Evaluation of the safety and efficacy of platelet-rich plasma in the treatment of female patients with chronic telogen effluvium: A randomised, controlled, double-blind, pilot clinical trial

Background: Chronic telogen effluvium is characterised by diffuse loss of hair of the scalp. One of the emerging lines of treatment is platelet-rich plasma. However, not much of published data exist. Aims: A pilot study was conducted on chronic telogen effluvium patients to evaluate the efficacy and safety of platelet-rich plasma, and to compare two different methods of platelet-rich plasma preparation. Methods: The study included 30 female patients with chronic telogen effluvium. Patients were randomised into three groups: Group (1): Special platelet-rich plasma tubes centrifuged at 3500 rpm; Group (2): Ordinary laboratory tubes centrifuged at 1000 rpm; Group (3): Normal saline as a placebo. Patients' evaluation was done with visual analog scale, hair pull test, trichoscopy, photos, satisfaction questionnaire, and safety. All patients received four monthly sessions. Patients were evaluated one month and three months after the last session. Results: The hair pull test,visual analogue scale, and patient satisfaction results showed a statistically significant difference between group 1 vs. group 3 and group 2 vs.group 3 at one and three months after the sessions, while there was no difference between group1 vs. group 2. Trichoscopy results (baseline, one and three months after treatment) showed a significant increase in hair density and thickness in the frontal area, temporal area, and the vertex in groups 1 and 2 only. There was no statistically significant difference between the three groups with regards to side effects. Limitations: The sample size was small with ten patients in each group. Furthermore, the follow-up of patients was for only three months. Conclusions: Platelet-rich plasma could be considered as a promising therapy for patients with chronic telogen effluvium with an excellent safety profile. The ordinary laboratory low-cost tubes might be a reliable alternative to the expensive special platelet-rich plasma kits tubes. The trial registry number is PACTR202006539654415

Discovery and molecular analysis of conserved circRNAs from cashmere goat reveal their integrated regulatory network and potential roles in secondary hair follicle

Background: Circular RNAs, a novel class in the eukaryotic transcriptome, are characterized by the 3' and 5' ends that are covalently joined in a covalently closed loop without free ends. Circular RNAs are considerably stable molecules and act as microRNA sponges with regulatory potential to the protein-coding genes. Results: Eight circular RNAs were found to be significantly upregulated at anagen skin tissue of cashmere goat compared with their counterparts at telogen. Rich and complex regulatory patterns were revealed among the eight upregulated circular RNAs at anagen and related miRNAs with their potential regulatory genes. The potential regulatory genes of eight upregulated circular RNAs at anagen were involved in several pathways related to the main physiological process of hair follicle, such as histone acetylation and axon. For chi_circ_1926, chi_circ_3541, chi_circ_0483, chi_circ_3196, and chi_circ_2092, overall, the relative expression in secondary hair follicle exhibited highly similar trends with their corresponding host genes during the different stages of the hair follicle cycle. However, the expression trends of chi_circ_0100, chi_circ_2829, and chi_circ_1967 were found to diverge from their corresponding host genes during the different stages of the hair follicle cycle. Conclusions: A total of eighteen circular RNAs were identified and characterized from skin tissue of cashmere goat. The eight upregulated circular RNAs at anagen might have significant roles in the secondary hair follicle of cashmere goat. Our results would provide a novel regulatory layer to elucidate the molecular mechanisms underlying the development of secondary hair follicle and the growth of cashmere fiber in cashmere goat.

Nuevas evidencias en la alopecia por strés: papel de los nutricosméticos con pasiflora / New evidences in stress alopecia: role of nutricosmetics with passiflora

RESUMEN: El estrés es un factor desencadenante del efluvio telógeno y de otros tipos de alopecia, dificultando su control. Elmodelo del "eje cerebro-folículo piloso", establece que el estrés altera el ciclo del folículo capilar, terminando prematuramente su crecimiento y activando la apoptosis y distintos eventos inflamatorios nocivos, alrededor del folículo. En él, la sustancia SP, un neuropéptidoinmunomodulador, desempeña un papel esencial. El extracto de pasiflora (Passifloraincarnata L.),autorizado por la EMA para el alivio temporal de los síntomas leves de estrés mental, ha demostrado ser eficaz y seguro frente al estrés subyacente a la alopecia. Actúa sobre la sustancia P y sobre el sistema de neurotransmisión del ácido gamma-aminobutírico (GABA), además de presentar propiedades antioxidantes. Se revisa a continuación la evidencia científica disponible.

