Impact of Photobiomodulation on the Quality of Life of Men and Women With Androgenetic Alopecia.

OBJECTIVES: Androgenetic alopecia (AGA) is the most common cause of hair loss in men and women, and it can affect the psychological and social activities of individuals, thus reducing their quality of life. Photobiomodulation (PBM) is a recent adjuvant treatment for this condition with promising results for hair regrowth. We aimed to assess the health-related quality of life of men and women with AGA before and after PBM sessions. METHODS: This is a single-center prospective observational study conducted with 42 men and 43 women with AGA. All participants answered a sociodemographic questionnaire in an interview and individually answered the Brazilian version of Skindex-29 (self-application). After 24 PBM sessions, two 20-minute sessions per week, with 48 to 72 hours of interval between sessions, participants answered the Skindex-29 again. RESULTS: Women had a large reduction in Skindex-29 total score after PBM (p<0.01; d=0.82) and lower scores in the emotions (p<0.01; d=0.89), psychosocial functioning (p<0.01; d=0.60), and symptoms domains (p=0.03; d=0.38). Men presented a moderate reduction in Skindex-29 total score after PBM (p<0.01; d=0.68), largely lower scores in the emotions domain (p<0.01; d=0.82) and a small reduction in the psychosocial functioning domain (p<0.01; d=0.47). CONCLUSIONS: The use of PBM in AGA is associated with improving the quality of life of men and women. This enhancement was higher regarding emotions, the major domain affected in the AGA population. Women had larger impacts on all domains of Skindex-29 after the use of PBM.

Novel Application of 1064-nm Picosecond Nd:YAG Laser for Male Androgenetic Alopecia Treatment.

Background: There are limitations and side effects of currently approved treatments for AGA, such as topical minoxidil, oral finasteride, and low-level light therapy. Objective: This study aimed to investigate the potential of fractional picosecond laser (FPL) therapy for promoting hair regrowth. Methods: This was a pilot study in which five male participants were treated with a 1064-nm FPL for mild-to-moderate AGA. The patients underwent three treatments at four-week intervals, followed by a four-week post-procedure assessment. Expert panel assessment score and patient satisfaction was assessed using a seven-point scale. Dermoscopic analysis was conducted to evaluate hair shafts. Adverse effects were also monitored. Results: Clinical improvement was observed at 1 to 4 months after treatment, with a significant increase in expert panel assessment scores (p<0.001). Patient satisfaction with hair density and thickness also improved significantly at 1 and 4 months (p=0.038 and p=0.007, respectively). Adverse effects were minimal and resolved within a week. Dermoscopic analysis showed minimal petechiae with no hair shaft damage. Conclusion: The preliminary study demonstrates the potential of 1064-nm FPL for promoting hair regrowth in male pattern hair loss. Nonetheless, further research is recommended to elucidate and ratify for the optimization of this promising treatment approach.

Hair Growth Promotion and Anti-Hair Loss Effects of By-Products Arabica Coffee Pulp Extracts Using Supercritical Fluid Extraction.

Coffee has been a common ingredient in many traditional hair loss remedies, but limited scientific evidence supports its use, particularly in coffee pulp. Androgenetic alopecia (AGA) is caused by androgens, inflammation, and oxidative stress. In the present study, supercritical fluid extraction (SFE) was used under various conditions to obtain six coffee pulp extracts. The SFE-4 extract, using 50% (v/v) ethanol as a co-solvent at conditions of 100 °C and 500 bars for 30 min, exhibited the highest phenolic, flavonoid, and caffeine contents. Additionally, the SFE-4 extract increased the migration and cell proliferation of HFDPCs (human hair follicle dermal papilla cells), which control hair cycle regulation, and had scavenging effects on ABTS and DPPH radicals. Additionally, the SFE-4 extract showed potassium ion channel opener activity in HFDPCs, as well as a stimulation effect on the enzyme matrix metalloproteinase-2 (MMP-2) (28.53 ± 1.08% of control), which may be related to the vascular endothelial growth factor (VEGF) gene upregulation. In human prostate cancer cells (DU-145) and HFDPC cells, the SFE-4 extract significantly decreased the expression of SRD5A1, SRD5A2, and SRD5A3, an essential pathway involved in AGA. Hair growth factor genes in the Wnt/-catenin (CTNNB1) and Sonic Hedgehog (SHH, SMO, and GLI1) pathways could be significantly activated by the SFE-4 extract. These results imply that employing SFE in coffee pulp extraction could help AGA treatment by preventing hair loss and promoting hair growth pathways. This would help small coffee producers gain economic empowerment and ensure the long-term sustainability of agricultural waste utilization.

