Is autologous platelet-rich plasma capable of increasing hair density in patients with androgenic alopecia? A systematic review and meta-analysis of randomized clinical trials.

FUNDAMENTALS: Platelet-rich plasma (PRP) has been progressively more used in androgenetic alopecia (AGA). OBJECTIVES: The authors aimed to evaluate PRP efficacy compared to placebo in AGA. METHODS: A comprehensive search was conducted across seven databases, until 01/04/2023. Randomized clinical trials focusing on AGA and PRP use to increase hair density were included. Patients aged between 15 and 63 years, diagnosed with AGA characterized by Norwood I‒VII and Ludwig I‒III scales, were included. Studies with a sample size <10, lacking PRP processing method, focusing on complementary therapies or other alopecias, were excluded. The authors conducted subgroup analysis for activator, spin method, study design, risk of bias, and gender. Meta-regression was conducted for activator, spin method, design, and gender. The authors used GRADEpro to assess evidence certainty and the RoB-2 tool for risk of bias. Asymmetry was measured through a Funnel plot followed by Egger's test. The protocol was registered at PROSPERO (CRD42023407334). RESULTS: The authors screened 555 registers and included fourteen studies involving 431 patients for qualitative synthesis, with 13 studies included in the meta-analysis. Meta-analysis demonstrated a mean difference of 27.55 hairs/cm2 and 95% CI (14.04; 41.06), I2 = 95.99%, p < 0.05. Hair diameter meta-analysis presented a mean difference of 2.02 µm, 95% CI (-0.85 µm; 4.88 µm), and I2 = 77.11% (p = 0.02). That is, low quality evidence. STUDY LIMITATIONS: Studies were highly heterogeneous, of low quality, and presented evident publication bias. CONCLUSIONS: Highly heterogeneous studies with publication bias suggest PRP effectively increases hair density in AGA, so further high-quality randomized clinical trials are recommended to strengthen the evidence.

Evolución de la técnica follicular unit extraction (FUE) / Evolution of the follicular unit extraction (FUE) technique

El microtrasplante capilar, método FUE, es la cirugía para la recuperación capilar que consta en la extracción de unidades foliculares con punches de distintos diámetros y longitudes, desde una zona llamada dadora, generalmente occipital y/o temporal aunque pueden utilizarse otras partes del cuerpo como barba, tórax, abdomen y pubis, para luego de seleccionarse y conservarse en forma adecuada ser implantadas en la llamada zona receptora. Tanto los avances en la técnica como en el uso de instrumental de última generación generan resultados mejores y más naturales, con una recuperación más rápida y menor daño de sus zonas dadoras.

Hair transplant, FUE method, is surgery for hair recovery that consists of the extraction of follicular units with punches of different diameters and lengths, from an area called the donor; usually occipital and/or temporal; although they can be used on other parts of the body such as beard, thorax, abdomen and pubes. After being appropriately selected and preserved, they are implanted in the so-called receiving area. Both advances in technique and in the use of cutting-edge instruments generate better and more natural results, with faster recovery and less damage to the donor areas

Use of autologous platelet-rich plasma in androgenetic alopecia in women: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to verify the efficacy of using autologous platelet-rich plasma (PRP) in female pattern alopecia (FPA). BACKGROUND: Androgenetic alopecia is the leading cause of hair loss in men andwomen and often impacts self-esteem and quality of life. DATA SOURCES: MEDLINE/PubMed, Cochrane Library, ClinicalTrials.gov, and EMBASE up to May 2021. STUDY SELECTION AND DATA EXTRACTION: We identified all studies evaluating the effect of PRP in FPA. A narrative synthesis was performed from data on the efficacy of PRP treatment and adverse effects; quantitative results of PRP use compared to control treatment for female androgenetic alopecia (AGA) were synthesized. The outcomes analyzed were terminal density and hair thickness. RESULTS: Seven articles were selected for this review. Meta-analysis showed that PRP-based interventions were able to increase terminal hair density compared to control (standardized mean difference (SMD)=2.98, 95% confidence intervals (CIs)=1.10, 4.85), with no significant increase in hair thickness (SMD = 1.16, 95% CI= -0.96, 3.28). During and after treatment, no major side effects were reported by patients or researchers. CONCLUSIONS: The use of autologous PRP injections in female AGA seems to be promising, with more consistent results on terminal hair density. However, caution is recommended in the interpretation of these results until they can be replicated in larger and more representative samples. PROSPERO registration number CRD42021257154.

