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Background Platelet-rich plasma (PRP) is effective in the treatment of androgenetic alopecia (AGA). Aims The purpose of this study is to assess the effect of PRP on the proliferation of human follicle dermal papilla cells (HFDPCs), to observe the effect of PRP on the growth of hair follicles and hair shaft in vitro, to measure growth factors, and to evaluate the efficacy and safety of PRP injection. Patients/methods The effect of PRP on the proliferation of HFDPCs was observed. The length of hair follicle and hair shaft in vitro was measured. Then, the concentration of growth factors (EGF, FGF-2, FGF-7, IGF-1, HGF, PDGF-BB, and VEGF-A) was evaluated. Half-head injection of PRP was conducted to 10 males. Three treatments were conducted at 30-day intervals. Digital photographs were taken; hair diameter, hair density, unit density of hair follicles, and terminal hair/ vellus hair were analyzed. Results Platelet-rich plasma significantly promoted the proliferation of HFDPCs. Under the PRP culture, the hair follicle and hair shaft were grown, and the hair growth length on the 3rd and 6th days was greater than that of the control. PRP contained growth factors such as EGF, FGF-2, FGF-7, IGF-1, HGF, PDGF-B, and VEGF-A. Hair diameter, hair density, and unit hair follicle density on the PRP injection side peaked in the 6th month. The terminal hair/ vellus hair of the PRP injection side reached a peak in the 4th month. The average patient satisfaction during the entire treatment was 5.4 points (0-10 points). Conclusion Platelet-rich plasma can promote hair growth. PRP injection is safe and effective for the treatment of AGA.

Background Hair is an essential identity of women. Femininity, sexuality, attractiveness, and personality are symbolically linked to a woman's hair. Female pattern hair loss is found in 20%-30% of patients with polycystic ovary syndrome (PCOS). Aim The aim of the present study was to evaluate the efficacy of QR678® and QR678 Neo® therapy in the treatment of female alopecia with PCOS. Method A total of 20 females diagnosed with PCOS in the age 25-50 years, with complaints of female pattern alopecia with Ludwig, grades I, and II were selected for the study. At each visit, 1.5 ml solution of QR678® was injected in the scalp skin of patients. A total of eight sessions were performed at an interval of 3 week each. All the patients were evaluated with standard global photography at baseline, 4th and 8th session, and 2 months after 8th session. Result Marked improvement was seen in the global photographic assessment score (mean = 8) which was maintained for over 1 year. In videomicroscopic assessment, after four sessions the patients had 8.07 fewer vellus hair, 6.07 more terminal hair, and average hair shaft diameter was 0.82 μm wider. After eight sessions, they had 11.66 fewer vellus hair, 13.77 more terminal hair, and hair shaft diameter was 2.86 μm wider than at baseline. Conclusion Intra-dermal injections of QR 678® hair growth factor formulation is an effective option for female pattern alopecia with PCOS. This is the first of its kind study using QR678® and QR678 Neo® in PCOS patients.

Background Human hair follicles (HFs) express the olfactory receptor (OR)2AT4, which is selectively stimulated by the synthetic sandalwood-like odorant, Sandalore® . In organ-cultured, human scalp HFs, Sandalore® prolongs anagen and suppresses apoptosis by up-regulating intrafollicular IGF-1 mediated signaling. Aims The objective of this study is to demonstrate whether effects of Sandalore® observed ex vivo translate into a clinically relevant effect in patients with telogen effluvium. Patients/methods In a randomized, double-blinded, placebo-controlled, clinical trial, 60 female volunteers (18-65 years) affected by telogen effluvium received over a period of 24 weeks treatment with either 1% Sandalore® solution (n = 30) or placebo (identically smelling, but non-OR2AT4 activating sandalwood oil n = 30). The study read-out parameters were the degree of hair shedding, hair volume, terminal/vellus hair ratio, anagen/catagen-telogen ratio, and patient self-assessment. Results Sandalore® 1% ameliorated clinical signs of telogen effluvium, namely it reduced hair shedding, and increased hair volume and the percentage of anagen HFs, the latter two parameters significantly more than placebo when changes were calculated to baseline. Sandalore® also increased the ratio of terminal/vellus hairs at week 8. Most of the anti-hair shedding effects were seen after 8 weeks and maintained at week 24. Patient questionnaire showed that verum group patients were more satisfied than the placebo group in regard to the overall results. Conclusion This clinical trial supports previous findings of anagen-prolonging effects of Sandalore® ex vivo with similar results now reproduced in clinical practice. It also provides proof-of-principle that a topically applied cosmetic odorant acting through HF olfactory receptors can be a therapeutic alternative to treat hair loss disorders characterized by excessive hair shedding such as telogen effluvium.

