Association of Obesity and Bariatric Surgery on Hair Health.

Obesity and obesity-related conditions today constitute a public health problem worldwide. Obesity is an "epidemic" chronic disorder, which is defined by the WHO as normal or excessive fat accumulation that may impair health. It is also defined for adults as a BMI that is greater than or equal to 30. The most common obesity-related diseases are type 2 diabetes mellitus, cardiovascular diseases, metabolic syndrome, chronic kidney disease, hyperlipidemia, hypertension, nonalcoholic fatty liver disease, and certain types of cancer. It has been also proven that obesity can have a negative effect on hair. It can lead to hair thinning. Patients with obesity can undergo bariatric surgery if they meet the inclusion criteria. The four common types of weight loss surgery include a duodenal switch with biliopancreatic diversion, laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Bariatric surgery can affect skin and hair and is associated with telogen effluvium due to weight loss, microelement deficiency, anesthesia, low calorie intake, and low protein intake. Patients who undergo bariatric surgery can experience post-bariatric surgery depression. Hair loss can have a major impact on self-esteem, negatively affecting one's self-image. The purpose of this narrative review is to critically review how obesity, obesity-related diseases, and bariatric surgery affect hair health in general and the hair development cycle, and how they influence hair loss.

The role of autologous micrografts injection from the scalp tissue in the treatment of COVID-19 associated telogen effluvium: Clinical and trichoscopic evaluation.

The clinical presentation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 COVID-19) varies from asymptomatic infection to a life-threatening, multiorgan disease. One of these manifestations is telogen effluvium (TE) which is characterized by diffuse hair loss occurring in patients previously infected with SARS-CoV-2 and lasts ~3 months, after which excessive hair loss follows. Hair follicles are known to contain a well-characterized niche for adult stem cells which is the bulge containing epithelial and melanocytic stem cells. Stem cells in the hair bulge, a demarcated structure within the lower permanent portion of hair follicles, can generate the interfollicular epidermis, hair follicle structures, and sebaceous glands. This study aims to evaluate autologous micrografts from scalp tissues as a therapeutic modality in the management of TE caused by COVID-19. Twenty patients of previous COVID-19 infection suffered from TE were included in this study for human follicle stem cells micrograft scalp treatment and they were evaluated after 3 months of treatment and after 6 months. There was significant improvement of the hair thickness and density compared with the start of the treatment and 6 months of follow-up. Autologous micrograft of the scalp showed marked improvement in the treatment of COVID-19 TE.

The Use of a 1,540 nm Fractional Erbium-Glass Laser in Treatment of Alopecia Areata.

BACKGROUND AND OBJECTIVES: Varieties of laser and light sources have been tried for treatment of alopecia areata (AA) and some success has been reported. To assess the effectiveness of 1,540 nm fractional erbium-glass laser in treatment of AA. STUDY DESIGN/MATERIALS AND METHODS: The patches of AA were divided into two groups, the study group (I) underwent six sessions of laser therapy at weekly interval with topical minoxidil solution applied twice daily for 6 weeks, while group (II), the control group was received only topical minoxidil solution. The patches were evaluated objectively (hair count and percentage of regrowth) and subjectively (patient satisfaction) at the end of follow-up period (another 6 weeks). RESULTS: The percentage of hair increment between pre-treatment and follow-up period was 30% for study patches versus 6.45% for control patches. Regarding the percentage of growth, the response rate for study patches was 60% versus 16% for the control. CONCLUSIONS: Erbium-glass laser seems to be effective in regrowing hair in AA. The durability of the response is unknown. Possible mechanisms of improvement include the induction of a thermal effect on papillary dermis, which stimulates hair regrowth, or an immunological effect on the follicle. In addition, the erbium-glass laser may enhance the delivery of minoxidil solution. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Biofibre hair implant: what is new, what is true?

