Medical Treatment for Androgenetic Alopecia.

Androgenetic alopecia is a common type of hair loss, which is generally influenced by genetic factors and systemic androgens resulting in follicular miniaturization.1 It can cause cosmetic problems leading to psychological distress among affected men and women. Effective standard medical treatments available are topical minoxidil 2 to 5%, oral finasteride, oral dutasteride, and hair transplantation.1 However, some patients do not achieve favorable results with standard treatments. For these reasons, other novel treatments have been developed, including new medications, regenerative medicines (autologous platelet-rich plasma, adipose-derived stem cells, micrograft generation, and exosome), and low-level laser therapy.

Prevalence of female pattern hair loss in postmenopausal women: a cross-sectional study.

OBJECTIVE: To identify the prevalence of female pattern hair loss (FPHL), hair characteristics, and associated factors in healthy postmenopausal women. METHODS: Two hundred postmenopausal women aged 50 to 65 years were recruited. Each participant was evaluated for FPHL according to Ludwig's classification using standardized global photography in all six views and trichoscopy for hair density and diameter. Three dermatologists re-evaluated all pictures for confirmation of FPHL. The time since menopause, levels of scalp sebum, serum testosterone, estradiol, thyroid stimulating hormone, and hemoglobin; family history of hair loss, as well as an evaluation of low self-esteem were evaluated. Women who underwent recent hair loss treatments were excluded. We used simple and multivariable logistic regression analysis to identify the factors affecting FPHL. RESULTS: In total, 178 postmenopausal women were evaluated for hair-loss patterns. The average age and time since menopause were 58.8±4.1 and 9.2 ± 5.6 years, respectively. The prevalence of FPHL was 52.2% (95% CI, 44.6-59.8). Severity of FPHL by Ludwig grades I, II, and III was 73.2% (95% CI, 62.9-81.8), 22.6% (95% CI, 14.6-32.4), and 4.3% (95% CI, 1.2-10.7), respectively. Logistic regression analysis revealed that age, time since menopause, and body mass index were all significantly associated with FPHL. After adjusting for age and family history of FPHL, only body mass index ≥25 kg/m2 was significantly associated with FPHL (adjusted OR = 2.65, 95% CI, 1.23-5.70). Conclusion: The prevalence of FPHL was high in postmenopausal women, raising the need for hair loss awareness in menopause clinics. Early detection and proper treatment of FPHL may increase the quality of life in postmenopausal women.

Red light emitting diode as an adjuvant treatment for epidermal growth factor receptor inhibitors-induced paronychia.

We evaluated the efficacy and safety of red light LED as an adjuvant treatment for epidermal growth factor receptor inhibitor-induced paronychia. Eight patients were recruited in this randomized, single-blinded controlled trial. They were randomized to receive red-light on one hand or foot 2-3 times/week for 6 weeks while the contralateral side served as controls. The standard treatments were continued. Erythema and lesion elevation observed by Anthera® 3D, severity and pain scores were obtained at weeks 0, 2, 4, 6, and 8. The red light group showed significantly lower erythema, severity, and pain scores at weeks 4, 6, and 8. The elevation was significantly lower in the red light group at every follow-up visit. No adverse events occurred. Red light therapy may be an option as adjunctive treatment for EGFRi-induced paronychia.

A Cadaveric Study of Dye Spreading: Determining the Ideal Injection Pattern for Masseter Hypertrophy.

BACKGROUND: Masseter hypertrophy is the main cause of an asymmetrical and squared lower facial contour in the Asian community. Botulinum toxin injection technique is crucial to treat this condition. OBJECTIVE: To improve injection techniques for masseter hypertrophy by elucidating the distribution of the injections within the masseter. METHODS: Thirty masseter muscles were divided into 6 groups of 5 muscles each. Each group received one 0.2- or 0.3-mL injection at Point A, B, or C according to a three-point technique. Muscle dimensions and dye of the primary and secondary dye spreading were measured. RESULTS: The average muscle length, width, and thickness were 69.87, 33.50, and 11.23 mm, respectively. The average primary longitudinal and horizontal spreading was 36.56 and 15.60 mm, respectively. No statistically significant difference was found between 0.2- and 0.3-mL injections at each point. CONCLUSION: The three-point technique best fits in the safe zone and should be the standard injection technique for masseter hypertrophy. Injection at Points B and C may create secondary spreading that affect the risorius muscle and the parotid gland which are the cause of asymmetrical smiling and xerostomia, respectively. The dosage should be adjusted according to the muscle volume and not only the thickness.

