EHRS Conference
Introduction
The 17th meeting of the European Hair Research Society (EHRS) was held in Tbilisi, Georgia, between 24-26 June 2016. This is the first time that the annual EHRS meeting takes place in Eastern Europe, with the aim of “broadening the borders”, as the logo of the meeting states, to reach new audiences. Indeed, the meeting attracted an unprecedented large number of physicians and scientists from Russia, Ukraine, Belarus, Georgia, Lithuania and other countries from Eastern Europe, proving proof for the success in achieving the goal of attracting new faces to this meeting.
The meeting was organized by George Galdava (Georgia) and Nino Lortkipanidze (Georgia) who served as co-presidents, and Oleg Kvlividze (Georgia) as the secretary general for the meeting. Together with the scientific committee headed by the EHRS president, Abraham Zlotogorski (Israel), they produced an interesting and dense scientific program, combining clinical with basic research.
Before the official start of the meeting, a pre-meeting course was held for the Russian-speaking population. The pre-meeting course in Russian under the guidance of Yuliya Ovcharenko (Ukraine), which preceded the main part of the congress, becoming a consolidating event for specialists from Eastern Europe and attracting more than 300 new participants from the post-Soviet space. The pre-course was geared towards practicing doctors and outlined modern ideas of the main issues in trichology, including genetic aspects, trigger factors, especially the diagnosis and treatment of trichopathologies, scalp diseases and future directions in the hair biology and pathology research. Reports were given by leading experts from Ukraine, Georgia, Russia, Belarus and Israel. At the conclusion, pre-course organizer Yuliya Ovcharenko (Ukraine), highlighted the importance of the collaboration of Western and Eastern experts and expressed the hope that the Georgian Congress would become a good tradition of holding EHRS meetings in Eastern Europe.
This course was followed by an introductory mini-course in English, providing tools for understanding the basics of hair research. Yuval Ramot (Israel) opened this course, inviting the audience to a “tour of the hair”, in which the normal anatomy and physiology of the hair follicle were discussed, with examples and explanations of how changes in the normal function of the hair follicle can lead to different hair disorders. Valentina Broshtilova (Bulgaria) discussed the differential diagnoses of several pathological findings of scalp biopsies, providing important insight on how the right interpretation of the pathologic slides can help in making the correct diagnosis of the hair disease. Lidia Rudnicka (Poland) concluded this session by discussing basic hair trichology, sharing her vast experience in trichoscopy and providing a list of common trichoscopic signs that can help in making the right diagnosis.
Social events
On the day before the start of the conference, a large number of participants went on a tour to view the beautiful sights of Tbilisi, and of the nearby UNESCO World Heritage Site, Mtskheta, including the Svetitskhoveli Cathedral (11th century) and the Jvari Monastery (6th century). The Gala dinner took place in the Metekhis Chrdili restaurant in Tbilisi, overviewing the Kura river. The dinner included a variety of delicious traditional Georgian dishes, which were accompanied by folk dancing and music.
Opening ceremony and John Ebling Lecture
After the welcome speeches by the meeting organizers, John Ebling Lecture, the highest award given by the EHRS, was presented to Jerry Shapiro (USA). Shapiro reviewed his 30 years’ experience in hair research, showing how trichology has changed from an unpopular subspecialty to one of the most wanted profession in dermatology. He has also given tools for young hair specialists for how to found a hair research center, which combines clinical and basic science in a university setting.
The fascinating John Ebling Lecture was followed by a wonderful and colorful show of traditional Georgian folklore dancing and singing, which culminated in a long standing ovation.