Ensuring the safety of hair implant fibers is essential. At the same time, good aesthetic quality and durability should also be considered in order to maintain expected result over the years. The main features required are biocompatibility, resistance to traction, absence of capillarity, resistance to physical-chemical stress, and low tissue trauma, in addition to good aesthetics. Biofibre® medical hair prosthetic fibers meet all the biocompatibility and safety requirements established by international standards for medical devices. They are available in 13 colors, with different lengths (15, 30 or 45 cm) and various shapes (straight, wavy, curly and afro). Biofibre® hair implants are indicated for diffuse hair loss or hair thinning in cases where an immediate aesthetic result is required, when patients request minor surgery without hospitalization, both for male and female patients, in combination with other hair restoration techniques to improve the final aesthetic result, to correct scars or scalp burns and in cases of poor donor areas. Biofibre® Hair Implant is in fact a minor surgery technique, performed under local anesthesia by either a manual implanter or an automatic machine which enables an immediate aesthetic result and the desired quantity of hair without pain or hospitalization. Clinical and histological studies have demonstrated that Biofibre® hair Implants are safe and well tolerated by patients and can be totally reversible if the need arises. This technique requires good after-care, periodical check-ups and yearly implant re-touches to maintain the best cosmetic result.

The Effect of Neodymium: Yttrium Aluminum Garnet and Fractional Carbon Dioxide Lasers on Alopecia Areata: A Prospective Controlled Clinical Trial.

BACKGROUND: Effective treatment options for alopecia areata (AA) are missing. Whether lasers might be effective is a topic of debate. OBJECTIVE: We aimed to evaluate whether neodymium: yttrium aluminum garnet (Nd:YAG) or fractional carbon dioxide lasers might stimulate the development of new hair. MATERIALS AND METHODS: Thirty-two patients who had long-standing and treatment refractory diseases were recruited for the study. Three different patches on the scalp were selected, 1 of which served as control. The mean outcome measure was the hair count, which was calculated with the digital phototrichogram. Response was defined as at least 25% increase in the mean hair count at the treated patch compared with the control patch. RESULTS: At the end of the study, there was no statistically significant difference in the mean hair count for the 3 patches. In 7 of 32 patients (22%), an increase in the mean hair count was observed on the whole scalp including the control patch, which resulted in an improved Severity of Alopecia Tool (SALT) score. CONCLUSION: We have observed that Nd:YAG or fractional carbon dioxide lasers did not increase the mean hair count on the treated AA patches when compared with the control patch. However, an SALT score improvement in 22% of the patients suggested spontaneous remission.

Effectiveness of 308-nm Excimer Laser Therapy in Treating Alopecia Areata, Determined by Examining the Treated Sides of Selected Alopecic Patches.

BACKGROUND: Some studies have reported the use of 308-nm excimer laser therapy for treating alopecia areata (AA); however, the effectiveness of this therapy on a theoretical basis has not yet been comparatively analyzed. OBJECTIVES: To determine the therapeutic effect of excimer laser therapy on AA. METHODS: One alopecic patch was divided into control and treated sides in 10 patients with AA. Then, 308-nm excimer laser therapy was administered twice a week for 12 weeks. Photograph and phototrichogram analyses were performed. RESULTS: Photographic assessments by both dermatologists and individuals of the general population showed objective improvements after excimer laser therapy. On the treated side, the hair count and hair diameter had statistically increased after treatment. However, only the hair diameter was found to be significantly high in the treated half when it was compared with the control side. CONCLUSION: The 308-nm excimer laser has a therapeutic effect on AA, which is proven by photograph and phototrichogram analysis by a side-by-side comparison.

Excimer laser: a module of the alopecia areata common protocol.

