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This article provides a review of the use of Janus Kinase inhibitors (JAKi) in the treatment of various types of scarring alopecia. It discusses the potential benefits of JAKi therapy in improving symptoms and hair regrowth in patients with conditions such as lichen planopilaris, central centrifugal cicatricial alopecia, folliculitis decalvans, frontal fibrosing alopecia, and dissecting cellulitis of the scalp. The article acknowledges the need for further research to fully understand the effectiveness and potential side effects of JAKi in this context. Overall, JAKi therapy shows promise but more investigation is required. [Extracted from the article]

This may be relevant for treating alopecia areata, chemotherapy-induced alopecia or aggressive scarring alopecias, including use as bridging therapy while patients await meaningful hair growth from other medical treatments. Dear Editor, Hair loss has a profound impact on psychosocial health and quality of life.1 Patients living with alopecia may be at increased risk of depression, anxiety and low self-esteem.2 Alopecia also presents a significant financial expense, with 25-2% of patients describing a serious economic burden and 18-2% indicating income loss due to missed work.3 Despite this, treatments for alopecia are inconsistently covered by health insurers.1,2,4 While there exist several effective medical therapies for alopecia, and promising novel therapeutics in development, camouflaging techniques, such as cranial prostheses, remain an important element of patient management. [Extracted from the article]

Traction alopecia is hair loss that occurs after persistent pulling (e.g., during cosmetic procedures) on the roots of hair over time. Unlike plucking, which is painful, persistent pulling may go unnoticed until a patient presents with either bald spots or diffuse telogen shedding. Each hair follicle in the scalp contains an arrector pili muscle that, when contracted, erects the hair. The smooth muscle in the arrector pili expresses α1 adrenergic receptors (α1-AR). As such, we hypothesized that contraction of the arrector pili muscle via an α1-AR agonist would increase the threshold of force required to pluck hair during cosmetic procedures. Female subjects, ages 18-40, were recruited to study the effect of topically applied phenylephrine, a selective α1-AR agonist, on epilation force and hair shedding during cosmetic procedures. In our blinded study, 80% of subjects demonstrated reduced shedding on days using phenylephrine compared to days using a placebo solution. The average reduction in hair loss was approximately 42%. In addition, the force threshold required for epilation increased by approximately 172% following topical phenylephrine application. To our knowledge this is the first study demonstrating the utility of α1-AR agonists in the treatment of traction alopecia and hair shedding during cosmetic procedures. [ABSTRACT FROM AUTHOR]

Clinical response to 5% topical minoxidil for the treatment of androgenetic alopecia ( AGA) is typically observed after 3-6 months. Approximately 40% of patients will regrow hair. Given the prolonged treatment time required to elicit a response, a diagnostic test for ruling out nonresponders would have significant clinical utility. Two studies have previously reported that sulfotransferase enzyme activity in plucked hair follicles predicts a patient's response to topical minoxidil therapy. The aim of this study was to assess the clinical utility and validity of minoxidil response testing. In this communication, the present authors conducted an analysis of completed and ongoing studies of minoxidil response testing. The analysis confirmed the clinical utility of a sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to topical minoxidil for the treatment of AGA. [ABSTRACT FROM AUTHOR]

This article presents a case vignette of a 45-year-old women with a one-year history of scalp-hair loss. The author mentions the biology of hair loss and its causes. He discusses female-pattern hair loss (androgenetic alopecia) and other manifestations of hair loss, such as telogen effluvium and alopecia areata. Diagnosis of hair loss is discussed, including laboratory testing to rule out iron deficiency and thyroid dysfunction. Therapies for female-pattern hair loss, including topical minoxidil, antiandrogen medication and hair transplantation are discussed.

This article explores the relationship between seasonal trends and hair loss patterns using big data analysis of Google search patterns. The study collected monthly Google Trends data for 'hair loss' in the United States from 2004 to 2020 and found significant differences in search interest across months. The months with the highest average increase in search interest were August, September, and July, while the lowest average increase occurred in April, February, and December. These findings support previous studies that observed maximal telogen hair loss during these time frames and suggest a potential link between seasonal factors and the onset of hair loss conditions. The study concludes that understanding the complex interplay between seasonal factors and hair loss could lead to more effective preventive measures and treatment strategies. [Extracted from the article]

Background: Topical minoxidil solution (TMS) is widely used for androgenetic alopecia (AGA), and this is the first report of a large safety trial. Objectives: The aim of the study was to evaluate the safety profile of TMS by comparing hospitalization and death rates among subjects using TMS with controls. Cardiovascular safety and pregnancy outcomes were evaluated, and usage patterns were described. Methods: All subjects were followed at baseline, 3, 6, 9, and 12 months. Usage patterns, pregnancy status, overnight hospital stays, and cardiovascular risk factors were evaluated. Subjects rated effectiveness of TMS in the treatment of AGA. Statistical analyses were conducted to determine if TMS was associated with an increased risk of death or hospitalization. Results: TMS is a safe and effective treatment for AGA. There were no increases in cardiovascular events and no apparent increased risk for adverse pregnancy outcomes. Conclusions: This large, prospective study demonstrated the overall safety of TMS in the treatment of AGA. [ABSTRACT FROM AUTHOR]