Hair loss
Ramon Grimalt (Spain) described several disorders related to artificial hair loss in children, including for example trichotillomania, trichoteiromania (hair loss due to hair rubbing) and trichotemnomania (cutting or shaving of the hair), and the clinical differences between these conditions. Grimalt highlighted the importance of using the right terminology in these cases. Bianca Maria Piraccini (Italy) presented the benefits and potential adverse effects with the use of hair cosmetics, such as hair dyeing, bleaching, and hair additions. She emphasized the need for the hair clinician to be knowledgeable with the different hair cosmetics to be able to advice the patient properly to help with the relevant hair condition. Traction alopecia is a common hair loss disorder due to persistent pulling of the hair. Andy Goren (USA) presented the results of a clinical study that assessed the efficacy of a selective α1-adrenergic receptor agonist to reduce hair shedding during hair cosmetic procedures. He reported that topical application of this agonist was able to reduce hair shedding compared to placebo.
Androgenetic alopecia
Female pattern hair loss (FPHL) is a highly common condition, which can have severe implications on the patient’s confidence and quality of life. Dimitrios Ioannides (Greece) gave an educational talk that reviewed this condition, describing the common clinical features, possible differential diagnoses and treatment options. Being a hereditable disorder, a genetic basis for FPHL has been suggested. Regina Betz (Germany) reviewed the recent genetic studies that were performed to unveil the underlying genes for this condition. While the number of genetic studies are limited, it is evident that the overlap between FPHL and male pattern hair loss (MPHL) is very small. Moving from FPHL to another very common hair disorder, MPHL, Won Soo Lee (Korea) reviewed the different treatment protocols that have been developed for this condition, with special focus on the algorithmic evaluation that was developed by his group, which is based on the Basic and Specific (BASP) classification, a simplified universal classification system. One of the possible treatments for MPHL is dutasteride, a dual inhibitor of type I and type II alpha reductase, which has shown to be effective for MPHL. Lee has reviewed the available literature on the efficacy and safety of this treatment, and concluded that it should be considered as a treatment option for MPHL.
Rolf Hoffmann (Germany) reviewed the current cell-based therapies that are in development for the treatment of hair loss. A promising treatment modality is injection of autologous dermal papilla cells, which is currently evaluated in clinical studies. Minoxidil is FDA approved for the treatment of FPHL; however, only a minority of the patients respond to this treatment. Andy Goren (USA) presented a novel tool for prediction of the response to topical application of minoxidil utilizing laser Doppler imaging, by measuring blood perfusion to the scalp.
Alopecia areata
While alopecia areata (AA) is considered an autoimmune disease with a strong genetic basis, its exact pathogenesis is still obscure. Kevin McElwee (Canada) presented the candidate causes for AA, emphasizing the controversies that still exist on the development of AA, one of them is whether AA is a single condition or a cluster of related conditions that result in hair loss. One area, though, in which much progress has been made in recent years, is the understanding of the genetic basis for AA. Eddie Wang (USA) reviewed the results of several genome wide association studies, which highlighted the role of the NKG2D+ CD8 cells in AA pathogenesis, a finding that gave support for the use of JAK inhibitors in this disease. The NKG2D+ CD8 cells are only a subset of the immune cells that take part in AA development, and Amos Gilhar (Israel) presented novel findings, which demonstrate for the first time that innate lymphoid cells and gamma-delta T cells also take part in AA initiation and development. These findings clearly show that a complex interplay between a large variety of immune cells is responsible for AA.
Cicatricial alopecia
Cicatricial alopecias are trichologic emergencies, requiring quick diagnosis and treatment. Jerry Shapiro (USA) provided treatment algorithms for the more common cicatricial alopecias based on his vast experience, which combine topical, intralesional and systemic therapies according to the severity of inflammation. An increasingly common scarring alopecia is frontal fibrosing alopecia (FFA). Andrew Messenger (UK) presented the results of two questionnaire studies to evaluate possible environmental factors in its etiology. The results of these studies suggest that skin care products play a causative role in the disease, although further studies are needed to prove this hypothesis. Folliculitis decalvans is a neutrophilic scarring alopecia, which has been suggested to result from an abnormal host reaction to the presence of bacteria. Lidia Rudnicka (Poland) reviewed the clinical and trichoscopic features of this disease, which include tufted hairs, perifollicular epidermal hyperplasia in a starburst pattern, yellowish tubular scaling, follicular pustules and yellowish discharge. The different treatment options were also reviewed.
