Trichoscopy as a monitoring tool in assessing treatment response in 98 children with tinea capitis: A prospective clinical study.

Tinea capitis (TC) is the most common dermatophyte infection in children. Fungal culture the gold standard diagnostic method takes several weeks and has poor yields. Trichoscopy helps in rapid diagnosis and could work as a monitoring tool during antifungal therapy. Our main objective is to document the evolution of trichoscopic features with treatment and their correlation with clinical parameters in patients of TC. Forty-six and 52 children with clinically diagnosed TC that was confirmed by potassium hydroxide microscopy, received griseofulvin and terbinafine, respectively. Recruited children were subjected to clinical and trichoscopic assessment by calculation of CASS (clinical assessment severity score) and counting of TAHC (Total Altered hair count; negative and positive), respectively, at baseline and follow-up at 2, 4, and 6 weeks. McNemar, Wilcoxon singed ranked test and Spearman-rho correlation of various parameters was evaluated. Follow-up trichoscopy revealed significant (p < 0.009) disappearance of negative TAHC like black dot (second week onward), corkscrew, horseshoe and zigzag hair at 4 weeks and short broken hair, erythema telangiectasia hemorrhage (ETH) resolved at 6 weeks. Positive TAHC (regrowing hair) shows significant increase at 6 weeks (p < 0.001). CASS and negative TAHC showed significant difference at 4 weeks (p < 0.001) by analyzing boxplot graph. Therefore, trichoscopic resolution occurred before the clinical cure. Terbinafine subjects showed a higher clinical cure rate at 4 weeks (p = 0.02) as compared to griseofulvin. To conclude, trichoscopy is a good monitoring tool that could document the disappearance of almost all dystrophic hair at 4 to 6 weeks and is a more sensitive tool than microscopic examination. Regrowing hair and perifollicular scaling are markers of recovery.

Hair-to-Hair Trichoscopy: An Objective Method to Assess Effectiveness of Botulinum Toxin in a Clinical Trial for Androgenetic Alopecia.

Introduction: Androgenetic alopecia (AGA) is the most common alopecia affecting both genders leading to a potential decrease in quality of life and self-esteem. A current concern in trichology is how to accurately measure clinical response in both daily medical practice and academic research. Hair-to-hair (H2H)-matching technology™ has recently emerged as a technique to evaluate variations in follicular units, hair shaft number, and thickness. This study aimed to describe the methodology employed in a clinical trial using this technology to test the efficacy of botulinum toxin (BT) for male AGA. Methods: This pilot study is a triple-blind, randomized, split scalp, placebo-controlled clinical trial. Patients enrolled were submitted to injections half of the scalp with 50 IU of BT and the other half with 1 mL of normal saline as a control. The trial involved three visits (weeks 0, 12, and 24) and 8 global clinical photographs followed by H2H-matching trichoscopy were captured before the injections at each visit. Paired t test analysis was employed for matched pairs of the following parameters: total hair count, the total number of terminal hair strands, average shaft thickness, and the number of hairs lost or gained during each visit. Then, the software compared the differences between the two sides (BT vs. placebo) per scalp zone and a long time. Conclusion: The combination of manually corrected image processing, follicular map, and H2H-matching technology™ appears to be the most precise way to evaluate changes in hair count and thickness over time. The design is reproducible and can help other researchers and dermatologists in their clinical practice to obtain reliable results in similar scientific research.

Topically Applied Magnetized Saline Water Activates Autophagy in the Scalp and Increases Hair Count and Hair Mass Index in Men With Mild-to-Moderate Androgenetic Alopecia.

Introduction Water is essential for life and is vital for almost all functions of the human body. Recent studies have shown that treating water with magnets can alter its physicochemical properties, including intracluster bonds and water-ion interactions. Magnetized water also undergoes modifications in its physicochemical characteristics, such as pH, salinity, and dissolved oxygen. While there is a significant amount of literature on the use of magnetized water in agricultural settings, research on its potential biomedical applications is still limited. Based on previous findings indicating a potential relationship between autophagy activation and hair loss reversal, a pilot study was designed to explore the effects of topically applied magnetized saline water in patients with androgenetic alopecia. The hypothesis was that the process of water magnetization, which promotes the creation of hydroxyl ions, could potentially induce hair growth through the induction of alkali-induced autophagy in the scalp. Methods We recruited 20 Caucasian men with mild-to-moderate androgenetic alopecia (Norwood-Hamilton stages II-III). Initially, we conducted a 12-week open-label study to evaluate the potential of a topical lotion containing 95% magnetized saline water (2 mL applied once daily) to increase hair count and hair mass index (HMI). Subsequently, we investigated the effect of the lotion on two autophagy markers (Beclin-1 and LC3B) in scalp biopsies from a subgroup of 10 men. Results Hair count significantly increased after 12 weeks of topical treatment with magnetized saline water (from 20.6 ± 9.8 at baseline to 32.5 ± 12.4 at 12 weeks, P < 0.001). Similarly, the mean HMI increased from 37.8 ± 11.4 at baseline to 45.1 ± 13.6 at 12 weeks (P < 0.01). At the molecular level, the topical lotion effectively increased Beclin-1 levels in scalp biopsies by 44% at 12 weeks as compared to the baseline. Similarly, LC3B levels increased by 36% from baseline to 12 weeks, indicating that the lotion effectively activated autophagy in the scalp. Conclusions After 12 weeks of topical treatment, a lotion containing magnetized saline water activated scalp autophagy and significantly increased hair count and HMI in men with mild-to-moderate androgenetic alopecia.