Finasteride, a type 2-selective 5α-reductase inhibitor, was approved in 1997 as the first oral pharmacologic therapy for the treatment of men with androgenetic alopecia (AGA; male pattern hair loss). Originally developed for the treatment of men with benign prostatic hyperplasia (BPH) at a dose of 5 mg/day, finasteride has a well-established, excellent safety profile. Subsequent studies demonstrated that finasteride was an effective treatment for men with AGA at an optimal dose of 1 mg/day. This report summarizes the published peer-reviewed literature on the use of finasteride in the treatment of men with AGA, including the data on long-term (5 years) use of finasteride in a placebo-controlled clinical trial environment. [ABSTRACT FROM AUTHOR]

This article reviews the different treatments of alopecia areata (AA). The information includes both a review of the literature as well as practical aspects regarding the use of the most commonly used therapies for AA. These modalties are summarized in a practical algorithm that can be used as a guide. For patients less than 10 years of age, the options are topical corsticosteroids, topical minoxidil, and anthralin. For adults with less than 50% scalp involvement, the first option is usually the use of intralesional corticosteroids, followed by topical corticosteroid creams, minoxidil solution, or anthralin cream. For adults with more than 50% scalp involvement, topical immunotherapy and phototherapy are added to the other options. Other modalities such as cyclosporine, tacrolimus, interferon, dapsone, and cosmetic coverups are also discussed. [ABSTRACT FROM AUTHOR]

Introduction: Digital health solutions, specifically direct‐to‐consumer platforms, have been touted to make care accessible and convenient for patients. The aim of this article is to evaluate patients' reported reasons for choosing a platform for the treatment of hair loss and their experience. This platform (Keeps) is focused exclusively on the treatment of male pattern hair loss (MPHL) with approved medications such as oral finasteride and topical minoxidil. Methods: In order to evaluate patients' motivations to choose the platform and their experience, we administered two distinct questionnaires, with a total of 8983 respondents. Results: The results showed that patients on the platform report positive health outcomes at approximately 6 months, as 81% of respondents report hair regrowth or cessation of hair loss, and 91% never or rarely miss their medication. Additionally, the platform is expanding the market through education and awareness, as nearly 1 in 3 new patients, mostly in their 20s and early 30s, had never considered treating their hair loss before learning about this virtual care model. Conclusion: Such a model provides further insights into how digitally enabled care focused on a chronic condition, backed by quality and evidence‐based initiatives, can expand access and improve care for androgenetic alopecia (AGA). [ABSTRACT FROM AUTHOR]

Performance‐enhancing drugs, such as testosterone, are used by athletes and youth to increase muscle growth and strength, particularly among males. However, these therapies potentially pose health risks, including liver toxicity, gynecomastia, and hair loss. Testosterone use is rising for performance enhancement, physical appearance, and resistance training, but there remains an absence of standardized guidelines for safe dosages. This study examines the relationship between testosterone use and hair health in males, aiming to develop guidelines for safe, responsible testosterone use. Understanding treatment outcomes in this context is crucial for informed healthcare. [ABSTRACT FROM AUTHOR]

Stress may play a key role in alopecia areata (AA), though the exact interactions of stress with AA remain undefined. Corticotropin‐releasing hormone (CRH), the proximal regulator of the stress axis, has been recognized as an immunomodulatory factor in tissues and peripheral blood mononuclear cells (PBMCs). We used multicolour flow cytometry to identify receptor CRHR1 expression on PBMC subsets in AA patients (n = 54) and controls (n = 66). We found that CRHR1 was primarily expressed by circulating monocytes. CRHR1 expression on monocytes was enhanced in AA compared with controls (3.17% vs. 1.44%, p = 0.002, chi‐squared test). AA incidence was correlated to elevated CD14+ monocyte numbers (R = 0.092, p = 0.036) and markedly independently correlated with increased CRHR1 expression (R = 0.215, p = 0.027). High CRHR1 expression was significantly related to chronic AA (disease duration >1 year; p = 0.003, chi‐squared test), and large lesion area (AA area >25%; p = 0.049, chi‐squared test). We also observed enhanced percentages of active monocytes and reduced CD16+ CD3− NK cell numbers in AA patients' PBMCs (p = 0.010; 0.025, respectively). In vitro CRH treatment of PBMCs and human monocyte cell line THP‐1 promoted CD86 upregulation. The findings imply that stress‐related factors CRH and CRHR1 contribute to AA development and progression where higher CRHR1 expression is associated with chronic AA and larger lesions. [ABSTRACT FROM AUTHOR]

Focuses on the diagnosis and management of alopecia areata in Canada. Clinical features of the disease; Episodes of hair loss and hair regrowth during lifetime; Treatment plans for the patient.

The article offers information on the 2015 World Congress of Dermatology (WCD) to be held in Vancouver, British Columbia in June 2015 on topics including new treatments techniques for skin diseases, clinical practice guidelines to dermatologists and patient care.