Effectiveness and Safety of Combined Application of Three Modes of 2940-nm Erbium:YAG and 1064-nm Neodymium:YAG Lasers in Treatment of Meibomian Gland Dysfunction.

PURPOSE: To study the effectiveness and safety of upper and lower eyelid treatment with combined application of three modes of 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) and 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers in patients with baggy eyelids (formed by intraorbital fat herniation) who exhibited meibomian gland dysfunction (MGD). PATIENTS AND METHODS: In this prospective cohort study, patients with baggy eyelid who exhibited MGD received combined laser treatment at baseline, as well as at the 4-, 8-, and 12-week follow-ups. The primary endpoint was meibum quality score at 16- and 24-week follow-ups; secondary endpoints were ocular surface index scores, tear film lipid layer thicknesses, tear break up times (TBUTs), Oxford scheme grades, and meibography grades at 16- and 24-week follow-ups. Adverse events, uncorrected visual acuities, best-corrected visual acuities, and intraocular pressures were also recorded. RESULTS: Sixteen patients (four men and 12 women; mean age, 56.38 ± 8.64 years) were included. Meibum quality scores at the 16-week follow-up were significantly lower than scores at baseline (p=0.043) and at the 24-week follow-up (p=0.015). TBUT was significantly exacerbated at the 24-week follow-up, compared with baseline (p=0.001) and the 16-week follow-up (p=0.006). There were no significant changes in other parameters. All adverse events were mild and resolved without additional treatment. CONCLUSION: Combined application of three modes of 2940-nm Er:YAG and 1064-nm Nd:YAG lasers on upper and lower eyelids significantly improved meibum quality in patients with MGD; it ameliorated symptoms and signs of dry eye disease at 4 weeks after completion of laser treatment.

Efficacy and Safety of Oral Minoxidil 5 mg Once Daily in the Treatment of Male Patients with Androgenetic Alopecia: An Open-Label and Global Photographic Assessment.

INTRODUCTION: Oral minoxidil is an antihypertensive vasodilator known to stimulate hair growth. The use of low-dose oral minoxidil for the treatment of male androgenetic alopecia (AGA) is receiving increasing attention. The aim of this study was to evaluate the efficacy and safety of oral minoxidil for the treatment of male AGA. METHODS: This was an open-label, prospective, single-arm study. Thirty men aged 24-59 years with AGA types III vertex to V were treated with oral minoxidil 5 mg once daily for 24 weeks. Efficacy was evaluated by hair counts, hair diameter measurements, photographic assessment, and self-administered questionnaire. The safety of the treatment was closely monitored by means of physical examinations and laboratory investigations. RESULTS: There was a significant increase in total hair counts from baseline at weeks 12 (mean change + 26, range 182.5-208.5 hairs/cm2) and 24 (mean change + 35.1, range 182.5-217.6 hairs/cm2) (both p = 0.007). Photographic assessment of the vertex area by an expert panel revealed 100% improvement (score > + 1), with 43% of patients showing excellent improvement (score + 3, 71-100% increase). The frontal area also showed a significant response but less than that of the vertex area. Common side effects were hypertrichosis (93% of patients) and pedal edema (10%). No serious cardiovascular adverse events and abnormal laboratory findings were observed. CONCLUSION: Oral minoxidil 5 mg once daily effectively increased hair growth in our male patients with AGA and had a good safety profile in healthy subjects. However, oral minoxidil should be used carefully with men who have severe hypertension and increased risk for cardiovascular events.

Clinical characteristics, trichoscopy, histopathology and treatment outcomes of frontal fibrosing alopecia in an Asian population: A retro-prospective cohort study.

Frontal fibrosing alopecia (FFA) is a distinctive lymphocytic scarring alopecia with rapid increase in prevalence. Most FFA series are retrospectively reported from Caucasians with only few from Asians. The objective of this study was to characterize the clinical, trichoscopic and histopathological findings as well as treatment outcomes. This was a retro-prospective cohort study of patients diagnosed with FFA from 1 January 2010 to 1 November 2019. All patients were asked to present for re-examination. Clinical, trichoscopic, histopathological and laboratory data were recorded. A questionnaire was used to investigate hair care, hairstyle and facial skin care compared with age-matched normal controls. Multivariate analysis was performed in order to clarify factors associated with severity. All 58 FFA patients were female, of whom 27.6% were premenopausal, 37.7% had a history of surgical menopause, 13.8% had thyroid diseases, 69% had eyebrow loss and 32.8% facial papules. On physical examination, 10.3% showed linear pattern, 46.6% diffuse pattern and 43.1% pseudo-fringe sign. Concomitant lichen planopilaris was found in 25.9%, lichen planus pigmentosus in 24.1% and female pattern hair loss in 48.3%. The most common trichoscopic characteristics in the frontal hairline were lack of follicular ostia (91.4%), perifollicular scales (79.3%) and perifollicular erythema (63.8%). Up to 90% of patients reported FFA as improved or stable after receiving antiandrogen (finasteride or dutasteride) or antimalarial with topical treatment. Multivariate analyses revealed that facial lentiginous macules and trichoscopic perifollicular erythema at the frontal area were FFA severity-associated factors. "Front puff" Thai hairstyle was associated with FFA, while sunscreens and other cosmetic products were not. In conclusion, diffuse and pseudo-fringe sign pattern are common in Asian FFA. The most common autoimmune systemic comorbidity is thyroid disease, while common concomitant dermatological diseases are female pattern hair loss, lichen planopilaris and lichen planus pigmentosus. Antiandrogens or antimalarial plus topical treatment are the most useful therapy.