Background Male androgenetic alopecia (MAGA) is caused by the conversion of the terminal to vellus hair. Zinc is one of the most studied trace elements in hair disorders and biotin is one of the most prescribed supplement for its treatment. Objectives The study aimed to evaluate serum zinc and biotin levels in MAGA patients to answer the question if there is a value to add zinc or biotin as a supplements in the MAGA treatment. Patients and methods Sixty MAGA patients and 60 age, sex, and body mass index-matched healthy volunteers were included. We measured serum biotin and zinc in all participants. Results Zinc (µg/dL) was lower significantly in patients compared to controls (P = 0.01), suboptimal biotin (ng/L) levels were in patients, and within normal values in controls (P = 0.01). A positive significant correlation was found between serum zinc and serum biotin (r = 0.489, P = 0.001). Serum zinc and biotin showed a nonsignificant correlation with age and disease duration. A non-significant relation was obtained between the MAGA grades, and zinc (P = 0.485) and biotin levels (P = 0.367). Conclusions Serum zinc showed subnormal value and adding zinc supplement in MAGA treatment is recommended. Serum biotin showed a suboptimal level in MAGA patients that is not correlated with patients' age or disease severity. Biotin supplement in MAGA treatment may add value to hair quality and texture. We recommend future biotin evaluation in serum combined with its metabolites in MAGA patients' urine.

SummaryBackground Hair loss is a common condition among women with a range of causes including nutritional deficiencies. Aims To review the clinical data supporting the use of an oral marine supplement designed to promote hair growth. Patients/Methods Adult women with temporary thinning hair. Following an initial pilot study, five randomized, double-blind studies assessed the effectiveness of the oral marine supplement for promoting hair growth. Each study was approved by one or more institutional review boards. Results Together, these studies demonstrated the ability of oral marine supplements to increase the growth of terminal and vellus hairs, increase the diameter of terminal and vellus hairs, and decrease hair loss. This product is beneficial for men as well as women. Conclusions A dietary supplement containing a marine complex and other natural ingredients can safely and effectively promote hair growth and decrease hair shedding in women and men with thinning hair.

SummaryBackground Platelet-rich plasma has shown beneficial effects in the treatment of androgenic alopecia with its growth factor properties in accelerating the dermal papilla. Dermoscopy is a noninvasive method that allows the in vivo evaluation of microstructures not visible to the naked eye. Objective To ascertain the role of platelet-rich plasma (PRP) with microneedling, and to compare the pre- and post-treatment dermoscopic features in androgenetic alopecia. (AGA). Method Patients with mild to moderate AGA, aged 18-45 years with Hamilton-Norwood score 1-5 were included in both study and control group. Dermoscopy was performed using Dermlite II hybrid m; 3Gen dermoscope at 10× magnification in polarized mode, and photographs were taken. Those not responding or those not having any new hair growth to conventional therapy for at least 1 year were included. The study group were given autologous platelet-rich plasma injections with microneedling over a period of 3 months at 3 weekly interval. Baseline and post-treatment photographs were taken. Result Hair growth started after the first session. The patients’ satisfaction was more than 75% in 18 patients, on patients’ subjective hair growth assessment scale. In post-PRP-treated patients of AGA, increase in the number of vellus and total hairs, increased hair shaft diameter, and reduction in yellow dots were appreciated after 3 sessions. Hair pull test was negative after treatment in 14 patients (70%). Conclusion This study reinforces the importance of dermoscopy in not only aiding in the diagnosis, but also in evaluation of pre- and post-treatment response of AGA.