Efficiency of Hair Detection in Hair-to-Hair Matched Trichoscopy.

Introduction: Precise evaluation of changes in hair count is crucial for monitoring progression of hair loss and the effects of treatment. The focus of this study is the comparison of the various examination and assessment techniques in terms of the precision of hair count change observed in trichoscopy images. Methods: Controlled hair extraction of the same scalp spot was used to simulate hair loss, and the different examination techniques were performed to detect this change. The investigators who performed the counting were blinded. Results: For trichoscopy images, the average error in determining the terminal hair count change (relative to total hair count) was 9 ± 1% for automatic assessment with manual correction and 0.4 ± 0.2% for hair-to-hair matched images. For phototrichogram, the automatic measurement results were found to deviate from truth on average by 12 ± 2%. The manually corrected hair count results were much closer to the truth with average deviation at the level of 7 ± 1%. The hair-to-hair matched results corresponded to approximately 0.6 ± 0.3% average discrepancy. Conclusion: Combination of manually corrected image processing, follicular mapping, and hair-to-hair matching appears to be the most precise way of evaluating the change in hair count over time. These novel techniques should be considered valuable, especially in research and clinical trials.

Efficacy of non-surgical treatments for androgenetic alopecia in men and women: a systematic review with network meta-analyses, and an assessment of evidence quality.

BACKGROUND AND OBJECTIVE: Various treatments exist for androgenetic alopecia (AGA); we determined the relative efficacies of non-surgical AGA monotherapies separately for men and women. METHODS: Randomized controlled trials (RCTs) were systematically searched in PubMed, EMBASE, Scopus and clinicaltrials.gov. Separate networks were used for men and women; for each network, a Bayesian network meta-analysis (NMA) of mean change in hair count from baseline (in units of hairs per square centimeter) was performed using a random effects model. RESULTS: The networks for male and female AGA included 30 and 10 RCTs, respectively. We identified the following treatments for male AGA in decreasing rank of efficacy: platelet-rich plasma (PRP), low-level laser therapy (LLLT), 0.5 mg dutasteride, 1 mg finasteride, 5% minoxidil, 2% minoxidil, and bimatoprost. For female AGA the following were identified in decreasing rank of efficacy: LLLT, 5% minoxidil, and 2% minoxidil. The evidence quality of the highest ranked therapies, for male and female AGA, was judged to be low. CONCLUSIONS: While newer treatments like LLLT may be more efficacious than more traditional therapies like 5% minoxidil, the efficacy of the more recent treatment modalities needs to be further validated by future RCTs.

Histopathological Evidence of Occipital Involvement in Male Androgenetic Alopecia.

Background: The occipital region of the scalp is generally accepted as an unaffected area of androgenetic alopecia (AGA) for both genders. However, evidence of AGA involving the occipital scalp has been demonstrated in women; meanwhile, it is unclear whether occipital involvement also occurs in men. Objective: We aimed to determine if there is occipital involvement in men with AGA. Methods: This case-control study compared hair counts of scalp biopsy specimens from the occipital region of 82 men with Hamilton-Norwood III-VII and 82 unaffected men. Results: The mean ages of men with AGA and controls were 40.1 ± 8.9 and 38.6 ± 10.5 years, respectively (P = 0.291). A significant decrease in total hair follicles, terminal hair follicles, follicular units and terminal to vellus (T:V) ratio, along with a significant increase in follicular stelae was indicated in the AGA group compared to controls (all P < 0.05). Subgroup analyses revealed that average counts of total hair follicles, terminal hair follicles and T:V ratios were also significantly lower in males with Hamilton-Norwood VI and VII than in controls (all P < 0.05). There were no correlations between increasing age and hair count parameters, but a significant negative association was found between total follicle numbers and disease duration (r = -0.23, P = 0.02). Conclusions: AGA can involve the occipital area of male patients with advanced disease. Therefore, the occiput of particular cases should not be used to determine reference data for normal scalp hair, and preoperative measurements of miniaturized hairs in the donor site are strongly recommended in all persons undergoing hair transplantation.

Static and dynamic modes of 810 nm diode laser hair removal compared: A clinical and histological study.