The Effects of a Standardized Extract of Centella asiatica on Postlaser Resurfacing Wound Healing on the Face: A Split-Face, Double-Blind, Randomized, Placebo-Controlled Trial.

Background: Centella asiatica, a medicinal plant, has been used traditionally to promote wound healing. Its efficacy on promoting postlaser resurfacing wound healing is lacking. Methods: Thirty individuals with facial acne scars underwent a treatment with 2940 nm Er:YAG laser. Half side of the face was randomized to receive 0.05% w/w ECa 233 gel, a standardized extract of C. asiatica, and the other half a placebo gel. The gels were applied four times daily for 7 days then twice daily for 3 months. Erythema, melanin, and texture index (TI) from Antera3D,® and skin biophysics were obtained at baseline, days 2, 4, and 7, then every 2 weeks for the first month, and every month for 3 months. Three blinded dermatologists assessed the photographs and provided a grading scale of wound appearances. Results: The ECa 233 treated side exhibited significantly less erythema index over total follow-up by 0.03 U (coefficient = -0.03 [95% CI -0.06 to -0.0006]; p = 0.046). In keeping with the physicians' assessment that showed significantly higher improvements in skin erythema at days 2, 4, and 7 (p = 0.009, 0.0061, 0.012), crusting at days 2 (p = 0.02), and general wound appearance at days 2, 4, and 7 (p = 0.008, 0.001, 0.044), TI showed a trend toward better outcome in the ECa 233 group. Skin biophysics did not differ between the two groups. Conclusion: ECa 233 might be an option for postlaser treatment to improve wound appearance.

An Herbal Extract Combination (Biochanin A, Acetyl tetrapeptide-3, and Ginseng Extracts) versus 3% Minoxidil Solution for the Treatment of Androgenetic Alopecia: A 24-week, Prospective, Randomized, Triple-blind, Controlled Trial.

OBJECTIVE: We sought to evaluate the efficacy and safety profile of an herbal extract combination comprising biochanin A, acetyl tetrapeptide-3, and ginseng extracts, and compare this to 3% minoxidil solution for the treatment of andogenetic alopecia (AGA). METHODS: A 24-week, triple-blinded, randomized controlled study was conducted in male and female subjects (N=32) with mild to moderate AGA. All were randomized to receive twice-daily, 1mL applications of the herbal extract combination or 3% minoxidil solution. Clinical efficacy from photographic assessment and adverse reactions were evaluated. RESULTS: There were thirty-two subjects (16 male, mean age 41.3±13.8 years), with AGA onset and duration of 35.5±13.6 and 6.5±5.1 years, respectively. The herbal extract combination demonstrated a comparable efficacy to 3% minoxidil solution. Expert panel photographic assessment observed a response to both treatments in most patients at 24 weeks, with no statistically significant difference in an increase of terminal hair counts (8.3% [P=0.009] and 8.7% [P=0.002] at 24 weeks in the herbal extract combinations and the 3% minoxidil solution groups, respectively). No local adverse reactions from the herbal extract combination were observed, but one subject developed scalp eczema after using the 3% minoxidil solution. CONCLUSION: The non-significant difference in clinical efficacy and safety to 3% minoxidil solution suggests that the herbal extract combination evaluated here could potentially be an alternative treatment with for AGA. Further studies with larger groups and longer follow-up periods are recommended to verify our results.

Solid Composite Material for Delivering Viable Cells into Skin Tissues via Detachable Dissolvable Microneedles.