SummaryBackground Male pattern baldness, or androgenetic alopecia, affects approximately 50% of the adult population and can cause poor self-image, low self-esteem and have a significant negative impact on the quality of life. An oral nutraceutical supplement based on a marine complex formulation has previously been reported to significantly increase the number of terminal hairs in women with thinning hair. AIMS: The objective of this double-blind, placebo-controlled study was to confirm the beneficial effects of a similar marine complex supplement in adult male subjects with thinning hair (Viviscal® Man; Lifes2good, Inc., Chicago, IL, USA). Patients/Methods Healthy adult male subjects with thinning hair associated with clinically diagnosed male pattern hair loss were enrolled and randomized to receive study drug or placebo twice daily. Results At Day 90, subjects indicated a significant improvement in three of six quality of life measures as well as a significant overall improvement in quality of life. After 180 days, significant increases were observed for total hair count, total hair density, and terminal hair density (for each, P = 0.001). The investigator assessments revealed significant improvements in terminal and vellus hair count and terminal hair density. Hair pull test results were significantly lower (fewer hairs removed) for study drug vs. placebo at Days 90 (P < 0.05) and 180 (P < 0.01). There were no reports of treatment-emergent adverse events. Conclusion The results of this study showed for the first time that a dietary supplement containing a marine complex and other ingredients can decrease hair shedding and promote hair growth in men with thinning hair.

Summary Background Loose anagen hair (LAH) syndrome is a phenomenon in early childhood characterized by the presence of easily pluckable hair, where hair tufts can be pulled out easily and painlessly. Aims All reports in the English literature described mainly white patients with blond hair. We present the first report of LAH syndrome in dark-skinned children of Upper Egypt. Patients and methods Twenty-eight children with LAH were diagnosed and examined from 1996 to 2007. The main complaints were patchy or diffuse alopecia and/or slow growth of hair. Clinical examination, hair pull test, trichogram, and scanning electron microscopy (SEM) were performed. Results Children with LAH included 21 girls (75%) and seven boys (25%). Light microscopy of hair pull tests and trichograms disclosed a striking predominance of anagen hairs (90–100%) with misshapen hair bulbs and absent inner and outer root sheaths. SEM confirmed the misshapen anagen bulbs with ruffled appearance of cuticle and the longitudinal groove parallel to the long axis of the hair shaft. Most children improved spontaneously within few years, however, hair shed continued. Conclusion LAH syndrome occurs in dark-skinned children and could be under-diagnosed. The condition is of cosmetic concern and does not affect the general health.

Summary Background A penta-peptide, Gly-Pro-Ile-Gly-Ser (GPIGS), promotes proliferation of mouse hair keratinocytes and accelerates hair growth in mice. Aim of this study This study focused on the ability of the peptide to promote human hair growth. Methods We used a human hair keratinocyte proliferation assay and organ cultures of human hair follicle as in vitro systems. The lotions with and without the penta-peptide were administered to 22 Japanese men with androgenetic alopecia (AGA) for 4 months in a double-blind and randomized clinical study. Results The penta-peptide significantly stimulated the proliferation of human hair keratinocytes at a concentration of 2.3 μm (P < 0.01), and 5.0 μm of this peptide had a marked effect on hair shaft elongation in the organ culture (P < 0.05). The change in the proportion of thick hair (≥60 μm) compared to baseline in patients that received the peptide was significantly higher than in the placebo (P = 0.006). The change in the proportion of vellus hair (