This article discusses the findings of a study on scalp seborrheic dermatitis (SSD), a condition that affects the scalp. The study involved participants from 20 countries and found that the overall prevalence of SSD was 3.3%. The prevalence varied across regions, with North America having the lowest prevalence and East Asia having the highest. The study also found that men experienced a higher impact on their quality of life (QoL) due to SSD. The study suggests that healthcare providers should assess the QoL of patients with SSD, particularly men, in order to provide appropriate medical and psychological support. Another study mentioned in the article focused on the impact of a sensitive scalp on individuals' lives. The study found that many participants felt embarrassed about their sensitive scalp, which affected their personal and professional lives. It also had specific impacts on their work or study, caused them to feel shy about buying treatment products, and impacted their sex life. The study emphasizes the importance of addressing the impact of a sensitive scalp on individuals' overall well-being. [Extracted from the article]

The article "Haircare practices and scarring alopecia: a survey study" published in the International Journal of Dermatology discusses the potential association between haircare practices and scarring alopecia development. A survey of 265 individuals with scarring alopecia revealed common practices such as heat styling, dyeing, chemical treatments, and high-tension hairstyles. The study found that chemical treatments and high-tension hairstyles were associated with a younger age at first hair loss or alopecia diagnosis, while hair dye use was linked to an older age at onset. Further research with a diverse cohort is needed to explore these relationships and empower patients to make informed choices about their haircare routines. [Extracted from the article]

LDOM has enhanced treatment options for female AGA, yet its combined efficacy with therapies such as spironolactone, finasteride, or dutasteride remains inadequately explored. This study aims to compare the efficacy and safety of LDOM in combination with spironolactone versus LDOM with finasteride or dutasteride in women with AGA. Our analysis revealed that both combination therapies produced similar improvements in hair growth and had comparable safety profiles. Although the LDOM with finasteride/dutasteride group showed a greater average increase in hair width and density, these differences were not statistically significant. These results endorse the use of LDOM in combination with either spironolactone or finasteride/dutasteride for female AGA, and underscore the necessity for further research to validate these findings and assess long-term treatment outcomes. [ABSTRACT FROM AUTHOR]

Androgenetic alopecia (AGA) significantly impacts patients’ psychological well-being, and treatment options have historically been limited. However, the advent of low-dose oral minoxidil (LDOM) has revolutionized AGA management. This study compares the treatment response and safety of LDOM in patients with AGA alone versus those with AGA unmasked by telogen effluvium. Our findings indicate that LDOM is effective and safe for both groups, showing comparable efficacy and safety profiles. These results support the use of LDOM as a reliable treatment option for AGA, potentially improving patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Low dose oral minoxidil (LDOM) is an efficacious and safe treatment for alopecia, however, a notable side effect is hypertrichosis. Spironolactone, known for treating hirsutism, is also used off-label for the treatment of certain forms of alopecia and may reduce LDOM-induced hypertrichosis. We performed a retrospective review of 54 patients seen at NYU Langone Health and compared hypertrichosis rates in female alopecia patients on LDOM monotherapy versus those on combination therapy with spironolactone. Among 54 patients, 37 received LDOM alone and 17 received the combination. Hypertrichosis developed in 33.3% of patients, with lower rates in the combination group (17.6% vs. 40.5% for monotherapy). Although not statistically significant, the trend suggests spironolactone may mitigate hypertrichosis. The study highlights the potential of combination therapy to address hypertrichosis and calls for larger studies to confirm these findings. [ABSTRACT FROM AUTHOR]

Topical minoxidil is a mainstay treatment for non-scarring alopecia. Comparing combination low-dose oral minoxidil and topical minoxidil with oral minoxidil alone for the treatment of non-scarring alopecia: A retrospective chart review At 3-6 months follow-up, the mean change in hair caliber of patients treated with combination therapy ( 8.0 m, I p i < 0.001) was twice the mean change in hair caliber of patients treated with LDOM alone ( 4.0 m, I p i = 0.005). [Extracted from the article]

The widespread adoption of glucagon‐like peptide‐1 (GLP‐1) agonists in treating type 2 diabetes mellitus (T2DM) and obesity has sparked investigations into their impact on hair health, an area characterized by diverse conjectures. Some propose potential risks such as disrupted hair growth cycles or premature androgenetic alopecia (AGA), while others suggest benefits linked to improved insulin sensitivity and enhanced scalp blood circulation. However, despite these theoretical underpinnings, clinical evidence linking GLP‐1 agonists to hair loss remains sparse. The necessity for vigilant patient monitoring and collaborative efforts cannot be overstressed in comprehensively addressing any potential consequences of GLP‐1 agonist therapy on hair health as their use continues to expand. [ABSTRACT FROM AUTHOR]

In this response to a recent article on the off-label use of baricitinib for paediatric alopecia areata (AA), we raise additional points regarding the relationship between viral infections and AA relapse on Janus kinase inhibitor (JAKi) therapy, and the potential benefits of concomitant oral minoxidil therapy in mitigating the risk of relapse during JAKi dose reduction or discontinuation. [ABSTRACT FROM AUTHOR]