SUMMARY: Stress is a trigger for telogen effluvium and other types of alopecia and makes it difficult to control. The "brain-hair follicle axis" establishes that stress alters the hair follicle cycle, prematurely ending its growth and activating apoptosis and various harmful inflammatory events around the follicle. Substance P, an immunomodulatory neuropeptide, plays a key role in this cascade. The extract of passionflower (Passifloraincarnata L.), authorized by the EMA for the temporary relief of mild symptoms of mental stress, has shown to be effective and safe against the stress underlying alopecia. It acts on substance P and on the neurotransmission system of gamma-aminobutyric acid (GABA), in addition to its antioxidant properties. The available evidence is reviewed below.

El pelo: generalidades y enfermedades más comunes / Hair: its generalities and most common diseases

Resumen Las patologías del pelo reciben poca atención durante la formación del médico general, pero al tener alta prevalencia en la práctica clínica es importante considerar los principios básicos del crecimiento del pelo y las patologías más comunes que lo afectan, para llegar a un diagnóstico y un tratamiento correcto en cada situación.

Abstract Hair pathology is often overlooked during undergraduate medical training, however because of its high prevalence in the clinical practice it is important to know the basic principles of hair growth and the most frequent pathologies that afflict this structure and how to make an adequate diagnosis and treatment for each patient.

Localized Telogen Effluvium Following Hair Transplantation

Telogen effluvium is categorized in nonscarring alopecia, which shows scalp hair thinning and shedding diffusely resulting from inducing factors such as physiological stressful events and several acute or chronic diseases. It usually appears in female patients following parturition, as well as after febrile disease, major surgery, emotional stress, abrupt diet, chronic illness, or the taking of certain medication pills. Two patients who both recalled an operational history of hair transplantation visited our department with their frontal and both temporal hair loss. Physical examination of the both patients showed localized but diffuse hair loss, especially in the frontal and temporal scalp. Histopathological examination of biopsy specimen taken from their temporal scalp revealed normal follicular density and increased numbers of telogen hair follicles without any inflammatory cell infiltration around follicles. These clinical and histopathological findings were consistent with telogen effluvium. Both of them were reassured and placed on close follow-up without any treatment. From these cases, we demonstrate that localized telogen effluvium could be a cause of hair loss after hair transplantation.

Alopecia Areata - A literature Review

Alopecia areata (AA) is a disease marked by extreme variability in hair loss, not only at the time of initial onset of hair loss but in the duration, extent and pattern of hair loss during any given episode. This variable and unpredictable nature of spontaneous re-growth and lack of a uniform response to various therapies has made clinical trials in alopecia areata difficult to plan and implement. It is a type of alopecia that affects males and females equally. It occurs in both children and adults. The peak age of occurrence is 20 to 50 years .The most common clinical presentation is asymptomatic shedding of telogen hairs followed by patchy non scarring hair loss in association with nail pitting, Beau’s line and nail dystrophy. The disease may progress from this limited presentation to total loss of all scalp hairs (Alopecia totalis) or all body hair (alopecia universalis) with significant onychodystrophy. Mostly it is characterised by reversible hair loss involving the scalp although others areas of head including eyelashes, eyebrows and beard may also be affected. Although, it is a mostly cosmetic problem but it often has devastating effects on quality of life and self-esteem. The paper aims at providing an overview of Alopecia areata.

Estimation of Serum Ferritin Levels in Patients with Various Forms of Alopecia: A Case-Control Study.