Delivering cells to desired locations in the body is needed for disease treatments, tissue repairs, and various scientific investigations such as animal models for drug development. Here, we report the solid composite material that when embedded with viable cells, can temporarily keep cells alive. Using the material, we also show the fabrication of detachable dissolvable microneedles (DMNs) that can instantly deliver viable cells into skin tissue. B16-F10-murine-melanoma (B16-F10) and human-embryonic-kidney-293T (HEK293T) cells embedded in the solid matrix of the hyaluronic/polyvinylpyrolidone/maltose (HA/PVP/maltose) mixture show 50.6 ± 12.0 and 71.0 ± 5.96% survivals, respectively, when kept at 4 °C for 24 h. Detachable DMNs made of the HA/PVP/maltose mixture and loaded with B16-F10-cells were constructed, and the obtained DMN patches could detach the cell-loaded needles into the skin within 1 min of patch application. In vivo intradermal tumorgrafting mice with the DMNs containing 800 cells of B16-F10 developed tumors 10 times bigger in volume than tumors induced by hypodermic needle injection of suspension containing 100,000 cells. We anticipate this work to be a starting point for viable cell encapsulation in the solid matrix and viable cell delivery via DMNs.

Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia.

BACKGROUND: Platelet-rich plasma (PRP) treatment may encourage hair growth by promoting cellular maturation, differentiation, and proliferation. OBJECTIVE: The objective of this study was to evaluate the effectiveness of PRP as a treatment for androgenetic alopecia (AGA). MATERIALS AND METHODS: A literature search combined with meta-analysis was used to calculate the overall standardized mean difference (SMD) in hair density in patients treated with PRP injections in comparison with baseline and placebo treatment. Chi squared analysis and Fisher exact test were used to investigate variation in protocols. RESULTS: The overall SMD in hair density was 0.58 (95% confidence interval [CI]: 0.35-0.80) and 0.51 (95% CI: 0.23-0.80, p < .0004) in favor of PRP treatment when compared with baseline and placebo treatment, respectively. CONCLUSION: Platelet-rich plasma is beneficial in the treatment of AGA. It is recommended that 3 monthly sessions of PRP (once monthly ×3 treatments) be used followed by a 3- to 6-month maintenance period.

Pulsed-dye laser as an adjuvant treatment for papulopustular eruptions from epidermal growth factor receptor inhibitors, a randomized blinded split-faced controlled trial.

OBJECTIVES: To investigate the efficacy of pulsed-dye laser (PDL) as an adjunctive treatment for facial papulopustular eruptions from EGFR inhibitors (EGFRi). METHODS: Fourteen patients with facial acneiform eruptions were recruited. Half side of the face was randomized to receive PDL treatment while the other side served as a control. The treatments were delivered every 2 weeks for 4 sessions. The patients were seen at baseline, weeks 2, 4, 6, 8, and 10. Erythema index (EI) measured by colorimeter, the papulopustular lesion count and physician global assessment (PGA) were obtained. Patients were allowed to use their standard treatments for their eruptions. RESULTS: Both arms had a significant decrease in EI from baseline at each subsequent visit. In the laser treated side, the mean (95%CI) EI decreased from 23.5 (22.24-24.76) at baseline to 16.3 (15.01-17.59) at week 10, while those of the sham were 23.49 (22.23-24.75) to 20.51 (19.22-21.8), respectively. The mean change was significantly lower in the PDL arm from week 4 onwards. The lesion counts in both groups also decreased significantly, but the mean difference between the arms was not different. PGA scores followed the same pattern as EI. CONCLUSIONS: Adjunctive treatment with PDL was a safe and effective treatment. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Quantitative proteomic analysis of dermal papilla from male androgenetic alopecia comparing before and after treatment with low-level laser therapy.

BACKGROUND: Currently, low-level laser therapy (LLLT) has been approved as a new treatment for androgenetic alopecia (AGA). However, it has not been elucidated how LLLT promotes hair growth in vivo. OBJECTIVES: To investigate the change in protein expression from dermal papilla (DP) tissues in male AGA patients after LLLT treatment using liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. METHODS: This is an open-label, prospective, single-arm study obtained punch scalp biopsy specimens from patients with AGA before and after LLLT treatment. Each subject was self-treated with helmet type of LLLT (655 nm, 5 mW) device at home for 25 minutes per treatment every other day for 24 weeks. LC-MS/MS analysis based on the dimethyl labeling strategy for protein quantification was used to identify proteins expressed in DP tissues from AGA patients. RESULTS: Proteomic analysis revealed 11 statistically significant up-regulated and 2 down-regulated proteins in LLLT treated DP compared with baseline (P < 0.05). A bioinformatic analysis signifies that these proteins are involved in several biological processes such as regulation of cellular transcription, protein biosynthesis, cell energy, lipid homeostasis, extracellular matrix (ECM), ECM structural constituent, cell-cell/cell-matrix adhesion as well as angiogenesis. ATP-binding cassette sub-family G member, a transporter involved in cellular lipid homeostasis, was the most up-regulated protein. Additionally, LLLT increased the main ECM proteins in DP which results in a bigger volume of DP and a clinical improvement of hair diameter in AGA patients. CONCLUSION: We identified the proteome set of DP proteins of male patients with AGA treated with LLLT which implicates the role of LLLT in promoting hair growth and reversing of miniaturization process of AGA by enhancing DP cell function. Our results strongly support the benefit of LLLT in the treatment of AGA. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Pulsed-dye laser as an adjuvant treatment for discoid lupus erythematosus: a randomized, controlled trial.