Background: Topical minoxidil is the only US FDA‐approved drug for the treatment of female pattern hair loss (FPHL). While the safety profile of topical minoxidil is excellent, the efficacy of minoxidil in hair growth is extremely low. A recent survey of 8000 people observed that only 4% of hair loss patients using an over‐the‐counter minoxidil were very satisfied with their results. In contrast, in clinical studies with an intervening physician, approximately 30%‐40% of patients demonstrate an appreciable benefit. Compliance with topical drug regimens is often a major obstacle, limiting their effectiveness. Topical minoxidil leaves a greasy residue on the hair, which is especially problematic for women who do not wash their hair daily. Aims: We set out to develop an "After Minoxidil" companion spray to minoxidil that removes residual minoxidil from the hair, where it is not needed, yet leaves minoxidil on the scalp where it is required. We hypothesized that improving the cosmetic properties of minoxidil would improve patient compliance with the drug and subsequently improve clinical outcomes. Methods: A cohort of 20 FPHL patients was recruited to use the novel "After Minoxidil" spray and report changes in hair quality on a Likert scale. Results: In our cohort of FPHL patients, the novel "After Minoxidil" spray restored ease of styling and reduced greasiness to preminoxidil level in 65% and 85% of subjects, respectively. The average reduction in perceived greasiness was 78%. Importantly, 70% of subjects interviewed stated they would likely continue to use the minoxidil and "After Minoxidil" treatment regimen for 6 months, vs 0% willing to use minoxidil alone. Conclusion: The novel "After Minoxidil" spray improved ease of hair styling and reduced greasiness following application of topical minoxidil; thus, the novel "After Minoxidil" spray may help improve drug compliance and efficacy. [ABSTRACT FROM AUTHOR]

Background. The scalp biopsy plays an important role in diagnosis and subsequent management of many scalp disorders. This simple diagnostic procedure can be time-consuming and frustrating for most dermatologists. Objective. To outline an efficient technique for performing a scalp biopsy. Methods. The technique of performing a scalp biopsy is reviewed and suggestions are made to make this time-consuming procedure more efficient. Results. Sufficient specimen for histopathologic evaluation in a short perid of time is obtained. Conclusion. Attention to specific details in performing a scalp biopsy allows the physician to obtain a quick and histopathologically informative scalp biopsy. [ABSTRACT FROM AUTHOR]

BACKGROUND Mesotherapy, a technique of transdermal microinjections of specific preparations, is increasingly used in fields such as dermatology and specifically for alopecia treatment. Its popularity stems from its ability to deliver drugs in a targeted manner while minimizing systemic side effects. OBJECTIVE To assess and review current knowledge regarding the use of mesotherapy to deliver alopecia medications and highlight future directions for research. MATERIALS AND METHODS The authors used research databases including PubMed and Google Scholar to identify current literature on mesotherapy and alopecia. The following search terms were used among other terms: "Mesotherapy" or "Intradermal" AND "Alopecia". RESULTS Recent studies are promising for the intradermal delivery of dutasteride and minoxidil in the treatment of androgenetic alopecia. CONCLUSION Although limitations exist with dutasteride and minoxidil therapies, further research regarding the preparation, delivery, and maintenance of these drugs is warranted as mesotherapy could establish this technique as a safe, effective, and viable treatment option for androgenetic alopecia. [ABSTRACT FROM AUTHOR]

Female patterned hair loss (FPHL) is a common form of androgenetic alopecia in women and is characterized by a hormonally directed diffuse hair loss on the scalp. Management of FPHL is well described in the literature; however, treatment of FPHL in patients with co‐morbid polycystic ovarian syndrome (PCOS), an endocrinologic condition found in reproductive‐aged women, has not yet been reviewed. Due to the different pathomechanism of the diseases and complexity of FPHL in PCOS patients, this study aimed to review current diagnosis and management approaches for hair loss in PCOS patients specifically and highlight the growing need for more research in this growing patient population. [ABSTRACT FROM AUTHOR]

Alopecia, the loss of hair on the scalp and/or body, experienced by millions of people worldwide, can be a very debilitating condition. Specifically, androgenetic alopecia (AGA), commonly known as male or female pattern baldness, is the most common form of hair loss. In the African diaspora, oils have traditionally been used to promote hair growth and recently, the application of hair oils to the scalp for the treatment of alopecia has become increasingly popular. With the recent surge of hair oil usage in the Black community, more research is needed to determine the efficacy of hair oils, as most studies have primarily used mice subjects. This article reviews the existing literature to better understand the use of hair oils in the treatment of androgenetic alopecia. Specifically, we investigate the popular carrier oils, castor oil, and pumpkin oil as well as the essential oils, lavender, peppermint, rosemary, and tea tree oil. [ABSTRACT FROM AUTHOR]