Background: Hair is considered as one of the most essential feature of human appearance. It is an ectodermal structure with no vital function, yet its cosmetic and emotional significance is enormous, as is evident from the distress of losing hair. It is a widespread hitch affecting up to 50 percent of males and females during their lives. The most commonly accepted causes of hair loss include nutritional deficiencies, particularly that of iron. Hair loss could also be a sign of underlying systemic illness like anemia, hypothyroidism, hyperthyroidism, chronic infectious diseases, etc. Serum ferritin is directly related to intracellular ferritin and thus to total body iron stores. Iron deficiency results in low serum ferritin concentrations. The association of low serum ferritin level with hair loss has been a controversial topic over the years. Hence, the present study was conducted to measure the serum ferritin level in various types of alopecia and comparison with controls. Objectives: To measure the serum ferritin level in various types of non-cicatricial alopecia and comparison with controls. Methods: This study was conducted on 100 non-cicatricial alopecia patients reporting to the Department of Dermatology, Nepalgunj Medical College and Teaching Hospital, Nepalgunj, Nepal for the period of one year from May 2014 to June 2015. All study participants were enrolled after a detailed medical history and clinical examination by the same experienced dermatologist to rule out conditions that can cause hair loss. In addition to clinical examination, the baseline investigations including, haemoglobin level, ESR and serum ferritin levels were also carried out. Serum ferritin was measured by standard enzyme-linked immunosorbent assay (ELISA) method. The lower reference limit of serum ferritin taken in this study was 40 ng/ml. The statistical analysis was done using student ‘t’ test for the difference of means and chi-square test for ratios. The p-value of <0.05 was taken to be significant. Results: Out of 100 cases, 80% were that of alopecia areata, followed by 12% of telogen effluvium and 8% of androgenetic alopecia. Amongst 100 patients of alopecia, alopecia areata was observed in 21-25 years of age group (25%); telogen effluvium was found between 15-20 year age group (41.7%) and androgenetic alopecia was seen most commonly in the 26-30 year age group (50%). Alopecia areata and telogen effluvium were found more in female patients (82.5% and 91.7%, respectively) where as androgenetic alopecia was observed mainly in males (62.5). An extremely significant difference (p<0.001) in the mean serum ferritin levels was seen in the cases (68±41.89 ng/ml) and controls (26.37±16.01 ng/ml). The mean ferritin levels of patients with alopecia areata (59.46±53.37 ng/ml) and androgenetic alopecia (114.88±58.15 ng/ml) were significantly higher than that in the controls (p<0.0001), whereas the mean ferritin level of patients with telogen effluvium (29.67±14.14 ng/ml) was not significantly different from that of controls (p=0.49). Conclusion: Estimation of total serum ferritin levels may be important in cases of unexplained hair fall. Appropriate counselling and treatment can then be particularly directed at the etiology of hair loss, thus improving the patient outcome.

Eficacia de un complemento alimenticio con serenoa serrulata y tocotrienol-tocoferol frente a la alopecia androgenética y el efluvio telógeno femeninos: A propósito de un estudio piloto / Effectiveness of a dietary supplement with serenoa serrulata and tocotrienol-tocopherol against female androgenetic alopecia and telogen effluvium: Report of a pilot study

Introducción: la alopecia androgenética femenina (FAGA) y el efluvio telógeno (ET), son causas comunes de pérdida de cabello en las mujeres. Un hecho conocido en estos tipos de alopecia es la mayor actividad de la 5α-reductasa, que reduce la testosterona a dihidro-testosterona, andrógeno que acelera el ciclo capilar y acorta su duración. La Serenoa serrulata es una especie vegetal, cuyos componentes presentan un efecto inhibidor de la 5α-reductasa. Objetivo: el objetivo principal de este estudio, consistió en valorar la eficacia y la tolerancia, frente a la alopecia femenina de la administración diaria oral, de un complemento alimenticio con extracto de Serenoa serrulata, L-cistina, complejo tocotrienol-tocoferol, hierro, zinc y vitaminas H, B1, B2, B3, B5, B6 y B12 durante seis meses. Material y Método: estudio piloto unicéntrico, abierto, no aleatorizado, a simple ciego, de 180 días de duración, llevado a cabo en voluntarias con FAGA o ET. Se valoró el aspecto macroscópico del cabello, la densidad capilar mediante microfotografía, la relación anágena / telógena (A/T) mediante tricograma, el número de cabellos desprendidos mediante ensayos de peinado ("combing test") y de lavado ("wash test"). Se realizó una encuesta de autovaloración de los resultados. Resultados: la edad media de las participantes (n=10) fue de 40±15,5 años. El tiempo de evolución fue de 4,5±2 años y de tres meses para la FAGA y el ET, respectivamente. Al final del tratamiento las participantes presentaron un incremento medio del 6,9%, en la proporción de cabellos en fase anágena y la relación A/T media aumentó a 3,3. El 80% mostraron una mayor densidad capilar al finalizar el estudio. Al cabo de tres meses, todas las participantes presentaron una reducción media de la pérdida de cabellos del 56%, respecto de la visita basal. El 90% percibieron una mayor o igual cantidad de cabello al final del estudio y el 80% lo notaron más fuerte. No se registró ninguna molestia inducida por el tratamiento. Conclusiones: la buena evolución de las variables analizadas apunta a un beneficio terapéutico, frente a la FAGA y el ET. Estudios con mayor número de pacientes, son necesarios a futuro.

