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Use of the phototrichogram to assess the stimulation of hair groth - An in vitro study of women with androgenetic alopecia
Abstract
We carried out a 6-month, randomized, double-blind, placebo-controlled study of an oral combination product of millet seed extract, L-cystine and calcium pantothenate in women with androgenetic alopecia. The study endpoint was defined as change of anagen hair rate, as determined by phototrichogram, from abnormal (< 80%) at baseline to normal (> 85%) at the follow-up (after 3 months) and final visits (after 6 months). The active group, but not the placebo group, reached the study endpoint, thus establishing study product efficacy in female androgenetic alopecia.
... In 24 patients with AGA, oral administration of combined cystine, methionine, histidine, zinc, and copper led to a significant mean change in total hair count [14]. Millet seed, rich in sulfur containing amino acids like methionine and cysteine, used in combination with L-cystine and calcium pantothenate, produced a significant increase in anagen rate compared to baseline [16]. ...
... Micronutrients, including vitamins and minerals, play an important role in cellular turnover of hair follicle cells [47•]. Calcium pantothenate, a form of vitamin B5, has been used in combination with L-cystine for the successful treatment of AGA [16]. Coenzyme A (CoA), essential for cellular metabolism including hair growth and maintenance, requires calcium pantothenate for synthesis [47•]. ...
Purpose of Review
Androgenic alopecia (AGA) is the most common form of non-scarring alopecia, affecting millions of men and women in the United States (U.S.). This review highlights alternative and complementary treatment options for AGA.
Recent Findings
The treatment regimens for AGA have increased in pharmacotherapeutics, surgical, and complementary (CAM) categories. Each of the different treatment approaches can now be utilized by dermatologists to combat patient hair loss.
Summary
The U.S. Food and Drug Administration (FDA) has approved only two agents to treat AGA: prescription-only, oral finasteride and over-the-counter (OTC), topical minoxidil. Increased availability of therapies claiming hair regrowth properties, coupled with limited pharmacotherapeutic options for AGA, lead patients to seek alternative treatments. Increased awareness of the current evidence supporting complementary and alternative therapies among dermatologists will facilitate appropriate and timely education of AGA patients.
... [29][30][31][32] Two studies included cyproterone acetate in one treatment arm, 27,30 and two included flutamide. 30,31 A further 10 studies addressed other interventions: alfatradiol, 19 0AE5% octyl nicotinate and 5AE0% myristyl nicotinate, 33 topical melatonin-alcohol solution, 34 topical fulvestrant solution, 35 an oral combination product of millet seed extract, L-cystine and calcium pantothenate, 36 oestrogen ointment, 37 systemic oestrogens, 38 0AE75% adenosine lotion, 39 the application of a pulsed electrostatic field, 40 and spironolactone. 31 Several of the trials compared and evaluated a number of these interventions. ...
... 19,27 Other treatment options Some studies did not address our primary or secondary outcomes, and were not included in our systematic review. 31,34,36,38 Other studies provided limited data, and in view of this paucity of data no firm conclusions can be drawn. Octyl nicotinate (0AE5%) and myristyl nicotinate (5%) might be more effective than placebo. ...
Female pattern hair loss (FPHL) or androgenic alopecia is the most common type of hair loss affecting women with reduced hair density and can have a serious psychological impact. It is characterized by progressive replacement of slow cycling terminal hair follicles by miniaturized, rapidly cycling vellus hair follicles. The frontal hair line may or may not be preserved. The aim of this review was to assess the evidence for the effectiveness and safety of the treatments available for FPHL. Searches included: Cochrane Skin Group Specialised Register, Cochrane Central Register of Controlled Clinical Trials in The Cochrane Library, MEDLINE, EMBASE, AMED, PsycINFO, LILACS and several ongoing trials registries (October 2011). Randomized controlled trials in women with FPHL were identified. Twenty-two trials, comprising 2349 participants, were included. A range of interventions was evaluated, with 10 studies examining varying concentrations of minoxidil. Pooled data from four studies indicated that a greater proportion of participants treated with minoxidil reported a moderate increase in their hair regrowth compared with placebo (relative risk 1·86, 95% confidence interval 1·42-2·43). There was no difference between the number of adverse events experienced in the twice daily minoxidil and the placebo intervention groups, except for a reported increase with minoxidil 5% twice daily. Single studies accounted for most of the other comparisons, which were assessed as either having high risk of bias and/or they did not address the prespecified outcomes for this review and provided limited evidence of either the effectiveness or safety of these interventions. Further well-designed, adequately powered randomized controlled trials investigating other treatment options are still required.