Introduction: The physical impact of alopecia areata (AA) is visible, but the psychological and social consequences and emotional burden are often underrecognized. Methods: In this cross-sectional study, 547 participants recruited via the National Alopecia Areata Foundation completed a survey encompassing demographics; AA illness characteristics; and five patient-reported outcome measures on anxiety and depression, perceived stress, psychological illness impact, stigma, and quality of life (QoL). Differences in disease severity subgroups were assessed via analysis of variance (ANOVA) and t tests. Results: Mean age was 44.6 years, and 76.6% were female. Participants with more severe hair loss tended to report longer duration of experiencing AA symptoms (P < 0.001). Overall, participants reported negative psychological impact, emotional burden, and poor QoL due to AA. Participants with 21–49% or 50–94% scalp hair loss reported greater psychological impact and poorer QoL than those with 95–100% scalp hair loss (most parameters P < 0.05). Similar results were observed for eyebrow/eyelash involvement subgroups. Conclusions: These results suggest that participants with AA experience emotional burden, negative self-perception, and stigma, but the impact of AA is not dependent solely on the amount of hair loss. Lower impact among participants with 95–100% scalp hair loss may indicate that they have adapted to living with AA. [ABSTRACT FROM AUTHOR]

Alopecia areata is characterised by non-scarring loss of scalp, face, or body hair. We investigated the efficacy and safety of ritlecitinib, an oral, selective dual JAK3/TEC family kinase inhibitor, in patients with alopecia areata. In this randomised, double-blind, multicentre, phase 2b–3 trial done at 118 sites in 18 countries, patients aged 12 years and older with alopecia areata and at least 50% scalp hair loss were randomly assigned to oral ritlecitinib or placebo once-daily for 24 weeks, with or without a 4-week loading dose (50 mg, 30 mg, 10 mg, 200 mg loading dose followed by 50 mg, or 200 mg loading dose followed by 30 mg), followed by a 24-week extension period during which ritlecitinib groups continued their assigned doses and patients initially assigned to placebo switched to ritlecitinib 50 mg or 200 mg loading dose followed by 50 mg. Randomisation was done by use of an interactive response system and was stratified by baseline disease severity and age. The sponsor, patients, and investigators were masked to treatment, and all patients received the same number of tablets to maintain masking. The primary endpoint was Severity of Alopecia Tool (SALT) score 20 or less at week 24. The primary endpoint was assessed in all assigned patients, regardless of whether they received treatment. This study was registered with ClinicalTrials.gov , NCT03732807. Between Dec 3, 2018, and June 24, 2021, 1097 patients were screened and 718 were randomly assigned to receive ritlecitinib 200 mg + 50 mg (n=132), 200 mg + 30 mg (n=130), 50 mg (n=130), 30 mg (n=132), 10 mg (n=63), placebo to 50 mg (n=66), or placebo to 200 mg + 50 mg (n=65). 446 (62%) of 718 patients were female and 272 (38%) were male. 488 (68%) were White, 186 (26%) were Asian, and 27 (4%) were Black or African American. Of 718 patients randomly assigned, 104 patients discontinued treatment (34 withdrew, 19 adverse events [AEs], 12 physician decision, 12 lack of efficacy, 13 lost to follow up, five rolled over to long-term study transfer, four pregnancies, two protocol deviations, one declined to attend follow-up due to COVID-19, one attended last visit very late due to COVID-19, and one non-compliance). At week 24, 38 (31%) of 124 patients in the ritlecitinib 200 mg + 50 mg group, 27 (22%) of 121 patients in the 200 mg + 30 mg group, 29 (23%) of 124 patients in the 50 mg group, 17 (14%) of 119 patients in the 30 mg group, and two (2%) of 130 patients in the placebo group had a response based on SALT score 20 or less. The difference in response rate based on SALT score 20 or less between the placebo and the ritlecitinib 200 mg + 50 mg group was 29·1% (95% CI 21·2–37·9; p<0·0001), 20·8% (13·7–29·2; p<0·0001) for the 200 mg + 30 mg group, 21·9% (14·7–30·2; p<0·0001) for the 50 mg group, and 12·8% (6·7–20·4; p=0·0002) for the 30 mg group. Up to week 48 and including the follow-up period, AEs had been reported in 108 (82%) of 131 patients in the ritlecitinib 200 mg + 50 mg group, 105 (81%) of 129 patients in the 200 mg + 30 mg group, 110 (85%) of 130 patients in the 50 mg group, 106 (80%) of 132 patients in the 30 mg group, 47 (76%) of 62 patients in the 10 mg group, 54 (83%) of 65 patients placebo to ritlecitinib 200 mg + 50 mg in the extension period, and 57 (86%) of 66 patients in the placebo to 50 mg group. The incidence of each AE was similar between groups, and there were no deaths. Ritlecitinib was effective and well tolerated in patients aged 12 years and older with alopecia areata. Ritlecitinib might be a suitable treatment option for alopecia areata in patients who are candidates for systemic therapy. Pfizer. [ABSTRACT FROM AUTHOR]

The article discusses several papers on alopecia areata (AA) that are published within the issue including the ways to quantify hair loss, the differential diagnosis of AA and the histopathology of AA.