Introduction: female androgenetic alopecia (FAGA) and telogen effluvium (TE) are common causes of hair loss in women. A known fact in these types of alopecia is the increased activity of 5a-reductase which reduces testosterone to dihydrotestosterone, accelerating hair cycle and shortening its duration. Serenoa serrulata is a plant species whose components have an inhibitory effect on 5a reductase. Objective: the main objective of this study was to evaluate the efficacy and tolerance against female alopecia of a food supplement with Serenoa serrulata extract, L-cystine, tocotrienol-tocopherol complex, iron, zinc, and vitamins H, B1, B2, B3, B5, B6 and B12 administered daily for six months. Material and Methods: single-center, open-label, non-randomized, single-blind, 180-days pilot study conducted in women with FAGA or TE. The study assessed the macroscopic appearance of the hair, hair density by microphotograph, the anagen / telogen ratio (A/T) by trichogram, and the number of detached hair by combing and wash tests. Self-assessment survey of the results was performed. Results: the mean age of participants (n = 10) was 40 ± 15.5 years. FAGA and ET had an evolution of 4.5 ± two years and three months, respectively. After treatment the participants had an average increase of 6.9% in the proportion of hairs in anagen phase, and the mean A/T ratio increased to 3.3. Eighty percent or patients showed an increased capillary density at study end. After three months, all participants had a mean reduction of hair loss of 56% vs baseline. Ninety percent perceived a greater or equal amount of hair at the end of the study and 80% noticed it stronger. No adverse effects induced by treatment were observed. Conclusions: the good results of the analyzed variables suggest a therapeutic benefit against FAGA and ET. Additional research is warranted to confirm the observed data.

Comments to "Alopecia Areata in a Patient Treated with Interferon Alpha-2a for Chronic Hepatitis B" / 대한피부과학회지

No abstract available.

Telogen effluvium.

Telogen effluvium (TE) is one of the most common causes of diffuse nonscarring hair loss. In its acute form, it generates a lot of anxiety in the patient, which can be signifi cantly allayed with a confi dent diagnosis. In its more chronic form, however, the hair loss may go unnoticed for long periods of time. Here in, the dermatologist’s role in differentiating it from the more common patterned hair loss is signifi cant. Differentiating TE from other causes of diffuse nonscarring hair loss can indeed be a daunting task and TE is often used as a waste basket diagnosis. A number of factors have been implicated in the causation of TE, however, clear evidence in their support is lacking. The role of stress as a causative factor as well as the result of hair loss needs to be adequately understood. This review aims at summarizing our current level of knowledge with respect to this very common cause of hair loss. An attempt is made to help the readers reliably differentiate TE from other causes of diffuse nonscarring hair loss. The possible causative factors, pathogenetic mechanisms, clinical presentation, and possible treatment options are discussed.

A 10-Year Retrospective Review of Non-Scarring Alopecia in a Tertiary Hospital in Malaysia

Background Non-scarring alopecia is a common hair disorder with paucity of clinical reviews. Objectives We aim to study the spectrum of non-scarring alopecia, its’ demographic, clinical and treatment pattern among patients at University Malaya Medical Centre. Methodology We have retrospectively reviewed the demography, clinical characteristics and treatment of non-scarring alopecia at University Malaya Medical Centre (UMMC). A total of 154 records were reviewed. Results A majority of patients had alopecia areata (28.6%), followed by androgenetic alopecia (12.3%), telogen effluvium (3.2%), tineacapitis (2.6%) and unspecified hair loss (53.2). Treatment for alopecia areata included topical steroids (53.3%), intralesional steroids (26.7%), topical minoxidil (17.8%), oral steroids (11.1%), oral finasteride (2.2%) and oral azathiopine (2.2%). Prescribed treatment for androgenetic alopecia comprised of topical minoxidil (68.1%) or oral finasteride (10.5%). Conclusion We concluded that alopecia areata was the most common cause of nonscarring alopecia diagnosed at UMMC and deduced that the high number of patients diagnosed with unspecified hair loss was attributed to the lack of confidence amongst out-patient physicians in diagnosing the cause of alopecia.