... Oral L-cystine (unknown dose) was also studied in combination with histidine, copper, and zinc taken 4 times daily, resulting in a significant mean change in total hair count after 50 weeks (29 vs. 11% for placebo) in 24 patients with AGA [10]. Millet seed containing amino acids, silicic acid, several B vitamins, and dietary minerals including manganese in combination with L-cystine (2 mg), and calcium pantothenate (Priorin ® ; Bayer Inc., Mississauga, ON, Canada) taken twice daily for 6 months showed a significantly increased anagen rate in 40 female patients [11]. Supplementation with L-cystine (20 mg), medicinal yeast, pantothenic acid, thiamine, keratin, and para-aminobenzoic acid (Pantogar ® ; Merz Pharmaceuticals GmbH, Raleigh, NC, USA) in 30 women with telogen effluvium (TE) resulted in significant improvement and normalization of the mean anagen hair rate after 6 months compared with placebo [12]. ...
The treatment of alopecia is limited by a lack of therapies that induce and sustain disease remission. Given the negative psychosocial impact of hair loss, patients that do not see significant hair restoration with conventional therapies often turn to complementary and alternative medicine (CAM). Although there are a variety of CAM treatment options on the market for alopecia, only a few are backed by multiple randomized controlled trials. Further, these modalities are not regulated by the Food and Drug Administration and there is a lack of standardization of bioactive in gredients in over-the-counter vitamins, herbs, and supplements. In this article, we provide a comprehensive review of the efficacy, safety, and tolerability of CAM, including natural products and mind and body practices, in the treatment of hair loss. Overall, there is a need for additional studies investigating CAM for alopecia with more robust clinical design and standardized, quantitative outcomes.
... For a detailed overview on the different miscellaneous products, please refer to the long version of the guidelines. 1 When looking at the includes studies, 21 trials examined a single product, 37,39,50,[115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132] while five trials investigated combinations of different products. 36,40,45,116,133 Evaluation of individual ingredients is limited, as most of the tested products contain multiple different substances. ...
Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80% Caucasian men and 42% of women. Patients afflicted with androgenetic alopecia may undergo significant impairment of quality of life. The European Dermatology Forum (EDF) initiated a project to develop evidence-based guidelines for the treatment of androgenetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.
Background:
Female pattern hair loss (FPHL), or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on women.
Objectives:
To determine the efficacy and safety of the available options for the treatment of female pattern hair loss in women.
Search methods:
We updated our searches of the following databases to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (2015, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1872), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), and Web of Science (from 1945). We also searched five trial registries and checked the reference lists of included and excluded studies.
Selection criteria:
We included randomised controlled trials that assessed the efficacy of interventions for FPHL in women.
Data collection and analysis:
Two review authors independently assessed trial quality, extracted data and carried out analyses.
Main results:
We included 47 trials, with 5290 participants, of which 25 trials were new to this update. Only five trials were at 'low risk of bias', 26 were at 'unclear risk', and 16 were at 'high risk of bias'.The included trials evaluated a wide range of interventions, and 17 studies evaluated minoxidil. Pooled data from six studies indicated that a greater proportion of participants (157/593) treated with minoxidil (2% and one study with 1%) reported a moderate to marked increase in their hair regrowth when compared with placebo (77/555) (risk ratio (RR) = 1.93, 95% confidence interval (CI) 1.51 to 2.47; moderate quality evidence). These results were confirmed by the investigator-rated assessments in seven studies with 1181 participants (RR 2.35, 95% CI 1.68 to 3.28; moderate quality evidence). Only one study reported on quality of life (QoL) (260 participants), albeit inadequately (low quality evidence). There was an important increase of 13.18 in total hair count per cm² in the minoxidil group compared to the placebo group (95% CI 10.92 to 15.44; low quality evidence) in eight studies (1242 participants). There were 40/407 adverse events in the twice daily minoxidil 2% group versus 28/320 in the placebo group (RR 1.24, 95% CI 0.82 to 1.87; low quality evidence). There was also no statistically significant difference in adverse events between any of the individual concentrations against placebo.Four studies (1006 participants) evaluated minoxidil 2% versus 5%. In one study, 25/57 participants in the minoxidil 2% group experienced moderate to greatly increased hair regrowth versus 22/56 in the 5% group (RR 1.12, 95% CI 0.72 to 1.73). In another study, 209 participants experienced no difference based on a visual analogue scale (P = 0.062; low quality evidence). The assessments of the investigators based on three studies (586 participants) were in agreement with these findings (moderate quality evidence). One study assessed QoL (209 participants) and reported limited data (low quality evidence). Four trials (1006 participants) did not show a difference in number of adverse events between the two concentrations (RR 1.02, 95% CI 0.91 to 1.20; low quality evidence). Both concentrations did not show a difference in increase in total hair count at end of study in three trials with 631 participants (mean difference (MD) -2.12, 95% CI -5.47 to 1.23; low quality evidence).Three studies investigated finasteride 1 mg compared to placebo. In the finasteride group 30/67 participants experienced improvement compared to 33/70 in the placebo group (RR 0.95, 95% CI 0.66 to 1.37; low quality evidence). This was consistent with the investigators' assessments (RR 0.77, 95% CI 0.31 to 1.90; low quality evidence). QoL was not assessed. Only one study addressed adverse events (137 participants) (RR 1.03, 95% CI 0.45 to 2.34; low quality evidence). In two studies (219 participants) there was no clinically meaningful difference in change of hair count, whilst one study (12 participants) favoured finasteride (low quality evidence).Two studies (141 participants) evaluated low-level laser comb therapy compared to a sham device. According to the participants, the low-level laser comb was not more effective than the sham device (RR 1.54, 95% CI 0.96 to 2.49; and RR 1.18, 95% CI 0.74 to 1.89; moderate quality evidence). However, there was a difference in favour of low-level laser comb for change from baseline in hair count (MD 17.40, 95% CI 9.74 to 25.06; and MD 17.60, 95% CI 11.97 to 23.23; low quality evidence). These studies did not assess QoL and did not report adverse events per treatment arm and only in a generic way (low quality evidence). Low-level laser therapy against sham comparisons in two separate studies also showed an increase in total hair count but with limited further data.Single studies addressed the other comparisons and provided limited evidence of either the efficacy or safety of these interventions, or were unlikely to be examined in future trials.