The article discusses various reports published within the issue including one by Dr. McElwee about the etiology, potential mechanisms and research direction of cicatricial alopecias and another by Dr. Hordinsky about the chronic cutaneous lupus of the scalp.

This article discusses the potential exacerbation of alcohol hangover symptoms in patients who take oral minoxidil, a vasodilator commonly used to treat hair loss. The authors have observed that some patients experience worsened hangover symptoms, such as headaches and nausea, after taking oral minoxidil. While the exact mechanism is not fully understood, it is believed that the interaction between alcohol and minoxidil may contribute to these effects. The authors recommend that patients avoid taking oral minoxidil on days when they anticipate heavy alcohol consumption. Further research is needed to better understand this interaction and develop strategies to mitigate these symptoms. [Extracted from the article]

Background: Female pattern hair loss (FPHL) is a very common problem in women. The underlying pathophysiology remains unclear, and there are no universally agreed treatment guidelines. Objective: We explored the clinical features, relevant medical and family history, laboratory evaluation, and treatment and compliance of 210 patients with FPHL. Methods: Data analysis from case notes was performed on 210 patients with a diagnosis of FPHL seen from January 2011 to December 2011. Results: The youngest individual was 8 years old and the oldest was 86 years old. Nearly, 85% of the patients had a family history of androgenetic alopecia. Hypothyroidism and hypertension are the most common medical problems. Telogen effluvium (TE) is the most common concurrent hair loss condition. Only 38% of the patients were found to have normal Vitamin D level, 71% had ferritin level above 30 µg/L, and 85% had normal zinc level at the first consultation. Fifty-nine percent of the patients failed to attend any follow-up appointments. Limitations: One of the limitations of this study is its retrospective nature. Moreover, the severity of FPHL in terms of Ludwig score was not routinely documented in the medical charts. Conclusion: History of TE, hypothyroidism and hypertension, and low serum Vitamin D is common in our patients with FPHL. [ABSTRACT FROM AUTHOR]

Background: To date, there is no standard treatment of folliculitis decalvans (FD), a rare type of cicatricial alopecia. Objective and Methods: The records of 23 patients with FD (1998-2012) were retrospectively analyzed, with added data review on the course and treatment of long-standing cases. Results: Initial management consisted mostly of intralesional triamcinolone acetonide, clobetasol lotion, and either cephalexin, minocycline, doxycycline, or tetracycline. Alternatives consisted of rifampicin, clindamycin, ciprofloxacin, and isotretinoin. Remission was achieved in weeks to months in more than half of the cases, with low occurrence of relapse. The poor responders had a protracted course of temporary improvement and multiple relapses. Conclusion: The majority of patients showed improvement and subsequent remission with oral antibiotics. In some patients, it took years of slow taper before the antibiotic could be discontinued. Only a few patients had recalcitrant disease, with minimal response to their initial and alternative medications. [ABSTRACT FROM AUTHOR]

Hair shedding in female patients is a frequent complaint in dermatological, endocrinological, and gynecological consults. Previously, the Sinclair Hair Shedding Scale was developed to assess normal versus excessive hair shedding in female pattern hair loss (FPHL) subjects. However, the prevalence of hair shedding in females not suffering from FPHL is unknown. To gain better understanding of hair shedding in the general population, we recruited 300 subjects visiting a public hospital for conditions other than alopecia. Of the 300 subjects recruited, 263 did not suffer from FPHL. Among those subjects, approximately 40% reported experiencing excessive hair shedding (as defined by the Sinclair Hair Shedding Scale) on hair washing days. In comparison, in our subject population, approximately 60% of subjects with FPHL reported excessive hair shedding on hair washing days. To best of our knowledge, this is the first study to quantify the prevalence of hair shedding in women. While, no treatment currently exists for this condition, we hope that this study would encourage physicians and researchers to address this frequent concern. [ABSTRACT FROM AUTHOR]

Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved for defining its severity. In this high-level review of the literature, we discuss the traditional classification systems for AA severity and their strengths and weaknesses. Most recent classifications have focused on the extent of scalp hair loss as a defining feature, but additional clinical aspects of the disease, including location, pattern, and duration of hair loss as well as impact on the patient's quality of life, are also relevant. These various components have typically been used unidimensionally to classify patients. We propose a multidimensional framework to define AA severity that incorporates multiple patient- and illness-related domains. Using such a framework, dermatologists may better assess the severity of the disease for the individual patient beyond the extent of hair loss. [ABSTRACT FROM AUTHOR]