Caracterización del tricograma en pacientes chilenos / Characterization of trichogram in Chilean patients

Introducción: El tricograma consiste en extraer pelos del cuero cabelludo que luego son examinados mediante un microscopio para determinar qué porcentaje de éstos se encuentra en telógeno, anágeno o catágeno. Objetivos: Caracterizar el tricograma en pacientes chilenos y determinar las diferencias existentes entre los porcentajes de anágeno y telógeno entre cuero cabelludo normal y la zona de menor densidad. Material y Métodos: Estudio observacional descriptivo y retrospectivo de análisis de tricogramas diferenciales de cuero cabelludo. Resultados: Las diferencias del porcentaje de anágeno y telógeno entre cuero cabelludo normal y la zona de menor densidad fueron estadísticamente significativas.

Introduction: Trichogram consists in removing hair follicles from the scalp and examining them under a microscope to determine the percentage of them that are in telogen, anagen or catagen. Aim: To characterize trichogram in chilean patients and determine the differences in anagen and telogen percentages between normal scalp and a lower density zone. Material and Methods: Observational, descriptive and retrospective study of the analysis of differential trichograms of the scalp. Results: The differences in anagen and telogen percentages between normal scalp and the lower density zone were statistically significant.Key words: Trichogram, anagen, telogen.

A Clinical Study of Prevalence of Telogen Effluvium after Childbirth / 대한피부과학회지

BACKGROUND: Telogen effluvium (TE) is a form of nonscarring alopecia, characterized by diffuse scalp hair thinning in response to some form of physiologic stress. It is commonly described in women subsequent to childbirth. OBJECTIVE: The purpose of this study was to evaluate the prevalence of TE after childbirth. METHODS: Medical records from January 2006 to June 2007 of 240 postpartum patients from our obstetric department were reviewed. Telephone interviews with TE patients were conducted to investigate the initial occurrence time, restoration time, and treatment history. RESULTS: Prevalence of TE according to parity is higher in multiparas than primiparas (p=0.026). In addition, the prevalence of TE after a cesarean section delivery is higher than that after non-surgical delivery (p=0.014). Prevalence of TE with respect to weight gain is higher in the groups displaying agreater increase in weight (p=0.014). Finally, prevalence of TE according to gestational age is higher in groups giving birth after 38 weeks gestational age (p=0.015). CONCLUSION: Prevalence of telogen effluvium may be associated with multiparity, cesarean section, marked weight gain, and high gestational age.

Hair Follicles of Anterior Parietal Region are More Vulnerable than Occipital Region in Classic Acute Telogen Effluvium

Background: The well known clinical feature of the classic acute telogen effluvium is diffuse hair loss from all over the scalp and the diagnosis is confirmed by a trichogram showing an increased telogen count. While the telogen hair shedding continues, newly cycled back young anagen hairs develop in the involved scalp. Objective: To see if there is a regional difference in the numbers of the involved hair follicles in that seemingly diffuse hair loss. Methods: In 7 cases of the telogen effluvium, the telogen count was done at two sites, anterior parietal and occipital. During the count, the short tapered anagen hairs(<1cm) which developed during the course of the telogen effluvium were counted together and compared according to the regions. Results: The sum of the short anagen hairs and the telogen hairs was 50.3% in anterior parietal area, whereas it was 31.6% in occipital area(p<0.0l). Conclusion: Hair follicles in anterior scalp appear to be more vulnerable than occipital scalp in the acute telogen effluvium.

Analysis of Serum Stored Iron Levels in Female Chronic Telogen Effluvium / 대한피부과학회지

BACKGROUND: Chronic telogen effluvium is a common problem in middle-aged women. It has been suggested that reduced iron stores are a cause of this type of baldness. OBJECTIVE: We performed this study in order to elucidate the pathogenesis of chronic telogen effluvium and to evaluate the differences in serum stored iron levels between normal females and those with chronic telogen effluvium. METHODS: Blood levels of hemoglobin, iron, ferritin, and TIBC were examined in 20 patients with chronic telogen effluvium and 20 normal females. RESULT: 1) Ferritin levels were significantly decreased in the patients group(p=0.008). 2) TIBC levels were significantly increased in the patients group(p=0.001). 3) There were no significant differences in Hb and serum iron in both groups (p<0.05). CONCLUSION: These findings suggested that the variation of serum ferritin level may play a role in the pathogenesis of chronic telogen effluvium, but further studies will be needed for evaluation of this condition.