Bicalutamide and the new perspectives for female pattern hair loss treatment: What dermatologists should know.

Female pattern hair loss (FPHL) is the most common form of alopecia in women. FPHL may compromise body image and strongly affect self-esteem, negatively impacting quality of life. Currently, the only Food and Drug Administration (FDA) approved drug for its treatment is topical minoxidil, with a variable response rate. Recently, a few studies in FPHL have pointed out bicalutamide as an emergent selective androgen receptor antagonist with a favorable safety and tolerability profile. This review aimed to summarize and discuss the key information on this new therapy for FPHL. Bicalutamide has no diuretic effect. It does not cross the blood-brain barrier, and it has little effect on serum luteinizing hormone. Additionally, bicalutamide was found to be effective on women presenting with other features of hyperandrogenism such as seborrhea, acne, and hirsutism with mild and well-tolerated adverse effects. Despite the high prevalence and psychosocial impairment, FPHL treatment remains challenging. Therefore, although future prospective, comparative, randomized clinical trials are essential to establish the ideal dose and efficacy of the drug, oral bicalutamide appears to be a promising option to expand the arsenal of FPHL treatment.

Efficacy of Minoxidil Combined With Photobiomodulation for the Treatment of Male Androgenetic Alopecia. A Double-Blind Half-Head Controlled Trial.

BACKGROUND: Androgenetic alopecia (AGA) is a hair loss disorder that frequently affects the male population. Conventional treatment modalities are limited to minoxidil, 5α reductase inhibitors, and hair transplantation procedures. The efficacy of low-level laser therapy (LLLT), also known as photobiomodulation, in the treatment of AGA has been reported, yet little is known about the outcomes of combining photobiomodulation with other conventional therapies. OBJECTIVE: To evaluate hair growth improvement in males with AGA, during the administration of minoxidil with and without photobiomodulation, using a half-head model. STUDY DESIGN/MATERIALS AND METHODS: Twenty-one men with AGA agreed to undergo 12 minutes of low-level laser irradiation (using a modified Capellux®), followed by topical minoxidil application (1 ml of 5% solution), to the affected scalp two times per day for 6 months. The photobiomodulation devices were modified such that the left half emitted light, and the right half did not. Efficacy was assessed by blinded analyses of clinical photos and automated phototrichograms (Trichoscan®) taken before treatment and after 3 and 6 months of therapy. RESULTS: None of the study participants experienced any adverse events. All patients showed improvements in hair coverage on both sides of the scalp at 3 and 6 months. On the side with combined treatments, the number of total hairs was significantly increased after 3 (P < 0.001) and 6 months (P = 0.001). A similar increase was also observed on the minoxidil-only side, at both 3 (P < 0.001) and 6 months (P < 0.001). No statistically significant differences were detected between sides (P > 0.05). CONCLUSION: Additional improvement was not observed with the association of photobiomodulation to topical minoxidil in male AGA. Differences from previous studies that might have influenced our result include non-collimated light source, higher dosimetry, and a cohort with darker skin phototype and more severe alopecia. Lasers Surg. Med. 2021. © 2021 Wiley Periodicals LLC.

Alopecia and severity of COVID-19: a cross-sectional study in Peru.

The aim of this study was to determine the relationship between COVID-19 severity and androgenic alopecia in patients hospitalized in the Surgery Service of Honorio Delgado Espinoza Hospital in Arequipa, Peru. A cross-sectional study was performed in male patients with a diagnosis of COVID-19. Alopecia, clinical characteristics, treatment, and evolution were collected. In all, 98 patients were included; median age was 55 years old (range 18-89), 32.7% with comorbidities, and 45.9% with androgenic alopecia. The severity of COVID-19 infection was moderate to severe in 13.2% of patients without alopecia, and in 88.9% of patients with alopecia (p>0.001). In the logistic regression model analysis, patients with alopecia had a higher risk of presenting moderate to severe symptoms due to SARS-CoV-2 infection (OR: 80.2; 95% CI 16.2-397.7). In conclusion, the severity of infection was statistically significant in patients over 60 years old and those with alopecia.