Introduction: Alopecia areata (AA) is an autoimmune disease characterized by hair loss. Patients with AA experience a range of social and emotional impacts, and the lack of effective treatments and multiple affected locations can deepen the burden of illness. The objective of the current study was to assess health-related quality of life (HRQL) among patients with AA, and to evaluate the relationship between patient-reported AA severity, HRQL and treatment patterns. Methods: A web survey was completed by participants recruited through the National Alopecia Areata Foundation. The survey included questions on disease characteristics, burden and impact (evaluated by the Skindex-16 for AA and items on work/school and sexual relationships), healthcare utilization and treatment experience. Analyses were conducted for the overall sample and by key subgroups, including AA severity and disease duration. Results: A total of 1327 participants with AA completed the survey. The mean age was 39.7 [standard deviation (SD) 12.3] years and 58.4% were female. On average, participants had experienced signs and symptoms of AA for 11.5 years (SD 12.5) and were diagnosed by a healthcare provider (HCP) 10.5 (SD 12.2) years ago. Participants reported a range of severity of current scalp hair loss, including 0% (2.6%), 1–20% (39.8%), 21–49% (26.2%), 50–94% (10.2%) and 95–100% (21.3%). Participants reporting 95–100% of scalp hair missing were less likely to be currently seeing an HCP and to currently be on treatments for AA. There was a non-linear relationship between HRQL and current AA severity. Participants with 1–20% to 50–94% of current scalp hair missing reported higher symptom, functioning and emotional impacts due to AA than participants with 0% missing scalp hair and/or 95–100% missing scalp hair. Similar findings were observed for current eyebrow and eyelash severity, except for emotional impacts. Conclusion: Severity of AA plays an important role in understanding the burden of illness and healthcare patterns of people living with AA. [ABSTRACT FROM AUTHOR]

Various nonfollicular scalp conditions can cause secondary scarring or permanent alopecia. Possible causes are congenital defects, trauma, inflammatory conditions, infections, and neoplasms (rarely drugs). Associated signs and symptoms and other diagnostic procedures such as histopathology may aid in the diagnosis. Detection of the underlying disorder may be difficult in end-stage lesions. Treatment is specific for active conditions. Surgery and hair transplantation are options for localized scars. [ABSTRACT FROM AUTHOR]

Background: Minoxidil is a widely used over‐the‐counter topical treatment for hair loss. The response rate for topical minoxidil is relatively low. Minoxidil is a pro‐drug, converted to its active form, minoxidil sulfate, by SULT1A1 enzymes located in the scalp. Recently, a novel topical formula that increases the activity of SULT1A1 in hair follicles was reported. Aims: To evaluate any benefit of applying the SULT1A1 enzyme booster prior to daily 5% minoxidil treatment. Methods: Male androgenic alopecia patients were recruited to a randomized blinded placebo‐controlled study. Patients were randomized to receive 5% topical minoxidil plus the novel formula or minoxidil plus a sham adjuvant. Patient's hair growth was monitored using global photography over 60 days. Results: Twenty‐four males with androgenic alopecia (Norwood scale average 4.4, range 2–6) were randomized and completed the trial: 12 in the active arm and 12 in placebo. 75% of the subjects who used the SULT1A1 adjuvant with their daily minoxidil treatments for 60 days regrew hair versus 33% of those using the placebo adjuvant (p = 0.023). Conclusions: In a small cohort of androgenetic alopecia men, adding the SULT1A1 adjuvant to their daily minoxidil treatment regimen improved hair regrowth. [ABSTRACT FROM AUTHOR]

Cutaneous involvement of the scalp is a common manifestation of dermatomyositis (DM), occurring in up to 82% of adults with DM. Scalp DM predominantly affects women and is characterized by dermatitis, alopecia, pruritus, and/or burning. While cutaneous DM negatively impacts quality‐of‐life, scalp symptoms in particular are often severe, debilitating, and recalcitrant to standard DM therapies. Currently, there is a paucity of guidelines to inform management of scalp symptoms in patients with cutaneous DM. In this narrative review, we summarize the treatments utilized to manage scalp DM and highlight potential areas for future research. We identified eight studies that reported on 27 treatments focused on cutaneous DM and described outcomes on scalp symptoms. A majority of the treatments were standard therapies for cutaneous DM and resulted in no or minimal improvement in scalp symptoms. Five therapies did result in complete resolution of scalp symptoms and were recommended as potential areas of future research. These included low‐dose naltrexone and platelet‐rich plasma, as well as two frequent and one less common therapy for cutaneous DM respectively: intravenous immunoglobulin, rituximab, and apremilast. Though the literature was not systematically assessed in this review, these findings illustrate not only that strategies for refractory scalp DM are lacking, but also that those demonstrating potential efficacy are limited by low levels of evidence. Additional studies, especially randomized controlled trials, are needed to better inform management of scalp DM. [ABSTRACT FROM AUTHOR]

Background: Although many hair disorders can be readily diagnosed based on their clinical appearance, their progression and response to treatment are often difficult to monitor, particularly in quantitative terms. We introduce an innovative technique utilizing a smartphone and computerized image analysis to expeditiously and automatically measure and compute hair density and diameter in patients in real time. Methods: A smartphone equipped with a dermatoscope lens wirelessly transmits trichoscopy images to a computer for image processing. A black‐and‐white binary mask image representing hair and skin is produced, and the hairs are thinned into single‐pixel‐thick fiber skeletons. Further analysis based on these fibers allows morphometric characteristics such as hair shaft number and diameters to be computed rapidly. The hair‐bearing scalps of fifty participants were imaged to assess the precision of our automated smartphone‐based device in comparison with a specialized trichometry device for hair shaft density and diameter measurement. The precision and operation time of our technique relative to manual trichometry, which is commonly used by hair disorder specialists, is determined. Results: An equivalence test, based on two 1‐sided t tests, demonstrates statistical equivalence in hair density and diameter values between this automated technique and manual trichometry within a 20% margin. On average, this technique actively required 24 seconds of the clinician's time whereas manual trichometry necessitated 9.2 minutes. Conclusion: Automated smartphone‐based trichometry is a rapid, precise, and clinically feasible technique which can significantly facilitate the assessment and monitoring of hair loss. Its use could be easily integrated into clinical practice to improve standard trichoscopy. [ABSTRACT FROM AUTHOR]