Alopecia areata (AA) is an autoimmune condition characterized by T cell-mediated attack of the hair follicle. The inciting antigenic stimulus is unknown. A dense perbulbar lymphocytic infiltrate and reproducible immunologic abnormalities are hallmark features of the condition. The cellular infiltrate primarily consists of activated T lymphocytes and antigen-presenting Langerhans cells. The xenon chloride excimer laser emits its total energy at the wavelength of 308 nm and therefore is regarded as a "super-narrowband" UVB light source. Excimer laser treatment is highly effective in psoriasis, another T cell-mediated disorder that shares many immunologic features with AA. The excimer laser is superior in inducing T cell apoptosis in vitro compared with narrowband UVB, with paralleled improved clinical efficacy. The excimer laser has been used successfully in patients with AA. In this context, evaluation of the potential benefit of 308-nm excimer laser therapy in the treatment of AA is clinically warranted. Herein, the use of a common treatment protocol with a specifically designed module to study the outcome of excimer laser treatment on moderate-to-severe scalp AA in adults is described.

Hair transplantation for therapy-resistant alopecia areata of the eyebrows: is it the right choice?

Alopecia areata is a common skin disorder of presumed autoimmune etiology and it usually shows an unpredictable course. Treatment of alopecia areata is challenging. There is very little information on the use of surgical therapies for the treatment of alopecia areata in the medical published work. A 24-year-old male patient was referred to a private hair transplantation clinic owned by one of the authors for the treatment of therapy-resistant alopecia areata affecting both eyebrows. He had quickly lost all body hair 4 years prior beginning from the scalp. He received psoralen and ultraviolet A (PUVA) therapy for alopecia universalis and all body hair re-grew except his eyebrows. Alopecia areata was stable for the 18 months following the last medical treatment he received. Because there was no response to various medical therapeutic agents, we decided to transplant occipital hairs to the eyebrow area. After the patient understood and accepted all risks, occipital hairs were transplanted to the eyebrows by using the follicular unit extraction technique. Postoperatively, the patient did not receive any topical or systemic therapies for alopecia areata. Although 40% hair re-growth was detected in his eyebrows at 1 year postoperation, this rate was 80% by 2 years postoperation. However, there was resistance to re-growth in the medial eyebrow regions. New eyebrows grew as occipital hairs and required trimming. His satisfaction from the surgical procedure was 90% at the end of the 24th postoperative month. Surgical treatment of diseases like alopecia areata is still controversial. Our case report offers an additional contribution to the published work on the surgical methods used in the treatment of stable alopecia areata.

Successful hair transplant of eyebrow alopecia areata.

BACKGROUND: Alopecia areata of the eyebrows can be difficult to treat. Intralesional triamcinolone or potent topical steroids are considered the mainstay of medical therapy. This case illustrates the results of an experimental hair transplant to the eyebrows following years of modest response to intralesional triamcinolone. OBJECTIVE: The aim of this study was to ascertain the benefits of a hair transplant for chronic eyebrow alopecia areata not responding to appropriate medical therapy. METHODS: A hair transplant was performed with tumescent anesthesia and a total of 85 mini and micrografts placed in the right eyebrow. Followup after the hair transplant occurs every 8 weeks. RESULTS: The patient was free of eyebrow alopecia areata for 8 months following the initial hair transplant. Although the disease relapsed, hair growth is now manageable with intralesional cortisone injection performed six times per year. CONCLUSIONS: For the first time in years, this patient was given 8 months of reprieve from his eyebrow alopecia areata and is currently well-maintained on monthly intralesional cortisone which originally was of only modest benefit. The patient is pleased with the outcome.

[Alopecia triangularis congenita. Clinical manifestations--surgical correction with autologous hair transplantation]. / Alopecia triangularis congenita. Klinisches Erscheinungsbild--operative Korrektur mit autologer Haartransplantation.

We present the case of a 22-year-old female patient with alopoecia triangularis congenita. Hair transplantation was successfully performed.

Fiber implantation for pattern baldness.

Examination of 20 patients who had fiber implantation for the treatment of pattern baldness showed that nearly all the fibers had fallen out by ten weeks. Complications observed were facial swelling, infection, foreign-body granulomas, scarring, and permanent hair loss. Scanning electron microscopy identified the fibers as modacrylic fibers. The complications, high monetary cost, and ultimate futility of fiber implantation make it an unacceptable procedure.