New Therapies for Hair Loss: What works and what doesn t?

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 2 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. 1

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5 What works and what doesn t? 6 What is the cause (or causes) of hair loss? 3

7 Prescribing an effective therapy to a patient with wrong diagnosis, will not help. 8 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). 4

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 9 10 injection of variable mixtures of natural plant extracts, homeopathic agents, pharmaceuticals, vitamins, and other bioactive substances in microscopic quantities through dermal multipunctures 5

11 Acceptable scientific evidence for its effectiveness and safety is lacking. 12 Depend on what your injecting and for what? (correct diagnosis then correct treatment) 6

13 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 14 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. 7

15 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) 16 Side effects were minimal with no statistically significant difference between the two groups (P > 0.05). 8

17 Platelet-Rich Plasma (PRP) 18 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. 9

19 20 It was widely used in oral and maxillofacial surgery and orthopedics, for the repairing of bone, cartilage and soft tissues. 10

21 PRP and Hair 22 Dermatol Surg. 2012 Jul;38(7 Pt 1):1040-6 11

23 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. 24 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. 12

25 The injection of mice with activated PRP induced faster telogen-to-anagen transition than was seen on control mice. 26 13

27 Dermatol Surg. 2011 Dec;37(12):1721-9. 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). 28 14

29 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. 30 15

31 (PRP&D/P MPs) Control (saline) 32 Microscopic findings showed thickened epithelium, proliferation of collagen fibers and fibroblasts, and increased vessels around follicles. 16

33 34 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. 17

35 J Cutan Aesthet Surg. 2014 Apr;7(2):107-10 36 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 18

37 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.) 38 19

39 40 Biomed Res Int. 2014;2014:760709. May 6 20

41 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. Three treatments were given for each patient, with intervals of 1 month. 42 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). 21

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45 46 PRP and Hair: Is it a practical way to treat AGA? Once treatment stop regrown hair will fall 23

47 Stem Cells and Hair 48 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. 24

49 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. 50 25

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55 Bioengineered hair follicles could restore physiological hair functions and could be applicable to surgical treatments for alopecia. 56 28

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59 60 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 30

61 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 62 a 35% percent increase in hair growth as compared to the placebo group (P = 0.003). No adverse events or side effects were reported. 31

63 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 64 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 32

65 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 66 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. 33

67 Dutasteride performed statistically significantly better than finasteride in the age category below 50 years at the central and vertex sites of the scalp. 68 finasteride 1.25 mg daily for 3 years 34

69 dutasteride 0.15 mg daily for 3 years 70 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 JY 1, Yeon JH, Choi JW, Kwon SH, Kim BJ, Youn SW, Park KC, Huh CH. 35

71 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%). 72 Topical Therapies 36

73 74 A total of 53 women, 18 to 55 years old, applied topical Ell- CranellR alpha 0.025% solution once daily for 8 months 37

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Investigator assessment: 77 78 39

79 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 80 40

81 Placebo Latanoprost 82 41

83 Int J Clin Pharmacol Ther. 2014 Oct;52(10):842-9. 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. 84 Conclusion: In the near future, treatments with topical 5- alfa-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. 42

85 Thank You 43