Genetic diseases
The development of next-generation-sequencing has revolutionized the diagnosis of monogenic hair disorders, and many novel genes have been found to underlie these diseases. However, after a burst of publications and reports on the finding of new genes, there are hardly any new genes that are detected in recent years for monogenic hair disease. Regina Betz (Germany) discussed the latest findings in this field, with examples from her own experience on the pitfalls that exist in monogenic hair research. Hair pigmentation is also controlled by genetic regulation, and over 300- pigmentation-associated genes have been descried to date. Desmond Tobin (UK) presented the new findings in genetic regulation of hair pigmentation, emphasizing the complex regulation of this phenotype in humans.
The hair follicle
Bruno Bernard (France) discussed a new topic, which has been neglected by the hair community for many years. He reviewed the available literature on the possible role of glycans in HF regulation and growth, discussing potential functions in the HF, possibly by affecting different signaling pathways such as Wnt and Notch or by controlling the release of growth factors. Bernard has shown evidence that different glycans have different expression patterns in the HF, suggesting that they possess a diverse functional potential. Claire Higgins (UK) focused her talk on the dermal fibroblasts, and presented her findings on heterogeneity between fibroblast populations in human skin. Ekaterina Kalabusheva (Russia) reviewed her recent work, which involves the development of a cell system that recapitulates HF morphogenesis, by combining dermal papilla cells with keratinocytes suspension in a hanging drop. Such a model might become useful for examining treatment options for alopecia. Another talk on hair morphogenesis was given by Ekaterina Voroteylak (Russia), who discussed different models for examining the role of stem cells in hair formation, and for the study of epithelial-mesenchymal interactions.
Trichoscopy
Trichsopcy is gaining much popularity in the clinical practice of hair diseases, and accordingly, many speakers presented and discussed trichoscopy images of patients. Furthermore, one session was dedicated to trichoscopy. During this session, Antonella Tosi (USA) presented the findings observed in scarring alopecia, and highlighted the trichoscopic differences between the different diseases. Tosi has also emphasized the utility of trichoscopy to help selecting the optimal biopsy site. Lidia Rudnicka (Poland) showed how proper trichoscopy of the hair shafts can help in the diagnosis of different hair conditions, such as AGA and focal alopecias including alopecia areata, trichotillomania and tinea capitis. Isabella Doche (Brazil) presented how trichosocpy can help identify the nature of concretions on the hair, being either nits, cosmetics or traction alopecia. Colombina Vincenzi (Italy) reviewed the use of trichoscopy for the diagnosis of inflammatory scalp conditions, highlighting the importance of the vascular pattern in distinguishing between these different disorders. Bohdan Lytvynenko (Ukraine) concluded this session by focusing on the dermoscopic appearance of melanocytic and non-melanocytic tumors on the scalp.
Psoriasis
Involvement of the scalp is very common in psoriasis, and hair loss was also described in this condition. Anna Lyakhovitsky (Israel) focused in her presentation on psoriatic alopecia, one of the less recognized manifestations of psoriasis, and emphasized the importance of early recognition of this condition, which is crucial to prevent scarring alopecia. Yuval Ramot (Israel) reviewed the literature on the treatments available for scalp psoriasis, providing a treatment algorithm for this condition, which is based on topical medications for the mild cases, and phototherapy and systemic medications (including biologics) for the more severe cases.