Sistemas de enfriamiento del cuero cabelludo para la prevención de la alopecia secundaria a quimioterapia / Scalp Cooling devices for the prevention of Chemotherapy-induced alopecia

INTRODUCCIÓN El enfriamiento del cuero cabelludo (ECC) durante las sesiones de quimioterapia es un procedimiento que se utiliza para prevenir la caída del cabello de las personas que se encuentran en tratamiento quimioterápico alopeciante. OBJETIVO Evaluar la efectividad, la seguridad y el coste-efectividad, y analizar los aspectos éticos, de pacientes, sociales, legales y organizativos, así como el posible impacto ambiental y las necesidades de investigación del uso de sistemas de ECC para la prevención o reducción de la extensión de la ASQ. METODOLOGÍA Seguridad y Efectividad Se realizó una revisión sistemática (RS) de la literatura publicada hasta noviembre 2021. Se seleccionaron ensayos clínicos aleatorizados (ECA). Cuando fue posible, se realizó síntesis cuantitativa de los resultados mediante meta-análisis. La evaluación de la calidad de la evidencia y la graduación de la fuerza de la recomendación se realizó de acuerdo a Grading of Recommendations Assessment, Development and Evaluation (GRADE). Coste-efectividad La RS elaborada en este informe incluyó la búsqueda de estudios de evaluaciones económicas completas realizadas en paralelo a estudios primarios o consistentes en modelos económicos. Se realizó una evaluación económica de novo para España con el objetivo de evaluar el coste-efectividad de los sistemas automatizados de ECC (DigniCap y Paxman) para la prevención de la alopecia inducida por quimioterapia en pacientes con cáncer de mama en estadios I-II, susceptibles de recibir el enfriamiento, desde la perspectiva del Sistema Nacional de Salud (SNS) y desde la perspectiva social. Se evaluaron dos escenarios distintos: uno en el que se asumió que no existen diferencias estadísticamente significativas en AVAC entre las estrategias en comparación, y otro en el que sí, asumiendo valores de utilidad para cada estado. Se llevó a cabo un análisis de impacto presupuestario, para el sistema Paxman, para estimar el coste que supondría para el SNS la aplicación del ECC en la población diana para un horizonte temporal de 5 años. Aspectos éticos, legales, organizativos, sociales y de pacientes, y ambientales Para el análisis de estos aspectos se realizaron búsquedas sistemáticas de publicaciones y una síntesis narrativa de los resultados en función de criterios de relevancia y coherencia de los resultados. RESULTADOS Efectividad y seguridad Trece ECA pudieron ser finalmente incluidos de acuerdo con los criterios de selección pre-establecidos, con un total de 832 participantes, de los cuáles, 813 (97,72%) fueron mujeres. En la mayoría de los estudios, el principal tratamiento quimioterápico aplicado fueron las antraciclinas o la combinación de antraciclinas y taxanos. Los resultados obtenidos indican que el ECC previene la pérdida de cabello (pérdida > 50%) un 43% frente al grupo control. En el análisis por subgrupos se obtuvo que tanto los sistemas de enfriamiento no automatizados como los automatizados, producen un efecto similar. No se encontraron diferencias significativas respecto al tipo de cáncer, no obstante, se advierte un efecto positivo de la intervención para personas con cáncer de mama, reduciendo el riesgo de sufrir alopecia un 45%. No se encontraron diferencias significativas en calidad de vida, ansiedad y depresión entre los grupos estudiados. No se registraron efectos adversos graves relacionados con el ECC. La mayoría de los pacientes definieron al proceso de ECC como razonablemente cómodo, cómodo o muy cómodo. Coste-efectividad y análisis de impacto presupuestario La RS identificó una evaluación económica en la que se comparó el sistema de ECC Paxman con la práctica habitual (no uso ECC), desarrollada en un estudio prospectivo no aleatorizado, con una muestra de pacientes con cáncer (mayoritariamente de mama) que reciben tratamiento quimioterápico. Este estudio no encontró diferencias estadísticamente significativas en AVAC; si bien resultó menos costosa que la práctica habitual, desde una perspectiva social. Los resultados del modelo desarrollado en este informe, para un escenario sin mejoras en AVAC, indican que desde las perspectivas del SNS y social, el sistema DigniCap y el sistema Paxman son más costosos que la práctica