New Therapies for Hair Loss: What works and what

12/7/2014
New Therapies for Hair Loss:
What works and what
doesn’t?
Dr. Adel Alsantali
Consultant Dermatologist,
Subspecialty: Hair Diseases and Hair Transplant
King Fahd Armed Forces Hospital
Jeddah, Saudi Arabia
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• Hair loss is a very common complaint and
dermatologists should be able to make the
correct diagnosis of different types of
alopecia and choose the best therapeutic
strategy.
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What works and what
doesn’t?
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What is the cause (or
causes) of hair loss?
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• Prescribing an effective therapy to a
patient with wrong diagnosis, will not
help.
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• Currently there is a myriad of new and
experimental treatments.
• These new therapeutic agents include
1. Mesotherpy,
2. low-level laser light therapy (LLLT),
3. Platelet rich plasma (PRP),
4. Latanoprost (prostaglandin analogue),
5. 17α-Estradiol
6. hair stem cell transplantation (bioengineered
hair follicular unit transplantation).
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Mesotherapy:
• Mesotherapy is the
injection of active
substances into the
surface layer of the skin
• This method allows a
slower spread, higher
levels, and longer
lasting effects of drugs
in the tissues underlying
the site of injection
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• injection of variable
mixtures of natural plant
extracts, homeopathic
agents, pharmaceuticals,
vitamins, and other
bioactive substances in
microscopic quantities
through dermal
multipunctures
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• Acceptable scientific evidence
for its effectiveness and safety is
lacking.
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• Depend on what your injecting and
for what? (correct diagnosis then
correct treatment)
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• Mesotherapy with dutasteride-containing
preparation was effective, tolerable and
minimally invasive treatment modality in
FPHL with better response for shorter
duration of the disease
J Eur Acad Dermatol Venereol. 2013 Jun;27(6):686-93
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• This study included 126 female patients with
FPHL.
• They were classified into two groups; group I (86
patients) injected with dutasteride-containing
preparation and group II (40 control patients)
injected with saline.
• Patients received 12 sessions and were evaluated
at the 18th week by: photographic assessment,
hair pull test, hair diameter and patient selfassessment.
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• Photographic improvement occurred in
62.8% of patients compared with 17.5% in
control group (P < 0.05)
• Mean hair diameter was significantly
increased (P < 0.05)
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• Side effects were minimal with no
statistically significant difference between
the two groups (P > 0.05).
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Platelet-Rich
Plasma (PRP)
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Platelet-rich plasma (PRP):
• PRP is a kind of plasma
with high concentration of
platelet,which includes a
lot of growth factors.
• The growth factors,
especially platelet derived
growth factor (PDGF) and
Transforming growth
factor beta TGF-beta,
plays an important role in
different stages and
aspects.
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• It was widely used in oral and
maxillofacial surgery and
orthopedics, for the repairing of
bone, cartilage and soft tissues.
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PRP and Hair
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Dermatol Surg. 2012 Jul;38(7 Pt 1):1040-6
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METHOD:
• PRP was prepared using the double-spin
method and applied to dermal papilla
(DP) cells.
• The proliferative effect of activated PRP
on DP cells was measured.
• In an in vivo study, mice received
subcutaneous injections of activated PRP,
and their results were compared with
control mice.
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• Activated PRP increased the proliferation of
dermal papilla (DP) cells and stimulated
extracellular signal-regulated kinase (ERK)
and Akt signaling.
• Fibroblast growth factor 7 (FGF-7) and
beta-catenin, which are potent stimuli for
hair growth, were upregulated in DP cells.
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• The injection of mice with activated PRP
induced faster telogen-to-anagen transition
than was seen on control mice.
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Dermatol Surg. 2011 Dec;37(12):1721-9.
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• OBJECTIVE :
• To identify the effects of PRPcontaining Dalteparin and protamine
microparticles (D/P MPs) on hair
growth.
• Dalteparin and protamine
microparticles (D/P MPs) can
effectively carry growth factors (GFs)
in platelet-rich plasma (PRP).
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• METHODS:
• 26 volunteers with thin hair who received
five local treatments of 3 mL of PRP&D/P
MPs (13 participants) or PRP and saline
(control, 13 participants) at 2- to 3-week
intervals and were evaluated for 12 weeks.
• Experimental and control areas were
photographed.
• biopsies for histologic examination.
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(PRP&D/P MPs)
Control (saline)
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• Microscopic findings showed
thickened epithelium, proliferation of
collagen fibers and fibroblasts, and
increased vessels around follicles.
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• D/P MPs bind to various GFs
contained in PRP.
• Significant differences were seen in
hair crosssection but not in hair
numbers in PRP and PRP&D/P MP
injections.
• The addition of D/P MPs to PRP
resulted in significant stimulation in
hair cross-section.
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J Cutan Aesthet Surg. 2014 Apr;7(2):107-10
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• Eleven patients suffering from hair loss due to
androgenic alopecia and not responding to 6
months treatment with minoxidil and
finasteride were included in this study.
• A total volume of 2-3 cc PRP was injected in
the scalp by using an insulin syringe.
• The treatment was repeated every two weeks,
for a total of four times
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RESULTS:
• A significant reduction in hair loss was
observed between first and fourth injection.
• Hair count increased from average number of
71 hair follicular units to 93 hair follicular
units.
• Therefore, average mean gain is 22.09
follicular units per cm(2.)