Hair transplantation
Two sessions were dedicated to this important treatment modality for hair loss, and many aspects relating to this option were covered. Akaki Tsilosani (Georgia) presented a technique to maximize donor harvesting in hair transplantation, which is crucial in the more severe cases of AGA. This technique is based on a combination of follicular unit transplantation (FUT) with follicular unit extraction on both sides of the FUT wound to decrease scalp tension. Bessam Farjo (UK) also reviewed a new technique for hair extraction, focusing on image-guided robotics. In his talk, Farjo showed examples of the capabilities of the robot, and demonstrated the possibilities to use robotics also for automated graft implantation. Aleksiy Makharashvili (Georgia) reported on a study aimed to evaluate the morphological changes of grafts and to define periods of follicle viability during hair transplantation. Using the results of this study, it would be possible to increase rate of survival of the grafts. Hair transplantation in scarring alopecia is highly challenging, owing to the thinning of the skin. Alex Ginzburg (Israel) reviewed the different types of scars and the insertion techniques that are utilized in scarring alopecia. Ekrem Civas (Turkey) also shared with the audience his experience with hair transplantation for primary and secondary scarring alopecia, further emphasizing the fact that satisfactory results can be achieved in patients with a sufficient donor site.
Hairline parameters in women are very different between men and women. Nilofer Farjo (UK) reviewed the differences and highlighted the special considerations that should be taken into account when using hair transplantation for women. Disorders and asymmetry of the eyebrows can be challenging conditions to treat. Salome Vadachkoria (Georgia) discussed different options for eyebrow restorations, providing also video of the procedure and demonstrations of several clinical cases.
Latin America session
Desmond Tobin (UK) opened this session by presenting the results of a big GWAS study that was performed on a large cohort to discover the genetic variants that control the features of scalp and facial hair. A total of 14 genomic regions were found for at least one hair trait. Tobin discussed these findings and their possible future implications.
The rest of the session was dedicated to interesting cases from Latin America (Mexico and Brazil), which presented diagnostic challenges for the audience. In addition, two presentations focused on trichoscopy: one on androgenetic aleopcia (Michela Starace, Italy) and the other on alopecia areata (Bianca-Maria Piraccini, Italy).
Clinical cases
Fascinating hair cases were presented in this session, emphasizing the sometimes-complicated diagnoses that hair specialists have to face. One especially interesting case was presented by Spartak Kaiumov (Russia), who described a patient that suffered from trichoteiromania, a compulsive disorder leading to consistent rubbing of the hair. This presentation received the EHRS prize for the most original case presentation.
Closing ceremony
The closing ceremony started with two talks that reviewed the new findings in basic hair research (Claire Higgins, UK) and clinical hair research (Abraham Zlotogorski, Israel). The studies that were reviewed were selected from the news section in the EHRS website, which publishes every month a summary of the most interesting publications in the field of clinical and basic hair research. Reading of this section can help the interested reader in staying up-to-date with the most important findings in the hair research field.
The meeting ended with handing of the prizes for the best oral and poster presentations:
Best oral presentations
- A. Tafazzoli (Germany). Role of micrornas in the etiology of alopecia areata: a genome-wide microrna association and analysis
- I. Doche (Brazil). Study of the neurogenic inflammation in lichen planopilaris and frontal fibrosing alopecia
Best poster presentations
- A. Rippa (Russia). Hair follicle morphogenesis and epidermal homeostasis in mice with postnatal alopecia
- MA. Martinez-Velasco (USA) Pilot study to evaluate a hair shedding scale in women with curly hair of 3 different lengths
EHRS Travel Grants
Travel Grants + registration fees were awarded to:
- Anna Khaldeieva, Ukraine
- Eva Katharina Barbosa Pfannes, Germany
- Maria Abril Martínez Velasco, Mexico
- Vered Molho-Pessach, Israel
- Maria Teresa Romano, Germany
- Eddy Hsi Chun Wang, USA
- Marcelo De Souza Teixeira, Brazil
- Olga Selezneva, Russia
- Norma Vazquez, Mexico
Summary
The meeting in Georgia has allowed for the first time close and intensive interaction between hair clinicians and researchers from West and Eastern Europe. Such interaction will hopefully lead to future fruitful collaborations between different research groups in Europe and outside of Europe. The large amount of presentations that were given during the meeting has once again emphasized the great advances that have been made in recent years in the field of hair research, and we are sure that many more findings that are interesting will be revealed in the future.
