Article

Cosmetic hair treatments improve quality of life in women with female pattern hair loss

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Abstract

Hair is a significant component of physical attractiveness and body image. Therefore, losing hair often affects an individual's self-image, self-esteem, and overall quality of life. A study was designed to determine whether cosmetic hair appearance improvements produced any quality of life changes for women, even though no reversal of their female pattern hair loss (FPHL) would necessarily occur. A study to assess quality of life changes during the period that patients attended a trichology center was conducted over a 24 month period. Each participant attended the trichology center every 4-12 weeks. The participants were advised of lifestyle changes to help their overall hair condition and given topical products and other treatments to help improve the cosmetic look of their hair loss problems. All participants were given the Kingsley Alopecia Profile (KAP) to complete at the initial consultation (month 0). The questionnaire was also given after six months of cosmetic treatments. The KAP is a valid and reliable 38 statement questionnaire which measures the effects of genetic alopecia on quality of life. The results demonstrated significant overall and subcategory (i.e., anxiety and depression, self- esteem, and psychosocial) improvements in quality of life after 6 months of treatment (p < 0.0001 ). This improvement in quality of life is indicated by a lower KAP and/or KAP subcategory score. The importance of hair loss on an individual's general quality of life should not be underestimated. This study has confirmed the results of many previous studies that FPHL has a major effect on the psychosocial and emotional well-being of women. With the lack of a reliable medical cure, chronic concerns of hair loss can lead to long term psychological problems. Therefore, the importance of a measurement which can quantify this impact for practitioners, thereby enabling them to treat the patient effectively, cannot be underrated. Topical trichology stimulants as well as a product1 based on a proprietary marine ingredient2 from Pharma Medico Group1, as used in this study, for treatment of FPHL have been shown to be of great value with respect to hair growth as well as the global improvement of the quality of life.

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... This unique method is referred to as 'Proteoglycan Replacement Therapy (PRT)' in clinical literature. Numerous clinical trials and papers have confirmed and demonstrated the clinical efficacy and safety of PRT with Nourkrin ® in patients with diffuse hair loss [6][7][8][9]. ...
... Subjective assessments also indicated a high rate of treatment satisfaction in Nourkrin ® users [6,7]. A later trial reported considerable improvements in overall quality of life and all of its sub-scores after adding Nourkrin ® to the treatment regimen of women with hair loss [9]. ...
... Long-term administration of Nourkrin ® Woman in our study did not induce any side effects. This finding signifies the safety of Nourkrin ® in treating women with diffuse hair loss and confirms the former observational and interventional clinical reports [6][7][8][9]. ...
... Subsequent to this finding, good effort had been made in research centres in Denmark, Norway, and Sweden to formulate a specific enzymatic-extracted mixture of proteoglycans aimed to treat hair loss problems. e resulting product (Nourkrin ® with Marilex ® ,Pharma Medico Aps, Aarhus, Denmark) has been found to produce promising results in different clinical settings [99][100][101], reviewed by om and colleagues [102]. As yet, this line of research has admittedly had limited effects on global standard therapeutic guidelines for hair loss management; however, it appears to be the time for reconsideration. ...
... 85 volunteers received treatment with Nourkrin ® added to a number of topical cosmetic products. After six months of treatment, overall quality of life and its subcategories were significantly improved as measured by Kingsley Alopecia Profile [99]. ...
... Further exploration revealed that close to half of the proteoglycan absorption in the jejunum and the ileum is via clathrin-mediated endocytosis [116]. Furthermore, since bioactivity depends on sufficient bioavailability and bioaccessibility, positive outcomes produced by oral PRT with Nourkrin ® in clinical trials in a variety of health conditions [95,[99][100][101]117] may be taken as indirect evidence for oral bioavailability of specific proteoglycans. However, making reliable conclusions would require direct in vivo pharmacokinetic studies. ...