habitual. En un escenario con mejoras en AVAC, desde las dos perspectivas utilizadas, ambos sistemas son más costosos y más efectivos frente a no aplicar el enfriamiento. Dado que las RCEI obtenidas son inferiores al umbral de 25.000 €/AVAC, se trataría de tecnologías coste-efectivas, siempre y cuando se den por ciertas las utilidades supuestas en el modelo. La aplicación de esta tecnología consigue que 2.930 mujeres más eviten una caída del pelo superior al 50%. Las estimaciones de impacto presupuestario para Paxman (único sistema de ECC incluido en el análisis de impacto presupuestario, dada la escasez de determinada información para el sistema DigniCap) muestran que, para una población de 6.217 mujeres susceptibles de recibir el ECC, el impacto presupuestario neto de introducir esta tecnología en el SNS es de 6. 749.644,31 € para el primer año. Aspectos éticos, legales, organizativos, sociales y de pacientes, y ambientales Para el análisis de estos aspectos se consideraron 18 artículos. Ninguno de ellos aborda aspectos ambientales relativos a la tecnología. CONCLUSIONES • Existe evidencia científica moderadamente sólida de que la intervención de ECC reduce el grado de pérdida de cabello en pacientes sometidos a tratamientos quimioterápicos frente a la no intervención. • No se encuentran diferencias en los resultados en relación al tipo de sistema de enfriamiento utilizado. • Solo se obtiene un efecto estadísticamente significativo a favor de la intervención en pacientes con cáncer de mama. • Con la evidencia disponible en la actualidad no es posible determinar si la eficacia del ECC para la conservación del cabello varía según dosis de quimioterapia o el grado y la duración del enfriamiento. • No se informaron efectos adversos graves del ECC en ninguno de los ECA incluidos. Sin embargo, el periodo de seguimiento post intervención no hubiera permitido la detección de un efecto adverso grave como es la reducción de efectividad del tratamiento de quimioterapia en el caso de metástasis en el cuero cabelludo. • En los pocos estudios que evaluaron calidad de vida y ansiedad y depresión, no se observaron diferencias estadísticamente significativas entre el grupo de ECC y el control. • En los pocos estudios que evaluaron la comodidad del proceso de ECC, la mayoría de pacientes consideraron a los dispositivos automatizados como razonablemente cómodos, mientras que todas las personas intervenidas con los no automatizados manifestaron cierta incomodidad. • La evaluación económica independiente realizada para este informe concluye que los sistemas de ECC automatizados (DigniCap y Paxman) son más costosos que la práctica habitual en España (no uso de sistemas de ECC), tanto desde la perspectiva del SNS como social. Ambos sistemas podrían ser coste-efectivos desde ambas perspectivas si se cumplieran una serie de supuestos asumidos por los autores, entre los que se incluyen la mejora en AVAC como resultado del enfriamiento y el menor coste por sesión asociado al pleno rendimiento del dispositivo. Estos últimos resultados deben tomarse con cautela. • La inclusión del sistema Paxman en el SNS para la aplicación del ECC en la población diana de este informe no generaría ahorros desde el punto de vista del SNS. • Del análisis de los aspectos éticos, legales, organizativos, sociales y de pacientes, y ambientales, se pueden extraer las siguientes conclusiones: - Para que la tecnología de ECC sea factible, es necesario garantizar que los/as pacientes que se sometan a ECC no sufran un retraso en lista de espera para recibir el tratamiento de quimioterapia como consecuencia de la incorporación de la tecnología en el flujo de trabajo. - Cuando el número de pacientes que solicita el tratamiento con ECC supera la disponibilidad de máquinas, puede haber un acceso desigual a la atención en un sistema de salud universal. - De cara a la implementación del ECC, es necesario que los/as profesionales sanitarios reciban la formación necesaria sobre el funcionamiento del sistema. Una buena planificación organizativa, con la participación de los/as profesionales implicados/as, es fundamental. SISTEMAS DE ENFRIAMIENTO DEL CUERO CABELLUDO PARA LA PREVENCIÓN DE LA ALOPECIA SECUNDARIA A QUIMIOTERAPIA 25 - Las herramientas de ayuda para la toma de decisiones compartidas pueden ayudar a los/as pacientes a aclarar sus valores y preferencias respecto a esta tecnología.

