Beware of the Impostors—Scalp Pathology Primer for the Hair Transplant Surgeon

Histopathological features are important for the practicing hair transplant surgeon to ensure proper case selection, diagnosis, choice of proper treatment, and successful outcome. While the primary focus of the hair transplant surgeon is androgenetic alopecia (AGA), it is important to be aware of other conditions that can mimic AGA, whose treatment may be different. This article outlines some of these conditions such as scarring alopecias, alopecia areata, etc., and how to distinguish them. Proper identification will ensure proper treatment and avoid potential missteps in management.     

Nutraceuticals for Androgenetic Alopecia

BackgroundSeveral oral nutraceuticals have recently emerged as products marketed to increase hair growth and thickness. However, these supplements typically lack the rigorous testing and statistically significant data that apply to pharmaceuticals. Therefore, the potential benefits of oral nutraceuticals for conditions of hair loss, such as androgenetic alopecia, have yet to be fully understood by dermatologists. ObjectiveThe purpose of this article is to evaluate current studies in the literature to assess the efficacy of popular oral nutraceuticals marketed for hair growth in subjects with androgenetic alopecia.MethodsThis article reviews the currently available literature on the nutraceuticals Nutrafol^® and Viviscal^® for hair growth and describes and evaluates the results observed.ResultsOral nutraceuticals are effective to a modest degree in promoting hair growth in men and women with androgenetic alopecia.ConclusionOral nutraceuticals have demonstrated efficacy in promoting modest hair growth in men and women with androgenetic alopecia and may serve as useful adjuncts to current treatments. As the popularity of nutraceuticals grows, it is important for dermatologists to be knowledgeable of the potential benefits and pitfalls of these supplements to appropriately counsel patients seeking treatment for hair loss.     

Follicular unit transplantation for male-pattern hair loss: Evaluation of 120 patients.

The main aim in surgical hair restoration is to restore hair, making the scalp look natural. Interviews with earlier patients who received hair transplants revealed that their complaints were - a straight anterior hairline that looked unnatural, and hair that looked like 'sprouted grass'. The use of follicular unit transplantation (FUT) technique, where hair roots are harvested under magnification, is becoming widespread. In this technique, hair roots are harvested into natural follicular units that contain 1-4 hair roots. In this article, we present our results related to hair transplantation by FUT technique, performed on 120 patients between the ages of 21 and 75 years with male-pattern hair loss. We made simple yet useful interventions to avoid the occurrence of the above-mentioned problems. Initially, drawings based on the middle line and the two temporal regression points were made for a natural-looking anterior hairline. Following this, irregular seeding was done instead of seeding in rows, to obtain a natural hairline. To avoid the 'sprouted grass' look, single hair roots were placed on the anterior hairline taking into consideration the direction of hair growth. However, the FUT technique is not adequate on its own for natural-looking hair restoration. Good planning and creation of an anterior hairline suited to the individual's forehead structure is fundamental for successful results. In addition, we believe that hair texture is very important in hair transplantation and additional care should be given particularly to patients with dark-coloured and hard hair.     

Regenerative Medicine Treatments for Androgenetic Alopecia

Regenerative medicine and the role of stem cells are being studied for applications in nearly every field of medicine. The pluripotent nature of stem cells underlies their vast potential for treatment of androgenic alopecia. Several advances in recent years have heightened interest in this field, chief among them are the evolution of simpler techniques to isolate regenerative elements and stems cells. These techniques are easy, outpatient procedures with immediate injection, often single session with harvest, and minimal manipulation (usually physical). This paper seeks to critically review the existing data and determine the current evidence and their role in practice.     