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Follicular proteoglycans are key players with structural, functional, and regulatory roles in the growth and cycling behaviour of the hair follicles. The expression pattern of specific proteoglycans is strongly correlated with follicular phase transitions, which further affirms their functional involvement. Research shows that bioactive proteoglycans, e.g., versican and decorin, can actively trigger follicular phase shift by their anagen-inducing, anagen-maintaining, and immunoregulatory properties. This emerging insight has led to the recognition of “dysregulated proteoglycan metabolism” as a plausible causal or mediating pathology in hair growth disorders in both men and women. In support of this, declined expression of proteoglycans has been reported in cases of anagen shortening and follicular miniaturisation. To facilitate scientific communication, we propose designating this pathology “follicular hypoglycania (FHG),” which results from an impaired ability of follicular cells to replenish and maintain a minimum relative concentration of key proteoglycans during anagen. Lasting FHG may advance to structural decay, called proteoglycan follicular atrophy (PFA). This process is suggested to be an integral pathogenetic factor in pattern hair loss (PHL) and telogen effluvium (TE). To address FHG and PFA, a proteoglycan replacement therapy (PRT) program using oral administration of a marine-derived extract (Nourkrin® with Marilex®, produced by Pharma Medico Aps, Aarhus, Denmark) containing specific proteoglycans has been developed. In clinical studies, this treatment significantly reduced hair fall, promoted hair growth, and improved quality of life in patients with male- and female-pattern hair loss. Accordingly, PRT (using Nourkrin® with Marilex®) can be recommended as an add-on treatment or monotherapy in patients with PHL and TE.
... This degenerative pathological phenomenon, known as Proteoglycan Follicular Atrophy (PFA), is understood to be an important pathology in common types of diffuse hair loss. Mitigating PFA by PRT with a specific, proprietary combination of proteoglycans (Marilex ® ), marketed as Nourkrin ® , has shown efficacy in improving hair growth, hair density and reducing miniaturisation in several clinical trials [17][18][19]. However, the subjective impression of patients about these clinical improvements in different populations has not been sufficiently investigated. ...
... No 54 This hypothesis has been corroborated by a clinical study designed to examine the subjective effects of therapy with Nourkrin ® [17]. A 6-month course of PRT significantly improved the feelings of anxiety and depression, self-confidence, social and sexual activities and work performance in female volunteers with hair loss as measured by the Kingsley Alopecia Profile (KAP). ...
... A 6-month course of PRT significantly improved the feelings of anxiety and depression, self-confidence, social and sexual activities and work performance in female volunteers with hair loss as measured by the Kingsley Alopecia Profile (KAP). Moreover, authors reported a substantial 39% increase in the overall KAP score for self-perceived quality of life at the end of the study [17], which is comparable with a 50% improvement in the quality of life of female participants after 12 months of treatment with the first-line medication, topical minoxidil, measured by dermatology life quality index [26]. ...
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TREATING FEMALE DIFFUSE HAIR LOSS
... A speci ic natural supplementation, classi ied as a proteoglycan replacement therapy, Nourkrin ® with Marilex ® , has been demonstrated to be effective for anagen induction and prolongation. An increase of up to 35.7% in hair count over a 6-month period in a double-blind placebo-controlled trial have been demonstrated and reported [35][36][37][38][39]. Studies have also shown a decrease in the number of vellus hairs and an overall increase in number of hairs. ...
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The few articles published on the interactions between psychological factors and alopecia seem to yield contrasting results. To assess the relationships between alopecia, gender, Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorders, and psychopathologic symptoms reactive to alopecia, we administered the Personality Disorders Questionnaire-Revised and the Symptoms Checklist-90 to a randomly selected sample of 116 outpatients with androgenetic alopecia. The prevalence of personality disorders in subjects with androgenetic alopecia proved to be significantly higher than the prevalence of such diagnoses in the general population. Women did not show a higher prevalence of personality disorders or more psychopathologic symptoms than men. The factor analysis demonstrated the existence of three personality profiles (F1, F2, and F3) significantly and specifically associated with the subject's gender and with the psychopathologic reactive symptoms, measured using the Symptoms Checklist-90. The most important factor in developing a psychopathologic reaction to alopecia seems to be the presence of a Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorder and not the subject's gender.