INTRODUCTION Scalp cooling (SC) during chemotherapy sessions is a procedure used to prevent hair loss in people undergoing chemotherapy-induced alopecia treatment. AIM To evaluate the effectiveness, safety and cost-effectiveness, and to analyze ethical, patient, social, legal and organizational aspects, as well as the possible environmental impact and research needs of the use of SC systems for prevention or reduction of extension of CIA. Methodology Safety and effectiveness A systematic review (SR) of the literature published up to November 2021 was carried out. Randomized clinical trials (RCTs) were selected. The main outcome measure was the extent of alopecia during and after chemotherapy treatment. The risk of bias was assessed according to the RoB 2.0 tool of the Cochrane Collaboration. When possible, quantitative synthesis of the results was performed by meta-analysis. Cost-effectiveness The SR performed in this report included the search for studies of complete economic evaluations carried out in parallel to primary studies or consisting of economic models. A de novo economic evaluation was conducted for Spain with the aim of evaluating the cost-effectiveness of automated SC systems (DigniCap and Paxman) for the prevention of chemotherapy-induced alopecia in patients with stage I-II breast cancer susceptible to receiving cooling, from the perspective of the National Health System (NHS) and from the social perspective. Two different scenarios were evaluated: one in which it was assumed that there were no statistically significant differences in QALY between the compared strategies, and another in which there were, assuming utility values for each state. A budget impact analysis was carried out for the Paxman system to estimate the cost that the application of the SC would entail for the NHS in the target population for a time horizon of five years. Ethical, legal, organizational, social and patient, and environmental aspects For the asessment of these aspects, systematic literature searches were conducted, and a narrative synthesis of the results was carried out, according to relevance and coherence of the results criteria. RESULTS Effectiveness and safety Thirteen RCTs could finally be included according to the pre-established selection criteria, with a total of 832 participants, of which 813 (97.72%) were women. In most of the studies, the main chemotherapy treatments applied were anthracyclines or the combination of anthracyclines and taxanes. The results obtained indicate that SC prevents hair loss (loss> 50%) by 43% compared to the control group. In the subgroup analysis, it was found that both non-automated and automated cooling systems produce a similar effect. No significant differences were found with respect to the type of cancer; however, a positive effect of the intervention is observed for people with breast cancer, reducing the risk of suffering alopecia by 45%. No significant differences were found in quality of life, anxiety and depression between the groups studied. No serious adverse effects related to SC were recorded. The majority of patients defined the SC process as reasonably comfortable, comfortable or very comfortable. Cost-effectiveness The SR identified an economic evaluation in which the Paxman CCT system was compared with routine practice (no SC use), developed in a non-randomized prospective study with a sample of cancer patients (mostly breast) receiving chemotherapy treatment. This study did not find statistically significant differences in QALY; although it was less expensive than the usual practice, from a social perspective. The results of the model developed in this report, for a scenario without QALY improvements, indicate that from the NHS and social perspectives, the DigniCap system and the Paxman system are more expensive than usual practice. In a scenario with improvements in QALY, from the two perspectives used, both systems are more expensive and more effective compared to not applying cooling. Given that the ICERs obtained are below the threshold of €25,000/QALY, they would be cost effective technologies, provided that the utilities assumed in the model are accepted as true. The application of this technology enables 2,930 more women to avoid hair loss of more than 50%. Budgetary impact estimates for Paxman (only SC system included in the analysis given the paucity of certain information for the DigniCap system) show that, for a population of 6,217 women eligible to receive SC, the net budgetary impact of introducing this technology in the NHS is €6,749,644.31 for the first year. Ethical, legal, organizational, social and patient, and environmental aspects Eighteen articles were considered for the assessment of these aspects. None of them address environmental aspects related to the technology. CONCLUSIONS • There is moderately strong scientific evidence that SC intervention reduces the degree of hair loss in patients undergoing chemotherapy treatments versus absence of intervention. • There are no differences in the results in relation to the type of cooling system used. • A statistically significant effect in favor of the intervention is only obtained in breast cancer patients. • With the currently available evidence, it is not possible to determine whether the efficacy of SC for hair preservation varies according to chemotherapy dose or the degree and duration of cooling. • No serious adverse effects of SC were reported in any of the included RCTs. However, the post-intervention follow-up period would not have allowed the detection of a serious adverse effect, such as the reduction in the effectiveness of chemotherapy treatment in the case of scalp metastases. • In the few studies that evaluated quality of life and anxiety and depression, no statistically significant differences were observed between the SC group and the control group. • In the few studies that evaluated the comfort of the SC process, the majority of patients considered the automated devices as reasonably comfortable, while all the people who were intervened with the non automated ones reported some discomfort. • The independent economic evaluation carried out for this report concludes that the automated SC systems (DigniCap and Paxman) are more expensive than the usual care in Spain (no SC use), both from the NHS and social perspectives. Both systems could be cost-effective from both perspectives if a series of assumptions assumed by the authors were met, including the improvement in QALY as a result of cooling and the lower cost per session associated with the full performance of the device. These latter results should be viewed with caution. • The inclusion of the Paxman system in the NHS for the application of the SC in the target population of this report would not generate savings from the point of view of the NHS. • The following conclusions can be drawn from the analysis of the ethical, legal, organizational, social and patient, and environmental aspects: - For SC technology to be feasible, it is necessary to ensure that patients undergoing ECC do not suffer a delay in the waiting list to receive chemotherapy treatment as a result of incorporating technology into the workflow. - When the number of patients requesting SC treatment exceeds the availability of machines, there may be unequal access to care in a universal health system. - For the implementation of the ECC, it is necessary that health professionals receive the necessary training on the operation of the system. Good organizational planning, with the participation of the professionals involved, is essential - Shared decision support tools can help patients clarify their values and preferences regarding this technology.

