Topical agents have a favorable side effect profile compared with systemic therapies, but many topicals have poor transcutaneous absorption, limiting their concentration and action at follicular targets in the dermis.

To test or not to test: A study examining the return rates of rosacea patients treated with a pulsed dye laser

Pulsed dye laser (PDL) is an effective treatment option for erythematotelangiectatic rosacea. The use of a test spot allows patients to experience the procedure on a small area prior to further treatment. The purpose of this study was to elucidate whether the use of a no charge test spot influenced return rates for further PDL treatment. Data were obtained retrospectively using International Classification of Diseases (ICD)-10 codes for rosacea. Sixty charts were identified: 26 patients initially received a PDL test area free of charge, whereas 34 patients initially underwent full PDL treatment. Patients who experienced the test spot laser treatment had a lower return rate compared to those that directly underwent full PDL treatment. However, this difference was not statistically significant (Fisher's exact test p = 0.2883). Future studies evaluating and identifying factors that influence PDL return rates are needed. Abbreviations: ETR: Erythematotelangiectatic rosacea; PDL: pulsed dye laser; ICD: International classification of diseases.

The rise of transcutaneous drug delivery for the management of alopecia: a review of existing literature and an eye towards the future

Introduction: Fractional lasers and microneedling devices are increasingly used with topical drugs to treat various conditions, including alopecia, as they grant access to dermal structures such as hair follicles and cutaneous vasculature. Objective: To perform a comprehensive review on transcutaneous drug delivery for the management of alopecia. Methods: PubMed, Embase, and Ovid Medline databases were searched using terms including: alopecia, microneedling, lasers, androgenetic alopecia (AGA), alopecia areata (AA), drug delivery. Articles were examined for inclusion criteria: diagnosis of alopecia regardless of type, use of fractional laser or microneedling devices, and subsequent administration of topical medication. Results: 8 studies, 6 prospective clinical trials and 2 case series, examining either AA or AGA were identified. For AA, five studies examined microneedling together with topical triamcinolone in three of these, while two studies used photodynamic therapy. Regarding AGA, two studies used topical minoxidil plus microneedling, and one examined topical finasteride with fractional erbium glass laser. Improvement was seen in 6 of the 8 studies. Discussion: Transcutaneous drug delivery via fractional laser and microneedling is a promising modality with preliminary evidence for increased hair regrowth over topical therapy alone. Further studies are needed to elucidate treatment parameters and appropriate device selection for drug delivery.

Dermoscopy findings of a one mm lentigo maligna

A 66-year-old man presented with a grayish 1mm macule on the left cheek. Dermatoscopic examination revealed annular-granular structures partially surrounding a single follicular ostium. Histopathologic examination demonstrated atypical, confluent single melanocytes at the basal layer with nesting, crowding, and upward migration descending along the hair follicle, consistent with the diagnosis of lentigo maligna (LM). This case presents evidence in support of the Schiffner progression model for LMs, starting with asymmetric pigmented follicular openings composed of annular-granular structures, which later coalesce into gray to dark black/brown streaks, and then form pseudo-networks or rhomboidal structures. The finding of annular-granular structures partially surrounding a single hair follicle may be the earliest recognizable dermatoscopic feature of an LM and may help clinicians diagnose facial LMs earlier.

Photobiomodulation therapy for androgenetic alopecia: A clinician's guide to home-use devices cleared by the Federal Drug Administration

The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code "OAP" to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium.

ABBREVIATIONS

AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.

Importance of Group Therapeutic Support for Family Members of Children with Alopecia Areata: A Cross-Sectional Survey Study

BACKGROUND/OBJECTIVES

The psychological effect of alopecia areata (AA) is well documented, but group interaction may help lessen this burden. We aimed to determine factors that draw patients with AA and their families to group events.

METHODS

Surveys were administered at the annual alopecia areata bowling social in 2015 and 2016. This event is a unique opportunity for children with AA and their families to meet others with the disease and connect with local support group resources from the Minnesota branch of the National Alopecia Areata Foundation. Data from 2015 and 2016 were combined. Comparisons of subgroups were performed using Fisher exact tests for response frequencies and percentages and two-sample t tests for mean values.

RESULTS

An equal number of men and women participated in the study (n = 13 each). The average age was 41.1 years. There were no significant differences (p > 0.05) in survey responses based on respondent age or sex. Twenty-three (88.5%) attendees sought to connect with others with AA and met three or more people during the event. Seventeen (65.4%) also attended other support group events. Twelve respondents (46.2%) came to support a friend or family member. One hundred percent of attendees identified socializing with others with AA as important.

CONCLUSIONS

Group interaction is an important source of therapeutic support for people with AA and their families.