PURPOSE: To evaluate the efficacy and safety of pulsed-dye laser (PDL) for discoid lupus erythematosus (DLE) in a double blinded, randomized, controlled fashion. METHOD: Forty-eight DLE lesions from nine patients were recruited. The lesions on one side of the body were randomized into the treatment group and the other side served as a control. Treatments with the PDL (595 nm) were delivered every four weeks for four consecutive months. The patients were evaluated at weeks 0, 4, 8, 12, 16 and 24. Erythema index (EI) and Texture index (TI) were obtained by Antera3D®. Modified Cutaneous Lupus Erythematosus Disease Area and Severity Index (mCLASI) and physician global assessment (PGA) scores were assessed in every visit. Lesional skin biopsies before and after the PDL treatment were taken from four patients. RESULTS: The lesions treated with the PDL demonstrated significantly more decreases in EI, TI and improvement in PGA scores compared to the control. Though there was improvement of mCLASI in the laser group, the significance difference was not observed. Interestingly, real-time polymerase chain reaction showed a reduction in CXCL-9, 10, IFN-γ, IL-1ß, TNF-α and TGF-ß. Additionally, post-treatment DLE lesions demonstrated decreased CD3, CD4, CD8 and CXCR3-positive cells. CONCLUSIONS: Improvements of DLE can be achieved with PDL.

Sun protection behavior and knowledge of patients attending laser clinic to prevent adverse events of laser: A cross-sectional, single-center, tertiary care study.

BACKGROUND: Limited data of sun protection knowledge in laser treatment patients exists therefore, preventative information should be provided by dermatologists to minimize harmful effects. OBJECTIVE: To assess sun protection knowledge-behavior and knowledge to prevent adverse events from laser therapy among patients who visited a laser clinic at a tertiary university hospital in Bangkok, Thailand. METHODS: This is a self-reported questionnaire, cross-sectional survey. All participants from the Laser Clinic in KCMH were recruited into the study. RESULTS: A Total of 385 patients were enrolled into the study; 80.5% female participants. Patients who never received laser treatment significantly lacked proper sun protection knowledge to prevent adverse events of lasers when compared to those who previous received laser treatments regarding the application of sunscreen after laser treatment (56.6% vs 17.4%, P < .001), consistent application of sunscreen 4-6 weeks prior to receiving laser treatment (60.5% vs 18.9%, P < .001), application of topical corticosteroid after laser (67.1% vs 54.1%, P = .048), and sun protection in the post laser area (41.9% vs 20.4%, P < .001). CONCLUSION: The attitude and knowledge of sun protection to prevent adverse events were significantly different among the group of educational levels and previous history of laser treatment.

Anterior Tragal Crease Is Associated With Atherosclerosis: A Study Evaluating Carotid Artery Intima-Media Thickness.

The utility of the ear crease sign, anterior tragal crease (ATC), as a marker of atherosclerosis is yet to be established. The intima-media thickness of the common carotid artery (IMT-CCA) has been used as a noninvasive surrogate marker for atherosclerosis. History of traditional risk factors for atherosclerosis was obtained from 147 volunteers; ear examination was also performed and venous blood was drawn for laboratory analysis. The volunteers then underwent an ultrasonography measurement of the IMT-CCA. In univariate analysis, presence of ATC, age, underlying hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular disease, cigarette smoking, low-density lipoprotein, and high-sensitivity C-reactive protein were significantly associated with the IMT-CCA. Further multivariate analysis confirmed a significant association between the presence of ATC and IMT-CCA, when adjusted for other factors (adjusted ßATC = .010, 95% confidence interval: 0.0021-0.019). Anterior tragal crease is a potential clinical sign that can predict atherosclerosis. The sign is easily recognizable and may help health-care professionals to identify those at risk of atherosclerosis, especially in people with no clinical signs of the disease.