Tumid Lupus Erythematosus Presenting as Patchy Alopecia: A Discussion of Alopecia Associated With Lupus Erythematosus.

Tumid lupus erythematosus (TLE), a subtype of chronic cutaneous lupus erythematosus (CCLE), presents with firm erythematous plaques that lack surface changes such as follicular plugging or scale. These lesions most commonly occur on the face and other photosensitive areas but may also present on the scalp as recurrent circumscribed patches of non-cicatricial alopecia. Including TLE as part of the differential for non-cicatricial alopecia can prove helpful in patients who fail to improve with empiric first-line treatments for more common causes of hair loss. We report a case of TLE that clinically mimicked alopecia areata and seek to highlight the relevant clinical and histological features to promote earlier diagnosis of this entity. A discussion of improved diagnostic and treatment modalities, as well as identifying the uncommon but possible association of TLE with underlying systemic disease, adds to the importance of maintaining clinical suspicion for TLE. Finally, we provide an overview to discriminate TLE from other forms of cutaneous lupus and their unique patterns of alopecia when presenting on the scalp.

Hair loss treatment and restoration: Online interest trends and video-based social media content.

BACKGROUND: Public interest in hair loss topics and treatments can be observed by examining online trends, such as those monitored by Google Trends. Social media has also gained the interest of the dermatology community. Video-based social media sites are being used to provide the public with informational content related to hair loss and treatments, but it may not always be unbiased or reliable. AIMS: This research examined the interest in hair loss and treatment related trends in recent years through Google Trends, as well as examined what videos from YouTube and TikTok that the average person may encounter when performing searches related to hair loss and treatments. RESULTS: Google Trends showed that the COVID-19 pandemic had an initial negative impact on interests of hair loss and treatment related topics, both worldwide and in the United States. External events, such as a celebrity receiving a hair transplant, can influence the interests of the general public with the topic. The social media sites showed that there was a high level of interest in the topics, approximately 25% of videos involved a medical professional, and many involved personal experiences or natural remedies. CONCLUSIONS: Interest in hair loss and treatments continues to grow. Clinicians should do their best to follow the current public interests and be aware of where patients may be obtaining information. Being aware of general interest trends online can benefit clinicians by allowing them to prepare their clinics for potential influxes.

Treatment of Androgenetic Alopecia Using PRP to Target Dysregulated Mechanisms and Pathways.

Androgenetic alopecia ("AGA") is the most prevalent type of progressive hair loss, causing tremendous psychological and social stress in patients. However, AGA treatment remains limited in scope. The pathogenesis of androgenetic alopecia is not completely understood but is known to involve a hair follicle miniaturization process in which terminal hair is transformed into thinner, softer vellus-like hair. This process is related to the dysregulation of the Wnt/ß-catenin signaling pathway, which causes premature termination of the anagen growth phase in hair follicles. Historically used for wound healing, platelet rich plasma ("PRP") has recently been at the forefront of potential AGA treatment. PRP is an autologous preparation of plasma that contains a high number of platelets and their associated growth factors such as EGF, IGF-1, and VEGF. These factors are known to individually play important roles in regulating hair follicle growth. However, the clinical effectiveness of PRP is often difficult to characterize and summarize as there are wide variabilities in the PRP preparation and administration protocols with no consensus on which protocol provides the best results. This study follows the previous review from our group in 2018 by Cervantes et al. to analyze and discuss recent clinical trials using PRP for the treatment of AGA. In contrast to our previous publication, we include recent clinical trials that assessed PRP in combination or in direct comparison with standard of care procedures for AGA such as topical minoxidil and/or oral finasteride. Overall, this study aims to provide an in-depth analysis of PRP in the treatment of AGA based on the evaluation of 17 recent clinical trials published between 2018 and October 2021. By closely examining the methodologies of each clinical trial included in our study, we additionally aim to provide an overall consensus on how PRP can be best utilized for the treatment of AGA.

Hair follicle-derived mesenchymal stem cells decrease alopecia areata mouse hair loss and reduce inflammation around the hair follicle.