Micro needling: A novel therapeutic approach for androgenetic alopecia, A Review of Literature.

Androgenetic alopecia (AGA) is an androgen-dependent hereditary trait resulting in hair miniaturization. It is the most common type of alopecia in men and women. During the last years, multiple treatment modalities have been studied, but only topical minoxidil and finasteride have been approved by the US Food and Drug Administration. Microneedling (MN) is a minimally invasive technique that induces collagen formation, as well as growth factors production and neovascularization. Even though not many studies of MN in alopecia have been performed, it remains a favorable treatment modality; however, no standardized protocol for MN in hair loss has been proposed yet. Current evidence is not sufficient to allow a direct comparison with other therapies, but it shows promises to increase hair density, thickness, and quality of hair, especially when combined with other treatments or when used as a drug delivery system. This article aims to summarize the available literature regarding the use of MN alone or associated with other therapies for the treatment of androgenetic alopecia.

Excellent response to mesotherapy as adjunctive treatment in male androgenetic alopecia.

Androgenetic alopecia (AGA) is the most common type of alopecia. Currently, only topical minoxidil and oral finasteride, for men, are approved for its treatment. We report a case of a patient with male pattern AGA treated with topical minoxidil and oral finasteride for 2 years, with partial improvement. At this point, we added mesotherapy to the previous treatment. The patient had 20 sessions of sterile mesotherapy blend, containing minoxidil, finasteride, biotin, and D-panthenol. We did the injections every two weeks and made the response assessment with global clinical photographs at the 10th and the 20th sessions when we noted a significant visible improvement in hair density and thickness. Mesotherapy or intradermotherapy is defined as a technique that involves the use of multiple intradermal injections of a mixture of compounds in low doses, at many points, near/over the affected sites. In our case, the patient had an excellent response to intradermotherapy as an adjunctive treatment, with no side effects. Although we still need additional clinical trials to standardize the therapy and treatment guidelines, mesotherapy seems to be a therapeutic option in the treatment of AGA, especially if the procedure happens in a medical facility, with correct indication and adequate execution of this promising technique.

Técnica de microagulhamento para tratamento de alopecia x em cães / Microneedling technique for treatment of alopecia X in dogs

A alopecia X é uma dermatopatia hormonal que afeta principalmente raças nórdicas e tem como características a ocorrência de alopecia não inflamatória bilateral e simétrica, melanodérmica. Ela não afeta a região distal dos membros e cabeça, acometendo, sobretudo, a região cervical, dorsal e perianal. O diagnóstico é baseado nos sinais clínicos que o animal apresenta, na exclusão de dermatopatias endócrinas como hiperadrenocorticismo e hipotireoidismo, em exames laboratoriais e em biopsia cutânea. O tratamento consiste na castração, melatonina, trilostano e/ou hormônio do crescimento. Recentemente, o microagulhamento tem sido uma alternativa viável em pacientes com alopecia X. O presente trabalho teve como objetivo relatar o uso da técnica de microagulhamento em cães com alopecia X. Foram acompanhados dois cães, machos, da raça Spitz Alemão, com 2 e 5 anos de idade respectivamente, com um quadro alopécico e melanodermia na região de dorso e flanco e região cervical, caudal e perianal há mais de 2 anos. Depois de caracterizados como pacientes alopécicos X, os animais foram conduzidos à técnica de microagulhamento, exibindo repilação nas áreas alopécicas. Conclui-se dessa forma que o microagulhamento é uma técnica promissora para o tratamento da alopecia X.(AU)