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The mind plays a dual role in the pathology of the hair follicle: the disease has repercussions on the mind, and the mind in turn may trigger off or exacerbate its course. As all skin diseases, those involving the hair follicles have much to do with vision, and they profoundly alter the images the subjects has of himself (self image) and offers to other persons. Repercussions on the mind are particularly intense with these diseases since they usually occur on the face and during adolescence. It results from these findings that a dual, somatic and psychological approach of the patient is indispensable. Moreover, this approach increases the patient's compliance with the treatment prescribed.
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Quality of life and maladjustment related to hair loss were studied by means of a standardized interview in a group of 58 women with alopecia androgenetica who applied for treatment at the Department of Dermatology. The hair loss was found to have a negative influence on the quality of life on the majority of them. In 88%, hair loss had negative effects on their daily life; in about 75%, the hair problems were manifested in negative self-esteem and about 50% experienced social problems. General psychosocial maladjustment in relation to hair loss was indicated in almost one-third of the women.
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Few studies have quantified the psychosocial effects of hair loss using standardized instruments in men not seeking treatment for hair loss. Examine self-perception of hair loss and its effects on men from the community. Men 18-50 years of age recruited without regard to hair loss, from households near Dayton, Ohio, completed a questionnaire assessing self-perception of hair loss, satisfaction with hair appearance, hair-loss-specific effects and general health status. Men with greater hair loss had more bother, concern about getting older, perceived noticeability to others and greater dissatisfaction with their hair appearance than men with less hair loss. These effects decreased with age for men with hair loss, but regardless of age, perceived noticeability of hair loss increased monotonically with degree of hair loss. Men with greater hair loss report more negative effects due to their hair loss across all age groups, but the effects were more pronounced in younger men.
Despite the prevalence of androgenetic alopecia (AGA) and the acceptance of its associated psychological factors in women, few studies have directly queried women about which specific aspects of their lives are affected by hair thinning and the relative importance of such effects. Perceptions of such negative effects can influence patient satisfaction, health-related quality of life (HRQL) and the impetus to seek medical attention for hair loss. Women (n = 120) aged 22-66 years with at least mild (Ludwig I) AGA were recruited from two dermatology clinics and from a large worksite and asked to complete a questionnaire. The questionnaire solicited information about specific aspects of their lives potentially affected by AGA and the relative importance of those aspects. Inability to style their hair, dissatisfaction with their appearance, concern about hair loss continuing, and concern about others noticing their hair loss were most important to women. Emotional aspects also ranked high, including self-consciousness, jealousy, embarrassment, and feeling powerless to stop their hair loss. In summary, women with AGA report numerous ways in which their hair thinning affects their lives. Knowledge of these effects may be beneficial in counseling such patients and in designing clinical trials or epidemiological studies to evaluate hair loss in women.
Article
Balding men are viewed as less desirable in a physical, personal, and social sense. Given the stereotype, it is not surprising that some men with androgenetic alopecia (AGA) appear to have a lower self-image, depression resulting in increased introversion, and increased feelings of unattractiveness. Ours is a culture that places a premium on physical appearance. In this context, appearance-altering conditions can be psychosocially insidious, especially conditions such as AGA with an uncertain course and a negative social meaning. To date, little or no data have been available regarding the psychosocial and quality-of-life aspects of AGA in a representative sample of community men. It is unknown whether AGA is a causal factor in the development of low self-esteem, depression, introversion, and feeling of unattractiveness, or whether there are underlying problems in certain patients prior to hair loss. Longitudinal studies will be important to investigate the temporal relationships between the degree of hair loss and psychosocial variables associated with AGA. A patient with male pattern baldness will be better treated and consequently more satisfied (better quality of life) if he receives effective anti-alopecia agents and simultaneously is evaluated and treated, if needed, for his psychological disorder.