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 ±â€…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 ±â€…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.

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.

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.

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.

Patient Recovery from COVID-19 Infections: Follow-Up of Hair, Nail, and Cutaneous Manifestations.

BACKGROUND: COVID-19 is a pandemic disease worldwide. Although cutaneous manifestations may present in affected patients, there have been limited studies on the cutaneous findings and hair and nail abnormalities after discharge. OBJECTIVE: To establish the cutaneous manifestations, hair and scalp disorders, and nail abnormalities in patients who recovered from COVID-19 infections. METHODS: A retrospective chart review and telephone interviews were conducted to determine the cutaneous manifestations, hair and scalp disorders, and nail abnormalities of patients aged over 18 years who were diagnosed with COVID-19 infections at Siriraj Hospital, Bangkok, Thailand, between January and June 2020. RESULTS: Ninety-three patients with prior COVID-19 infections participated in the study. The COVID-19 severity had been mild for most (71%). Cutaneous manifestations were reported in 8 patients (8.6%), with the common skin conditions being maculopapular rash and urticaria. The onsets of the skin conditions were before admission (1%), during admission (4.3%), and after discharge (3.2%). Increased hair shedding was also reported in 22 patients (23.7%), with a female predominance. Three patients were affected during admission, while the others were affected after discharge. The patients with moderate, severe, and critical COVID-19 infections experienced significantly more hair shedding than those with asymptomatic and mild diseases. Only 2 patients with mild COVID-19 disease reported nail abnormalities (chromonychia and brittle nails). CONCLUSIONS: Cutaneous manifestations, hair disorders, and nail abnormalities can occur in patients with COVID-19 after their discharge from hospital. Patients should therefore be followed up in anticipation of dermatological problems.

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.

A review of the etiologies, clinical characteristics, and treatment of canities.

Hair pigmentation is regulated by follicular melanogenesis, in which the process consists of melanin formation and transfer to keratinocytes in the hair shaft. Human hair follicles contain two types of melanin: the brown-black eumelanin and yellow-red pheomelanin. Eumelanin is commonly present in black and brown hair while pheomelanin is found in auburn and blonde hair. Hair follicle melanogenesis is under cyclical control and is concurrently coupled to hair growth. Many factors including intrinsic and extrinsic factors affect the follicular melanogenesis. Though many studies have been conducted to identify the pathogenesis and regulation of hair pigmentation, the etiology of canities and hair pigmentation is still unclear. The pathogenesis of canities or gray hair is believed to occur either from insufficient melanin formation due to melanocyte degeneration or a defect in melanosomal transfer. Canities is an aging sign which often interferes with one's socio-cultural adjustment. On the other hand, premature canities correlate with diseases such as osteopenia and cardiovascular disease. Risk factors associated with canities are not only genetic but also external causes. For example, smoking, alcohol consumption, and stress are among the most common factors. Camouflage techniques are still used as the primary treatment of canities. Further treatments for canities are being developed to achieve the true reversal of hair pigmentation.

Molecular functional analyses revealed essential roles of HSP90 and lamin A/C in growth, migration, and self-aggregation of dermal papilla cells.

Previous expression study using quantitative proteomics has shown that immune-mediated pathway may not be the main mechanism inducing alopecia areata (AA). Nevertheless, functional impact of such expression data set remained unknown and unexplored. This study thus aimed to define potentially novel mechanisms of the AA pathogenesis by functional investigations of the differentially expressed proteins previously identified from lesional biopsies. From 122 altered proteins, protein-protein interactions network analysis revealed that downregulated heat shock protein 90 (HSP90) and lamin A/C served as the central nodes of protein-protein interactions involving in several crucial biological functions, including cytoskeleton organization, extracellular matrix organization, and tissue development. Interaction between HSP90 and lamin A/C in dermal papilla cells (DPCs) was confirmed by reciprocal immunoprecipitation and immunofluorescence co-staining. Small-interfering RNA (siRNA) targeting to HSP90 (siHSP90) and lamin A/C (siLamin A/C) effectively reduced levels of HSP90 and lamin A/C, respectively and vice versa, comparing to non-transfected and siControl-transfected cells, strengthening their interactive roles in DPCs. Functional investigations revealed that DPCs transfected with siHSP90 and siLamin A/C had defective cell proliferation and growth, prolonged doubling time, cell cycle arrest at G0/G1 phase, and defective self-aggregation formation. Moreover, siHSP90-transfected cells had less spindle index, reduced levels of vimentin (mesenchymal marker) and fibronectin (extracellular matrix), and defective migratory activity. Our data have demonstrated for the first time that HSP90 and lamin A/C physically interact with each other. Moreover, both of them are essential for growth, migration, and self-aggregation of DPCs and can be linked to the disease mechanisms of AA.

Differential proteomics of lesional vs. non-lesional biopsies revealed non-immune mechanisms of alopecia areata.

Alopecia areata (AA) is one of the common hair disorders for which treatment is frequently ineffective and associated with relapsing episodes. Better understanding of disease mechanisms and novel therapeutic targets are thus required. From 10 AA patients, quantitative proteomics using LTQ-Orbitrap-XL mass spectrometer revealed 104 down-regulated, 4 absent, 3 up-regulated and 11 newly present proteins in lesional vs. non-lesional biopsies. Among these, the decreased levels of α-tubulin, vimentin, heat shock protein 70 (HSP70), HSP90, annexin A2 and α-enolase were successfully confirmed by Western blotting. Protein-protein interactions network analysis using STRING tool revealed that the most frequent biological processes/networks of the down-regulated proteins included tissue development, cell differentiation, response to wounding and catabolic process, whereas those for the up-regulated proteins included biological process, metabolic process, cellular transport, cellular component organization and response to stimulus. Interestingly, only 5 increased/newly present proteins were associated with the regulation of immune system, which may not be the predominant pathway in AA pathogenic mechanisms as previously assumed. In summary, we report herein the first proteome dataset of AA demonstrating a number of novel pathways, which can be linked to the disease mechanisms and may lead to discovery of new therapeutic targets for AA.

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.

Tissue-selective effects of injected deoxycholate.

BACKGROUND: Recent studies suggest that the principal active ingredient in phosphatidylcholine-containing injectable fat-reduction formulations is actually deoxycholate (DC). This bile acid acts as a detergent to rapidly disrupt cell membranes. Thus, it is not obvious why DC would preferentially target fat. OBJECTIVE: To investigate possible mechanisms for the selectivity of DC for fat tissue using in vivo and in vitro models. METHODS AND MATERIALS: Histology, drug distribution studies, and cell viability assays were used to examine possible mechanisms contributing to DC selectivity. RESULTS: In vitro, DC caused the lysis of all cell types tested within the tested concentration range. DC injected into fat tissue caused adipocyte death, whereas other cell types appeared less affected. Physiological concentrations of albumin or protein-rich tissues decrease the ability of DC to lyse cells. Furthermore, DC relocated to the gastrointestinal tract in animals within hours of injection. This suggests that similar mechanisms may be present in humans. CONCLUSION: We report observations that provide a possible explanation for the in vivo preferential fat targeting by DC. Fat tissue, being deficient in cell-associated proteins and interstitial albumin, may be unable to sufficiently neutralize the detergent activity of DC, possibly making fat uniquely sensitive to DC.

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.