Alopecia X is a hormonal dermatopathy that affects mainly Nordic breeds and has as its characteristics the occurrence of bilateral and symmetrical, melanodermic non-inflammatory alopecia. It does not affect the distal region of the limbs and head, mainly affecting the cervical, dorsal and perianal regions. The diagnosis is based on the clinical signs that the animal presents in the exclusion of endocrine dermatopathies such as hyperadrenocorticism and hypothyroidism, in laboratory tests and in cutaneous biopsy. Treatment consists of castration, melatonin, trilostan and/or growth hormone. Recently, microneedling has been a viable alternative in patients with alopecia X. The present work aimed to report the use of the microneedling technique in dogs with alopecia X. Two male German Spitz dogs, 2 and 5 years old respectively, with alopecia and melanodermia in the dorsum and flank region and cervical, caudal and perianal region for more than 2 years were followed. After being characterized as alopecia X patients, the animals were conducted to the microneedling technique, exhibiting repopulation in the alopecia areas. The conclusion is that microneedling is a promising technique for the treatment of alopecia X.(AU)

Técnica de microagulhamento para tratamento de alopecia x em cães / Microneedling technique for treatment of alopecia X in dogs

A alopecia X é uma dermatopatia hormonal que afeta principalmente raças nórdicas e tem como características a ocorrência de alopecia não inflamatória bilateral e simétrica, melanodérmica. Ela não afeta a região distal dos membros e cabeça, acometendo, sobretudo, a região cervical, dorsal e perianal. O diagnóstico é baseado nos sinais clínicos que o animal apresenta, na exclusão de dermatopatias endócrinas como hiperadrenocorticismo e hipotireoidismo, em exames laboratoriais e em biopsia cutânea. O tratamento consiste na castração, melatonina, trilostano e/ou hormônio do crescimento. Recentemente, o microagulhamento tem sido uma alternativa viável em pacientes com alopecia X. O presente trabalho teve como objetivo relatar o uso da técnica de microagulhamento em cães com alopecia X. Foram acompanhados dois cães, machos, da raça Spitz Alemão, com 2 e 5 anos de idade respectivamente, com um quadro alopécico e melanodermia na região de dorso e flanco e região cervical, caudal e perianal há mais de 2 anos. Depois de caracterizados como pacientes alopécicos X, os animais foram conduzidos à técnica de microagulhamento, exibindo repilação nas áreas alopécicas. Conclui-se dessa forma que o microagulhamento é uma técnica promissora para o tratamento da alopecia X.

Alopecia X is a hormonal dermatopathy that affects mainly Nordic breeds and has as its characteristics the occurrence of bilateral and symmetrical, melanodermic non-inflammatory alopecia. It does not affect the distal region of the limbs and head, mainly affecting the cervical, dorsal and perianal regions. The diagnosis is based on the clinical signs that the animal presents in the exclusion of endocrine dermatopathies such as hyperadrenocorticism and hypothyroidism, in laboratory tests and in cutaneous biopsy. Treatment consists of castration, melatonin, trilostan and/or growth hormone. Recently, microneedling has been a viable alternative in patients with alopecia X. The present work aimed to report the use of the microneedling technique in dogs with alopecia X. Two male German Spitz dogs, 2 and 5 years old respectively, with alopecia and melanodermia in the dorsum and flank region and cervical, caudal and perianal region for more than 2 years were followed. After being characterized as alopecia X patients, the animals were conducted to the microneedling technique, exhibiting repopulation in the alopecia areas. The conclusion is that microneedling is a promising technique for the treatment of alopecia X.

Alopecia em pacientes anticoagulados / Alopecia in anticoagulated patients

Resumo A alopecia é uma complicação comum da terapia anticoagulante que pode ter repercussões psicológicas importantes nos pacientes, especialmente nos do sexo feminino, e interferir na decisão de extensão da anticoagulação. Esta revisão tem como objetivo descrever os mecanismos potencialmente envolvidos na gênese da alopecia durante a terapia anticoagulante, pois eles ainda não estão totalmente esclarecidos, e as terapias existentes, para a adoção das condutas mais adequadas.

Abstract Alopecia is a common complication of anticoagulant therapy that may have important psychological repercussions for patients, especially female patients, and can interfere with the decision to extend anticoagulation. This review aims to describe the mechanisms potentially involved in the genesis of alopecia during anticoagulant therapy, since these are not yet fully understood, and discusses the existing therapies for the most appropriate management.

