What’s new in Hair— December 2017 | PD Dr. Annika Vogt

Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men – short version

J Eur Acad Dermatol Venereol. 2017 Nov 27. doi: 10.1111/jdv.14624. [Epub ahead of print]

Supported by the European Dermatology Forum, this group of leading trichologists provide the updated S3 guideline for the treatment of androgenetic alopecia (AGA), which is now replacing the previous version published in 2011. In men, mainstays of evidence-based treatments are still topical minoxidil 5% formulations as well as systemic finasteride 1 mg daily in men (or dutasteride 0.5 mg daily in case of treatment failure), while in women topical minoxidil 2% solution 2x daily has been complemented by the option for minoxidil 5% foam 1x daily. Among upcoming supporting treatments, Low Level Laser Light Therapy as well as Platelet-rich Plasma injections are for the first time discussed and listed individually, despite the fact that at this point there is still a need for controlled randomized clinical trials. The evidence-based recommendations will provide helpful guidance for the treatment of individuals affected by AGA.


Updated diagnostic criteria for frontal fibrosing alopecia

J Am Acad Dermatol. 2018 Jan;78(1):e21-e22. doi: 10.1016/j.jaad.2017.08.062.

Rediscussing a case series of 7 frontal fibrosing alopecia (FFA) patients presented by Dr. Tolkachjov, Dr. Vañó-Galván and his colleagues propose updated criteria for the diagnosis of FFA consisting of two Major Criteria: 1. Cicatricial alopecia of the frontal, temporal, or frontotemporal scalp on examination, in the absence of follicular keratotic papules on the body and 2. Diffuse bilateral eyebrow alopecia; and selected minor criteria: 1. Typical trichoscopic features: perifollicular erythema, follicular hyperkeratosis, or both; 2. Histopathologic features of cicatricial alopecia in the pattern of FFA and lichen planopilaris on biopsy; 3. Involvement (hair loss or perifollicular erythema) of additional FFA sites: occipital area, facial hair, sideburns, or body hair; and 4. Non-inflammatory facial papules. Diagnosis should be based on 2 major criteria or 1 major criterion and 2 minor criteria. Details and less frequent features of this disease entity are thoroughly discussed underlining that common understanding and precise criteria will help homogenize clinical diagnosis and future research.


Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases

J Am Acad Dermatol. 2018 Jan;78(1):203-205. doi: 10.1016/j.jaad.2017.07.035.

In this letter to the editor, Dr. Shapiro and co-workers retrospectively review demographic and baseline data as well as responsiveness to therapy of 92 patients (98% women) with frontal fibrosing alopecia (FFA). Comparisons are made for systemic and topical treatments and time to stabilization. 70.7% (65/92) of patients stabilized with treatment after an average of 10.4 (range 1-72) months with younger age being associated with lesser severe course of disease. Therapy largely relied on intralesional corticosteroid treatment combined with topical tacrolimus 0.3% or topical high potency corticosteroids. Among systemic treatments, no significant difference was observed between hydroxychloroquine or antibiotics (e.g., doxycycline, tetracycline, minocycline), but the latter was more frequently associated with side effects. Limitations of the study with regard to its retrospective and monocentric design are being discussed and underline the need for larger prospective, controlled clinical trials.


5α-Reductase isozymes and aromatase mRNA levels in plucked hair from young women with female pattern hair loss

Arch Dermatol Res. 2017 Nov 28. doi: 10.1007/s00403-017-1798-0. [Epub ahead of print]

Herein, Sanchez et al. apply RT-PCR analyses on material extracted from plucked hair follicles to assess mRNA levels of aromatase and 5α-R isozymes (type 1, type 2 and type 3) in normoandrogenic young women with female pattern hair loss (FPHL) compared to unaffected controls Different sets of 5α-R isozymes were increased in some, but not all, women with FPHL. Yet, aromatase mRNA levels were significantly lower in women with FPHL than in controls suggesting an association with an increased androgen/estrogen ratio in hair as a result of lower estrogen levels. The authors propose, that this non-invasive way of biomarker analysis could be a useful non-invasive tool to understand molecular profile of diseased hair follicles and enable selection of more appropriate pharmacological treatments


Computational derivation of a molecular framework for hair follicle biology from disease genes

Sci Rep. 2017 Nov 24;7(1):16303. doi: 10.1038/s41598-017-16050-9.

Dr. R.K. Severin and an interdisciplinary team of coworkers including the Data Science Institute, Columbia University New York, address the question as to how to bring existing information on genes involved in monogenic hair diseases together in a comprehensive way to advance precision medicine and genetic characterization of the hair follicle. Briefly, 684 genes identified from publicly available resources describing single gene hair disorders were used to curate a database. They were annotated across multiple molecular and functional domains and 4,937 terms significantly enriched by these genes were identified. Hierarchical clustering analysis and natural language processing (NLP) were applied to identify functional clusters of genes and describe relationships within and among these sets of genes. The extracted data were used to construct and analyze a hair follicle signaling network based on genes underlying monogenic disorders. This approach could give new insights into genetic regulators of hair follicle biology and relationships among disease genes or into previously unrecognized contributions of signaling molecules.


Spontaneous hair follicle germ (HFG) formation in vitro, enabling the large-scale production of HFGs for regenerative medicine

Biomaterials. 2017 Nov 6;154:291-300. doi: 10.1016/j.biomaterials.2017.10.056. [Epub ahead of print]

Kageyama et al use a custom-designed array plate to seed mixtures of mouse epidermal and mouse/human mesenchymal cells. Over a 3-day culture period they observed spontaneous organization into hair follicle germ-like aggregates suitable for intracutaneous transplantation. They further optimized their approach by encapsulation of the hair follicle germs in hydrogels and subsequent simultaneous transplantation of those spatially aligned germs. This finding facilitated the large-scale preparation of approximately 5000 such “self-sorted hair follicle germs” (ssHFGs) in a microwell-array chip made of oxygen-permeable silicone. Although still in animal models, such approach could become a highly promising strategy for up-scaling of hair germ generation and transplantation.

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