Summary Background Laser hair removal has become an accepted form of long-term hair reduction and is now one of the most common dermatologic procedures. Trichoscan is a validated method of assessing hair length, thickness, and density and growth rate using dermoscopy. Objective The study aimed to evaluate the trichoscopic changes during treatment of hirsutism with 1064-nm neodymium:yttrium–aluminum–garnet laser. Methods Seventy patients with idiopathic facial hirsutism referring to the laser centers of Al-Azhar University hospital (Asyut and Cairo) between December 2012 and October 2014 were enrolled in this open-label, multicentric study. All participants received six sessions of 1064-nm Nd:YAG laser at 4-week intervals. Mean hair density/cm2, percentage of terminal/vellus hair ratio, and hair thickness (mm) were assessed at baseline and 1 month after each session for six sessions using trichoscan. Results Seventy female patients completed the study protocol. At the final visit, mean hair density, terminal/vellus hair ratio, and hair thickness were significantly decreased from baseline (73.7 + 20.6, 72.5 + 14.7, 0.095 + 0.02, respectively) to (19.4 + 5.6, 21.3 + 5.2, 0.02 ± 0.007, respectively) (P

SummaryBaldness or androgenetic alopecia directly distresses self-confidence affecting the individual's quality of life. Hair loss is therefore a significant psychosocial manifestation that worth much expense on treatment. Androgenetic alopecia is noticed as a slow transformation of large scalp terminal hair follicles to shorter, thinner, and less deep vellus hair with a much shorter anagen. Although minoxidil, finasteride, and dutasteride including other synthetic therapeutic agents are mostly used for alopecia treatment, their adverse effects encourage sorting of alternative efficient treatment agent with a limited side effect particularly herbs. Thus, this review briefly summarized causes of hair loss and emphasized on active ingredients for treatment in particular currently used herbs and the potential candidates. Treatment choices will be further wider and conclusively select herbs that fitting the consumers' preference.

Summary Objective To provide retrospective clinical review of some uncommonly reported side effects of long-pulsed alexandrite laser treatment for hair removal. Material and methods Two hundred and fifty female patients suffering from hirsutism of the face were subjected to treatment by long pulse alexandrite laser for a maximum of 15 sessions per patient at 5- to 7-week intervals. Results Apart from the commonly reported side effects of pigmentary changes, occasional blistering and rare scarring, other untoward effects have been observed. These include – among others – de-novo growth of hair outside the area treated by laser, potentiation of co-existing vellus hair in the treatment area, induction or aggravation of acne, rosacea-like rash, premature grayness of hair, tunneling of hair under the skin, prolonged diffuse redness and edema of the face, focal hypopigmentation of the lip, angular cheilitis, allergic reaction to the cooling gas, and inflammatory and pigmentary changes of pre-existing nevi. Conclusion Although the efficacy of long-pulsed alexandrite laser seems unmistakable, the short- and long-term untoward effects of such treatment have yet to be carefully delineated and the underlying mechanisms are yet to be adequately clarified.

Summary Background Androgenetic alopecia is a common cosmetic hair disorder, resulting from interplay of genetic, endocrine, and aging factors leading to a patterned follicular miniaturization. Microinflammation seems to be a potential active player in this process. Aims To study the histopathological and ultrastructural changes occurring in male androgenetic alopecia (AGA). Patients/methods Fifty-five subjects were included in this study (40 with AGA and 15 as normal age-matched controls). Skin biopsies from frontal bald area and occipital hairy area were subjected to histopathological examination, immunohistochemical staining for collagen I and ultrastructural study. Results The frontal bald area of patients showed highly significant increase in telogen hairs and decrease in anagen/telogen ratio and terminal/vellus hair ratio (P

A 5-year-old girl was referred to our clinic because of a 5-month history of diffuse hair loss. Her hair was light brown and dull with evident patches of alopecia. There were no signs of scalp inflammation or scarring. A hair pull test revealed multiple hairs, easily and painlessly extracted. Light microscopic examination and trichogram were consistent with loose anagen hair syndrome. This is an unusual benign hair disorder of childhood that improves spontaneously with aging.