BACKGROUND: Alopecia areata (AA) is a common autoimmune hair loss disease with increasing incidence. Corticosteroids are the most widely used for hair loss treatment; however, long-term usage of hormonal drugs is associated with various side effects. Mesenchymal stem cells (MSCs) therapy has been studied extensively to curb autoimmune diseases without affecting immunity against diseases. METHODS: Hair follicle-derived MSCs (HF-MSCs) were harvested from the waste material of hair transplants, isolated and expanded. The therapeutic effect of HF-MSCs for AA treatment was investigated in vitro AA-like hair follicle organ model and in vivo C3H/HeJ AA mice model. RESULTS: AA-like hair follicle organ in vitro model was successfully established by pre-treatment of mouse vibrissa follicles by interferon-γ (IFN-γ). The AA-like symptoms were relieved when IFN-γ induced AA in vitro model was co-cultured with HF-MSC for 2 days. In addition, when skin grafted C3H/HeJ AA mice models were injected with 106 HF-MSCs once a week for 3 weeks, the transcription profiling and immunofluorescence analysis depicted that HF-MSCs treatment significantly decreased mouse hair loss and reduced inflammation around HF both in vitro and in vivo. CONCLUSIONS: This study provides a new therapeutic approach for alopecia areata based on HF-MSCs toward its future clinical application.

An Approach to Hair Loss in Pediatric Primary Care.

Pediatric hair loss is a cause of concern for patients and families. Early diagnosis and treatment are crucial, as delays in care for certain diagnoses can cause permanent scarring alopecia. The evaluation of hair loss includes a thorough history, physical examination, and other potential tests. The causes of hair loss can be classified as either acquired versus congenital. Acquired causes of hair loss can be subdivided into scarring and nonscarring; however, some conditions may present as nonscarring and progress to scarring alopecia. Recommendations for the evaluation and treatment of pediatric hair loss for the primary care practitioner will be summarized.

Hair loss treatment information on Facebook: Content analysis and comparison with other online sources.

BACKGROUND: Facebook is the biggest online social networking platform, and it is being utilized by patients for peer support as well as to explore treatment options. Hair loss patients can experience negative psychological effects and are likely to turn to social networking platforms for support and treatment information. AIMS: To evaluate the type and quality of Facebook hair loss treatment information that can be accessed by hair loss patients. METHODS: In August 2020, we searched Google for publicly accessible Facebook hair loss treatment content using the terms hair loss, alopecia, hair loss treatment, hair restoration, and hair transplant. We retrieved 133 Facebook pages and ranked them based on the number of visitors who received regular content updates. Content posted on the Top 5 most popular pages was analyzed based on type (advertising vs informational) and information quality (unsupported or supported by medical evidence). RESULTS: Most Facebook hair loss pages advertised products or hair restoration clinics, or were aimed at fundraising for alopecia organizations. There was high interest in natural hair loss treatments and follicular unit excision (FUE) procedures, consistent with global online search trends. Some products advertised as "natural" contained minoxidil. "Before & after" images of FUE procedures were popular with users. Only 3%-13% of hair loss treatment posts were supported by medical evidence and user engagement with this content was low. CONCLUSION: There is high user interest in hair loss treatment content on Facebook. Hair restoration specialists should discuss online sources of treatment information with potential patients.

Analysis of YouTube hair loss treatment information: What makes for engaging content?

Patients are increasingly seeking effective hair loss treatments. The internet and social media are popular sources of health information, but the quality and reliability of the content available to patients is highly variable. More than two thirds of American adults reported using YouTube in 2019. We investigated public interest in hair loss treatment information on YouTube and evaluated the quality of health information in videos with high viewer engagement. In July 2020, we used Google Trends, limited to YouTube searches, to analyze relative interest in hair loss treatments worldwide. We searched YouTube using nonsurgical and surgical hair loss treatment terms and we analyzed the retrieved video content. The DISCERN tool was used to evaluate the quality of health information in the hair loss treatment videos with highest viewer engagement. There is increasing public interest in YouTube searches for hair loss treatments. A large number of hair loss treatment videos are available on YouTube, but potential patients are likely to access mostly new content created by well-subscribed channels. Videos with high viewer engagement contain information that can be useful in guiding treatment decisions, but tend to be biased because they are intended to promote dermatology and hair restoration clinics. Patients are using YouTube as a source of hair loss treatment information. Videos created by hair restoration experts contain reliable information, but their quality can be improved by providing links to other sources.

The Utilization of YouTube as a Resource on Hair Loss Treatments.