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Biomed Res Int. 2014;2014:760709. May 6
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• A total of 10 male patients (age range: 22–60)
• with male pattern hair loss (MPHL)
• PRP, prepared from a small volume of blood,
was injected on half of the selected patients'
scalps with pattern hair loss.
• The other half was treated with placebo.
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• Three treatments were given for each patient,
with intervals of 1 month.
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• At the end of the 3 cycles of treatment a mean
increase of 18.0 hairs in the target area, and a
mean increase in total hair density of 27.7 (
number of hairs/cm(2)) compared with
baseline values.
• Microscopic evaluation showed the increase of
epidermis thickness and of the number of hair
follicles two weeks after the last AA-PRP
treatment compared to baseline value (P <
0.05).
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PRP and Hair:
• Is it a practical way
to treat AGA?
• Once treatment stop
regrown hair will
fall
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Stem Cells and
Hair
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• Several companies and academic research
groups are focused on the development of cell
mediated treatments for AGA.
• Two main approaches are under
investigation:
1. the direct injection of cultured cells
2. the use of cell secreted factors as a hair
growth promoting product.
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• It has been shown that cells from the hair
follicle mesenchymal tissue can be cultured
and then used to induce new hair follicle
formation from epithelial tissue.
• The injected cells can also migrate to resident
hair follicles to increase their size.
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• Bioengineered hair follicles could restore
physiological hair functions and could be
applicable to surgical treatments for
alopecia.
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Low-Level Laser Therapy(LLLT):
• Lower Level Laser Treatment with
wavelengths between 630 and 670 nm
• 655 nm is in between the above mentioned
recognized wavelengths, has become the
“gold standard” used in clinical studies to
test for efficacy
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• Forty-one male patients with AGA completed
the study (22 active, 19 placebo).
• TOPHAT655" unit containing 21, 5 mW
lasers (655 ± 5 nm), and 30 LEDS (655 ± 20
nm), in a bicycle-helmet like apparatus.
• at home every other day × 16 weeks (60
treatments, 67.3 J/cm(2) irradiance/25 minute
treatment),
Lasers Surg Med. 2013 Oct;45(8):487-95
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• a 35% percent increase in hair growth as
compared to the placebo group (P =
0.003).
• No adverse events or side effects were
reported.
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• Forty-two females patients completed the
study (24 active, 18 sham).
• TOPHAT655" unit containing 21, 5 mW diode
lasers (655 ± 5 nm) and 30 LEDS
(655 ± 20 nm), in a bicycle-helmet like
apparatus.
• Patients treated at home every other day × 16
weeks (60 treatments, 67 J/cm(2)
irradiance/25 minute treatment, 2.9 J dose),
Lasers Surg Med. 2014 Oct;46(8):601-7
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• a 37% increase in hair growth in the
active treatment group as compared to the
placebo group (P < 0.001).
• No adverse events or side effects were
reported
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Oral Finasteride and Dutasteride
in women with androgenetic
alopecia
• 30 women in two age categories: below and
above 50 years, and for both medications.
• treated for androgenetic alopecia with
finasteride 1.25 mg or dutasteride 0.15 mg,
for 3yr
• Hair thickness at three sites were measured
Indian J Dermatol Venereol Leprol. 2014 Nov-Dec;80(6):521-5
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• Hair thickness increase was observed in
81.7% women in the finasteride group and in
83.3% women in the dutasteride group.
• On average, the number of post-treatment
images rated as displaying superior density
was 68.9% in the finasteride group, 65.6% in
the dutasteride group.
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• Dutasteride performed statistically
significantly better than finasteride in the
age category below 50 years at the central
and vertex sites of the scalp.
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finasteride 1.25 mg daily for 3 years
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dutasteride 0.15 mg daily for 3 years
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• Int J Dermatol. 2014 Nov;53(11):1351-7..
• Effect of dutasteride 0.5 mg/d in
men with androgenetic alopecia
recalcitrant to finasteride.
• Jung JY1, Yeon JH, Choi JW, Kwon SH, Kim BJ,
Youn SW, Park KC, Huh CH.
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• Of the 31 patients who completed the
treatment, 24 patients (77.4%) were improved
by the global photography
• Side effects included transient sexual
dysfunction in six patients (17.1%).
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Topical
Therapies
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• A total of 53 women,
18 to 55 years old,
applied topical EllCranellⓇ alpha
0.025% solution once
daily for 8 months
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Investigator assessment:
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• A randomized
double-blind
placebo-controlled
pilot study to
assess the efficacy
of a 24-week
topical treatment
by latanoprost
0.1% on hair
growth in sixteen
healthy volunteers
with androgenetic
alopecia
J Am Acad Dermatol. 2012 May;66(5):794-800
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Placebo
Latanoprost
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• Int J Clin Pharmacol Ther. 2014 Oct;52(10):8429.
• A novel finasteride 0.25% topical solution
for androgenetic alopecia:
pharmacokinetics and effects on plasma
androgen levels in healthy male
volunteers.
• Caserini M, Radicioni M, Leuratti C, Annoni O,
Palmieri R.
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Conclusion:
• In the near future, treatments with topical 5alfa-reductase inhibitors and prostaglandin
agonists are expected.
• More evidence is needed to verify the efficacy
of PRP.
• Although hair follicle bioengineering and
multiplication is a fascinating and promising
field, it is still a long way from being available
to clinicians.
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Thank
You
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