自体头发单体毛囊移植治疗永久性秃发的疗效评价

目的采用自体枕部头发分离成单体毛囊，移植治疗永久性秃发（雄激素源性秃发及瘢痕性秃发），评价其效果。方法取患者自体枕部的头发优势区的毛发，在手术放大镜下将其分成含有1～4根毛发的单体毛囊，用小植发刀在受区根据术前设计作2mm的小切口，用显微手术镊取已分离好的单体毛囊，植入切口内。结果我科于2003年10月至2007年10月共手术163例，大部分患者术后移植的毛发均生长良好。结论自体毛发单体毛囊移植术治疗永久性秃发，手术效果好，手术创伤小，外观较满意。     

Patient Satisfaction and Quality of Life Among Adult Women with Androgenetic Alopecia Using 5% Topical Minoxidil

BACKGROUND: Androgenetic alopecia (AGA) is a common, genetically predisposed condition that begins after puberty and whose frequency increases with age; although biologically benign, AGA can impact patients both psychologically and socially, contributing to an impairment on their quality of life. OBJECTIVE: We sought to evaluate the psychological, social, and quality of life impairments inherent in women with AGA using 5% minoxidil daily for at least six months. DESIGN: Thirty-one women with diffuse central hair thinning and shaft miniaturization who were using 5% minoxidil daily for at least six months responded to a clinical questionnaire and underwent trichoscopy. RESULTS: 83.9 percent (n=26) of the participants reported they were satisfied with the 5% minoxidil treatment and its convenience. Hair loss influenced social life in 54.8 percent (n=17) of the respondents and choice of hair cut/hairstyle in 87.1 percent (n=27) of respondents. For 51.6 percent (n=16) hair loss was slightly increased, although it did not increase after beginning treatment. A frontoparietal pattern (74.2%, n=23), very low capillary density (61.3%, n=19), trichodynia (32.3%, n=10), and negative traction test (100%, n=31) were also observed. Miniaturization occurred in 100 percent (n=31) of patients, frontal/occipital hair thickness was reduced in 83.9 percent (n=26), and more than 10 percent of velus hair in the frontal area was observed in 83.9 percent (n=26) of patients. The number of hair shafts per follicular unit was reduced in 67.7 percent (n=21), and a higher frontal to occipital ratio of follicular units with one hair shaft was seen in 74.2 percent (n=23) of patients. Empty follicles, large numbers of peripillar brownish halo, scalp pigmentation, mild Ludwig''s baldness degree, and quality of life scores of 4±3.5 points were observed. CONCLUSION: Our results indicate that patient satisfaction and quality of life of women with AGA on 5% topical minoxidil are high, although hair loss influences daily habits and social life.     

Trichoscopy for the Hair Transplant Surgeon—Assessing for Mimickers of Androgenetic Alopecia and Preoperative Evaluation of Donor Site Area

Preoperative diagnostic confidence and donor site assessment are important for all hair transplant surgery patients. While the majority of patients seek hair transplantation for male or female pattern hair loss (androgenetic alopecia [AGA]), there are mimickers that must be differentiated from patterned hair loss, as they alter the candidacy of the patient for transplantation. They are termed mimickers as they also can present with patterned hair loss. The use of trichoscopy has become increasingly popular for such use. Patterned hair loss mimickers, which include the underappreciated alopecia areata incognita (AAI) and fibrosing alopecia in patterned distribution (FAPD), can be identified clinically with key trichoscopic findings such as yellow dots and peripilar casts, respectively, that correlate with their histologic diagnosis. Donor hair density and putative hair pathology of the safe donor area can also by assessed via trichoscopy. This article discusses the use of trichoscopy, particularly for diagnosing mimickers of patterned hair loss as well as preoperative donor site assessment.     