INTRODUCTION: To the best of our knowledge, no previous studies have evaluated the quality of videos discussing hair loss treatments METHODS: YouTube was searched on December 10, 2019, using the relevance and view count filters for the following search terms: hair loss treatment, baldness, alopecia, male pattern baldness, and female pattern baldness. The DISCERN criterion for assessing consumer health information was used to evaluate each video. A score of 1 indicates a low overall video quality, whereas a 5 indicates a high-quality source of information for patients. The DISCERN treatment assessment is a validated tool to assess the quality of patient information about treatment choices. Two-sample t tests and Mann-Whitney U tests were used to determine significance. RESULTS: We analyzed 90 videos receiving a total of 108,240,496 views with a mean view count of 1,202,672 views per video (Table 1). Pharmaceuticals including minoxidil and finasteride were the most commonly mentioned treatment (30% of videos) followed by nutraceuticals (20%). YouTube influencers (Table 2) represented 37.8% of authors followed by companies/advertisers (15.6%). Seventeen videos (18.9%) included board-certified dermatologists. The mean DS overall was 2.66, and the mean DS for bias was 2.98. DISCUSSION: Our data demonstrate the extensive use of YouTube for hair loss treatment information. While YouTube can be a valuable resource for patients, videos are often biased and can misinform patients. Moreover, the lack of a central review process or governing body to validate claims made in videos can be a safety concern. EBM LEVEL V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A combination of pyridine-2, 4-dicarboxylic acid diethyl ester and resveratrol stabilizes hypoxia-inducible factor 1-alpha and improves hair density in female volunteers.

OBJECTIVE: The aim of this study was first to demonstrate that a combination of pyridine-2, 4-dicarboxylic acid diethyl ester and resveratrol could synergize in vitro on biological pathways associated with hair growth and then to demonstrate the benefit on hair density in a clinical study. METHODS: The effects of pyridine-2, 4-dicarboxylic acid diethyl ester and resveratrol directly on the hypoxic inducible factor-1α protein (HIF-1α) and related genes expression were demonstrated on keratinocytes in culture in vitro using western-blot analysis and real time quantitative polymerase chain reaction analysis. The effect of resveratrol against oxidative stress induced by hydrogen peroxide treatment was studied in hair follicle and hair matrix cells in vitro using the sensitive probe Dichloro-dihydro-fluorescein diacetate (DCFH-DA). Finally, a randomized clinical study on hair density was conducted on 79 Caucasian female subjects to assess the effect of this combination of actives. RESULTS: Pyridine-2, 4-dicarboxylic acid diethyl ester and resveratrol stabilized HIF-1a protein and increased the expression of HIF-1α target genes. Resveratrol significantly reduced the oxygen peroxide-induced oxidative stress generated in hair follicle and hair matrix cells. The clinical study showed that a topical treatment with the combination significantly increased the hair density on women from 1.5 months. CONCLUSION: In addition to the antioxidant properties of resveratrol, the association of pyridine-2, 4-dicarboxylic acid diethyl ester and resveratrol revealed a synergistic effect on the HIF-1α pathway. The results of the clinical study confirmed the importance of such a combination to increase the hair density.

L'alopécie peut affecter 50% des femmes au cours de leur vie ce qui induit une perte de leur estime de soi et une diminution de leur qualité de vie. Au-delà des solutions chirurgicales et des traitements pouvant induire des effets secondaires potentiellement dangereux, il y a un besoin d'améliorer l'efficacité des produits cosmétiques qui permettent de prévenir la chute des cheveux tout en préservant la sécurité des patients. Ainsi, nous avons sélectionné une combinaison de pyridine-2, 4-dicarboxylic acide diethyle ester et de resvératrol pour activer des voies biologiques associées à la croissance du cheveu. Nous avons d'abord montré, in vitro, que la combinaison de pyridine-2, 4-dicarboxylic acide diethyle ester et de resvératrol permet de stabiliser la protéine HIF-1α conduisant ainsi à un effet synergique sur l'expression de gènes clés de la voie HIF-1α. Nous avons aussi démontré, in vitro, que le resvératrol permet de protéger significativement les follicules pileux et les cellules de la matrice du stress oxydatif induit par traitement au peroxide d'hydrogène. En final, une étude clinique randomisée mesurant la densité capillaire a été réalisée sur 79 femmes caucasiennes. Cette étude montre qu'une application topique d'une solution contenant de 5% pyridine-2, 4-dicarboxylic acide diethyle ester et 0.25% de resvératrol augmentent significativement la densité capillaire chez les femmes après 1.5 mois. En conclusion, ces résultats démontrent l'intérêt de stimuler la voie HIF-1α tout en protégeant les cheveux et le scalp du stress oxydatif afin d'améliorer la croissance des cheveux chez les femmes.

A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents.

Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions. Diagnostic tools for hair loss in children include a detailed history, physical examination with a focused evaluation of the child's hair and scalp, fungal screens, hair pull and tug test, and if possible, light microscopy and/or trichoscopy. Management of alopecia requires a holistic approach including psychosocial support because treatments are only available for some hair loss conditions, and even the available treatments are not always effective. This review outlines the clinical presentations, presents a diagnostic algorithm, and discusses management of these various hair loss disorders.