Physiopathology and current treatments of androgenetic alopecia: Going beyond androgens and anti-androgens.

Androgenetic alopecia (AGA) is the most diagnosed hair loss dysfunction. Its physiopathology comprises a genetic predisposition affording an exacerbated response of the hair follicles cells to androgens aggravated by scalp inflammation and extrinsic factors. This paper presents a review of the mechanisms and extrinsic factors involved in the AGA physiopathology as well as its conventional and emerging treatments. The research focused on reports regarding AGA physiopathology and treatments published between January 2001 and July 2019 in medical and related journals. The most used medical treatments for AGA-minoxidil and finasteride-present non satisfactory results in some cases. Currently, the low-level laser therapy is recognized as a safe and effective treatment for AGA. Some minimally invasive techniques-mesotherapy, microneedling, carboxytherapy, and platelet-rich plasma-are also used to stimulate hair growth. Pharmaceutical substances with mechanisms differing from the anti-androgen activity are under current investigation and many of them have botanical origins; however, formulations with higher performance are required, and the hair follicles ability of being a drug and nanoparticle reservoir has been researched. The association of different strategies, that is, substances with synergic mechanisms and the use of advantageous technologies associated with lifestyle changes could improve the treatment outcomes.

The role of photobiomodulation when associated with microneedling in female pattern hair loss: A randomized, double blind, parallel group, three arm, clinical study protocol.

The female hair loss pattern was originally described as a synonym for androgenetic alopecia. It has been defined as progressive miniaturizations of the hair follicles, with a great impact on the quality of life of affected patients, causing significant psychosocial limitations. It was recently proven that photobiomodulation is a safe and effective way to treat the different types of hair loss. It was also known that microneedling is a minimally invasive dermatological procedure that is applied to a wide range of dermatological conditions, including androgenic alopecia, telogen effluvium, as well as other facial and bodily conditions. GOAL: The aim of this study is to verify if there is an increase in the capillary density of strands of hair, when combining 660 nm red laser photobiomodulation and microneedling in addressing female pattern hair loss (FPHL). METHODS: There will be 66 patients divided into 3 treatment groups. G1: microneedling and 660 nm red laser photobiomodulation sham; G2: 660 nm red laser photobiomodulation and microneedling sham; G3: microneedling and 660 nm red laser photobiomodulation. The treatment will consist in 36 sessions, 3 times a week for 3 consecutive months, with an insertion of microneedling every 30 days. The patients and the researchers will be blinded. The patients will be evaluated before, during, and after the treatments, by digital photography and the trichoscopy method (dermoscopic imaging of the scalp and hair). EXPECTED RESULTS: It is expected that differences will be found in the growth rates of a strand of hair in mm/d, in the density of a strand of hair in n/cm, in the diameter of a strand of hair, as well as in the anagen/telogen ratio. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of November 28, 2018 (CAAE: 01381718.0.0000.5511 - Acceptance Number: 3044061). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-76VCCV). This study is not yet recruiting. Issue date: February 20, 2019.

Genetic and molecular aspects of androgenetic alopecia.

Androgenetic alopecia is the most common form of progressive hair loss in humans. A genetic predisposition and hormonal status are considered as major risk factors for this condition. Several recent advances in molecular biology and genetics have increased our understanding of the mechanisms of hair loss in androgenetic alopecia. We review these advances and examine the trends in the genetic and molecular aspects of androgenetic alopecia.

Fractional non-ablative laser-assisted drug delivery leads to improvement in male and female pattern hair loss.

Androgenetic alopecia, also known as male and female pattern hair loss, is a very prevalent condition; however, approved therapeutic options are limited. Fractionated laser has been proposed to assist in penetration of topical medications to the cutaneous tissue. We present four cases of androgenetic alopecia that underwent treatment with a non-ablative erbium glass fractional laser followed by the application of topical finasteride 0,05% and growth factors including basic fibroblast growth factor, insulin-like growth factor, vascular endothelial growth factor, and copper peptide 1%. During all laser treatment sessions, eight passes were performed, at 7 mJ, 3-9% of coverage and density of 120 mzt/cm2. A positive response was observed in all of the four patients. Photographs taken 2 weeks after the last session showed improvement in hair regrowth and density. No significant side effects were observed.