BACKGROUND AND AIMS: Laser hair removal has recently become a major indication. Diode lasers have become commercially available offering two modes of application: a stamping or static mode, and a dynamic mode whereby the handpiece is continuously moved across the target tissue. The present study was designed to compare the efficacy of these two approaches clinically and histologically. SUBJECTS AND METHODS: Twenty-five subjects participated in the study, 12 males and 13 females, ages ranging from 20 to 57 yr (Mean age 41.6 yr). A baseline hair count was performed on both the target areas. The ms-pulsed diode laser delivered 810 nm via a handpiece with a cooled tip, offering both static and dynamic modes which were used on the subjects' left and right crura, respectively. Pain during treatment was assessed using a visual analog scale (VAS) and gross inspection was performed immediately after treatment for any abnormality in the treated skin. Hair counts were performed on both crura at 1 and 3 months after the treatment, and compared with the baseline counts. Biopsies were performed in the dynamic mode treated skin at baseline and at 1 month after the treatment, and assessed with light microscopy, immunohistochemistry and transmission electron microscopy (TEM). RESULTS: All subjects completed the study. Compared with baseline, hair counts were significantly lower at 1 and 3 months post-treatment with no significant difference between the static and dynamic laser depilation modes, nor in the severity of the pain experienced during the procedure. Histologically, degenerative changes in the hair follicles were noted immediately after laser treatment. At one month, cystic formation was seen in the hair follicles showing a strong tendency towards apoptotic cell death. CONCLUSIONS: With the diode laser system and at the parameters used in the present study, high depilation efficacy was seen with no significant difference between the static and dynamic modes. Interestingly, good long-term depilation is probably a result of induced apoptotic cell death in the follicles rather than any other mechanism.

Topical application of the Wnt/ß-catenin activator methyl vanillate increases hair count and hair mass index in women with androgenetic alopecia.

BACKGROUND: Activation of the WNT/ß-catenin pathway has emerged as a potential therapeutic target in androgenetic alopecia (AGA). Methyl vanillate (MV) - a safe plant-derived ingredient - has been recently shown to activate the WNT/ß-catenin signaling. Objectives Two distinct substudies were conducted. First, we designed a 6-month, uncontrolled, open-label clinical study to investigate whether topically applied MV may increase hair count and hair mass index (HMI) in female AGA. Second, we conducted a molecular study on the effect of MV on WNT10B mRNA expression in scalp biopsies of women with AGA. METHODS: A total of 20 Caucasian women (age range: 25-57 years) with AGA (Sinclair grade 1-2) were included. The research product was an alcohol-free formulation supplied in the form of a spray containing 0.2% MV as the active ingredient. RESULTS: In the clinical study, hair count and HMI were found to increase at 6 months by 6% (P < 0.01) and 12% (P < 0.001), respectively, compared with baseline. No participant discontinued treatment due to adverse effects, and the overall patient satisfaction was good. At the molecular level, the topical application of the research product resulted in a 32% increase in WNT10B mRNA expression levels in the temporal scalp area (P < 0.001). CONCLUSION: Our pilot data suggest that topical MV can increase hair count and HMI by inducing WNT10B expression in the scalp, potentially serving as a novel treatment strategy for female AGA.

Histopathological investigation of clinically non-affected perilesional scalp in alopecias detected unexpected spread of disease activities.

Histopathological comparison between clinically affected and intact regions in alopecia patients has been considered to facilitate better understanding of the pathophysiology of ongoing disease. Theoretically, adjacent intact regions should provide ideal controls as they should share close histological characteristics, however, to what extent clinically non-affected neighboring regions maintain their pathological integrity has not been fully assessed. The goal of this study is to delineate histopathological characteristics of clinically intact perilesional regions in the patients with various forms of alopecia. Transverse sections of 4-mm punch biopsy at the levels of isthmus and suprabulbar portion were obtained from seemingly unimpaired perilesional scalp of 50 Japanese alopecia patients (16 alopecia areata [AA] multiplex, 19 scarring alopecia [SA], 15 other conditions) and subject to histopathological investigation. Initial screening detected decrease in anagen (anagen : telogen ratio = 82.4:17.6) when compared with previously reported standard hair counts in normal Asian scalp. This finding prompted further investigation. Unexpectedly, 33 (66%) specimens demonstrated some microscopic abnormalities, 10 (62.5%) AA specimens showed increase in telogen ratio, vellus hair count and miniaturization, while perifollicular inflammatory cell infiltration was detected in 5 (26.3%) SA cases. Exclusion of histologically affected specimens yielded average hair count numbers resembling those reported in Koreans, supporting the pathological integrity of selected samples and, more importantly, indicating normal hair counts in east Asians. These findings indicated a less recognized significance of histopathological investigation of clinically non-affected perilesional scalp in alopecias for better assessment of the spread of disease activities, which should enable better management of hair loss conditions.