新生植发3D技术治疗瘢痕秃发的效果

目的 分析新生植发3D技术在瘢痕秃发患者中的应用效果。方法 选取本院2020年2月-2022年2月 收治的60例瘢痕秃发患者为研究对象,随机分为对照组和观察组,各30例。对照组予以常规FUE毛发移植 治疗,观察组予以新生植发3D技术治疗,比较两组毛发覆盖率、临床疗效、负面情绪、生活质量及手术 满意度。结果 观察组毛发覆盖率高于对照组（P＜0.05）;观察组治疗总有效率为100.00%,高于对照组的 86.67%（P ＜0.05）;观察组治疗后SAS评分、SDS评分均低于对照组（P ＜0.05）;观察组SF-36各维度评 分均高于对照组（P＜0.05）;观察组手术满意度为100.00%,高于对照组的83.33%（P＜0.05）。结论 相比 于FUE毛发移植治疗,新生植发3D技术治疗瘢痕秃发的效果更为理想,可提高毛发覆盖率,减轻患者的负 面情绪,提高手术满意度,同时有利于改善患者的生活质量。     

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.     

穴位放血疗法联合微针配合米诺地尔治疗进展期雄激素性秃发疗效分析

目的:探讨穴位放血疗法联合微针配合米诺地尔治疗进展期雄激素性秃发的疗效。方法:将2016年1月-2018年1月笔者科室门诊收治的85例男性进展期雄激素性秃发患者随机分成两组,联合组(放血疗法联合微针配合米诺地尔)43例和对照组(微针配合米诺地尔)42例。比较两组患者治疗3个月、6个月后的疗效、毛发密度及血清睾酮(T)、双氢睾酮(DHT)、性激素结合球蛋白(SHBG)及游离睾酮(FT)水平,比较两组患者停药后的复发情况及治疗期间出现的不良反应。结果:治疗3个月、6个月后,联合组患者总有效率均明显高于对照组,终毛密度与总毛发密度均明显高于对照组(P<0.05),毳毛密度与对照组患者相比,差异无统计学意义(P>0.05);治疗3个月、6个月后,联合组患者DHT、FT水平比对照组明显降低,SHBG水平比对照组明显升高(P<0.05);T水平与对照组相比,差异无统计学意义(P>0.05);停药12个月后,联合组患者的总复发率低于对照组患者(P<0.05),联合组患者治疗期间不良反应发生率低于对照组患者(P<0.05)。结论:穴位放血疗法联合微针配合米诺地尔治疗进展期雄激素性秃发患者疗效确切,不仅可以明显增加患者头发密度、降低复发率,还可以平衡患者的性激素,且安全性高。     

A Systematic Review and Meta-analysis of Randomized Controlled Trials of United States Food and Drug Administration-Approved,Home-use,Low-Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology

BackgroundLow-level light/laser therapy (LLLT) can potentially stimulate hair growth in pattern hair loss (PHL), with many available home-use LLLT devices of different designs and technology on the market. However, not all devices are cleared by the United States (US) Food and Drug Administration (FDA), with very few studies to support their efficacy.ObjectivesThis systematic review and meta-analysis aimed to investigate the effectiveness of FDA-approved LLLT devices for PHL treatment.MethodsWe included articles related to FDA-approved home-use LLLT devices on PubMed and Medline, using the FDA 510(K) Premarket Notification database and the systematic search of articles up to January 2020. The standardized mean difference (SMD) for the changes of hair density treated by LLLT versus sham devices was analyzed.ResultsOnly 32 home-use LLLT devices have been approved by the FDA as of January 2020. The meta-analysis comprised seven double-blinded, randomized, controlled trials. The overall quantitative analysis yielded a significant increase in hair density in those treated by LLLT versus sham groups (SMD: 1.27, 95% confidence interval [CI]: 0.993–1.639). The subgroup analysis demonstrated the increased hair growth in male and female subjects with both comb- and helmet-type devices. There were significant LLLT sources in the LDs alone (SMD: 1.52, 95% CI: 1.16–1.88) and the LDs combination (SMD: 0.85, 95% CI: 0.55–1.16) (p=0.043).ConclusionLLLT is potentially effective for PHL treatment. Nonetheless, the long-term follow-up study in patients with severe PHL with combined standard treatment and comparison between LLLT devices and energy sources is recommended.