Lichen planopilaris is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp. Patients may also have associated scalp itching, burning or tenderness. Due to scarring, hair loss is typically permanent. The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss. Currently, the literature has limited evidence on treatments for this difficult condition, and most available evidence is from case reports and case series. Furthermore, the evidence shows a varied response to therapy, with frequent reports of poor response. This article reviews the diagnosis of this rare disease, summarize the currently available treatments, and provide insights and practices from alopecia experts. [ABSTRACT FROM AUTHOR]

Background: Platelet‐rich plasma (PRP), processed from autologous peripheral blood, is used to treat androgenetic alopecia (AGA). Objective: To determine the efficacy of PRP for hair growth promotion in AGA patients in a randomized, blinded, placebo‐controlled, pilot clinical trial (NCT02074943). Methods: The efficacy of an 8 week, five session, PRP treatment course was determined by measuring hair density and hair caliber changes in 10 AGA affected patients. For each PRP sample, the concentrations of selected growth factors were determined using a multiplex assay system. The clinical results were then correlated with the growth factor concentrations in PRP. Results: At 16 weeks, 8 weeks after the last PRP injection, treated areas exhibited increased mean hair density (+12.76%) over baseline compared to placebo (+0.99%). Mean hair caliber decreased in both treated and placebo regions (−16.22% and −19.46%, respectively). Serial analysis of PRP significant variability in concentrations between patients. Overall, there was a positive correlation between GDNF concentration and hair density (P =.004). Trends, though not statistically significant, were also observed for FGF2 and VEGF. Limitations: Small sample size and lack of comparative cohorts receiving protocol variations limit confidence in the study data. Conclusions: This small pilot clinical trial suggests PRP treatment may be beneficial for AGA. However, the variable hair growth responses between patients indicate there is a significant opportunity to improve PRP therapy protocols for hair growth promotion. The variability in growth factor concentration in PRP suggests standardization of growth factors postprocessing might improve hair growth responses. [ABSTRACT FROM AUTHOR]

Alopecia areata (AA) is thought to be an autoimmune process. In other autoimmune diseases, the innate immune system and Toll‐like receptors (TLRs) can play a significant role. Expression of TLR7, TLR9 and associated inducible genes was evaluated by quantitative PCR in peripheral blood mononuclear cells (PBMCs) from 10 healthy individuals and 19 AA patients, categorized according to disease duration, activity and hair loss extent. Microdissected scalp biopsies from five patients and four controls were also assessed by quantitative PCR and immunohistology. TLR9 was significantly upregulated 2.37 fold in AA PBMCs. Notably, TLR9 was most significantly upregulated in patients with active AA, as shown by a positive hair pull test, compared to stable AA patients. In hair follicle bulbs from AA patients, IFNG and TLR7 exhibited statistically significant 3.85 and 2.70 fold increases in mRNA, respectively. Immunohistology revealed TLR7 present in lesional follicles, while TLR9 positive cells were primarily observed peri‐bulbar to AA affected hair follicles. The increased expression of TLR7 and TLR9 suggest components of the innate immune system may be active in AA pathogenesis. [ABSTRACT FROM AUTHOR]

A preliminary observation of high frequency of male pattern hair loss among admitted COVID‐19 patients and suggest that androgen expression might be a clue to COVID‐19 severity. [ABSTRACT FROM AUTHOR]

The development of androgenetic alopecia is associated with a risk of developing cardiovascular diseases, but the association of alopecia areata with cardiovascular diseases in humans is largely unexplored. We measured the plasma level of two common cardiovascular disease markers, cardiac troponin I and Creactive protein, in alopecia areata and androgenetic alopecia-affected subjects. Also, we investigated the possible presence of pro-apoptotic factors in the plasma of hair loss subjects. The mean plasma cardiac troponin I level was highest in alopecia areata subjects, moderately higher in androgenetic alopecia subjects, and lowest in subjects without hair loss (p < 0.05). Alopecia areata subjects not receiving treatments had highest levels of cardiac troponin I (p < 0.05). Alopecia areata plasma samples with high cardiac troponin I levels also induced significantly higher rates of cardiomyocyte apoptosis in cell culture assays. The results suggest the potential for increased heart remodelling. Close monitoring of cardiovascular health in alopecia areata subjects, as well as subsets of androgenetic alopecia patients, may be appropriate. [ABSTRACT FROM AUTHOR]