Authors' conclusions:
Although there was a predominance of included studies at unclear to high risk of bias, there was evidence to support the efficacy and safety of topical minoxidil in the treatment of FPHL (mainly moderate to low quality evidence). Furthermore, there was no difference in effect between the minoxidil 2% and 5% with the quality of evidence rated moderate to low for most outcomes. Finasteride was no more effective than placebo (low quality evidence). There were inconsistent results in the studies that evaluated laser devices (moderate to low quality evidence), but there was an improvement in total hair count measured from baseline.Further randomised controlled trials of other widely-used treatments, such as spironolactone, finasteride (different dosages), dutasteride, cyproterone acetate, and laser-based therapy are needed.
Background and Design: In this study, we aimed to evaluate the effects of a formula composed of millet extract, wheat germ oil, calcium pantothenate and L-cystine in women with diffuse alopecia by using Digital Phototrichogram (Trichoscan). Materials and methods: We evaluated female patients who presented to Gazi University Faculty of Medicine Department of Dermatology between January 2008 and November 2008 with the complaint of diffuse hair loss. Digital phototrichogram was performed in the frontal and occipital regions of the patients. Using this method, anagen:telogen ratios were determined. 53 female patients whose ages were between 18 and 50 and who were diagnosed as having telogen effluvium type diffuse alopecia were included in the study. The patients were given a capsule containing 140 mg millet extract, 271 mg wheat germ oil, 2 mg L-cystine and 10 mg calcium pantothenate three times a day for three months. The criteria for assessing the efficacy of the therapy included number of hair loss per day, hair pull test and digital phototrichogram. Results: The reduction of daily average hair loss after the treatment was statistically significant. Statistically significant difference was found between the pre- and post-treatment results of the hair pull test. Before the treatment, the average anagen ratio was determined to be 69.0±11.2 in the frontal region, and 72.3±9.4 in the occipital region. After the treatment, the anagen ratio increased to 76.4±11.2 in the frontal region and to 79.9±8.6 in the occipital region. The increase in the anagen hair rate in the frontal and occipital regions after the treatment was found to be statistically significant. Conclusion: As a result, it was found that the formula composed of millet extract, wheat germ oil, L-cystine and calcium pantothenate may be effective in the treatment of telogen effluvium. However, controlled studies including larger groups of diffuse alopecia patients and placebo groups are needed.
Telogen effluvium develops as a result of excessive loss of telogen hair caused by an anomaly in hair cycle, and it is one of the most common types of alopecia among women with diffuse alopecia complaint. Patient complains about significant hair loss and often develops anxiety due to fear of losing her hair completely. The fastest growing tissue in the body after bone marrow is hair. Therefore, many metabolic disorders may appear as alopecia, and alopecia may be the clinical symptom of systemic diseases. Many factors such as endocrinal anomalies, malnutrition, drugs, physical and psychological stress may cause telogen effluvium. History and examination are important for the diagnosis of telogen effluvium. Additional diagnosis methods are hair pulling test, trichogram, phototrichogram, digital phototrichogram, trichoscopy and biopsy. There is no specific therapy for telogen effluvium. Patients should be inspected throughly and should be placed on an appropriate diet. Treatment of telogen effluvium includes use of aminoacids and vitamin combinations that are taken orally, shampoo and solutions.
Introduction:
Since skin and hair quality are potent vitality signals, and hair growth deficiency can cause significant psychological morbidity. In addition to clearly-defined hair loss disorders, milder forms of hair thinning or hair loss appear to be increasingly common, with a suggestion that sub-optimal diets and stressful lifestyles may be involved.
Methods:
Here we assess the value of a dietary marine-extract based dietary supplement in premenopausal women with subclinical hair thinning or hair loss conditions. This multi-site, randomized double-blind, placebo-controlled clinical trial was conducted with impact on hair shedding rate and hair fiber diameter (assessed by phototrichogram) as primary end points upon consumption of the oral supplement compared to a placebo. A total of 96 eligible female subjects were enrolled aged 21-55 years of age from Asian, Caucasian, and Hispanic ethnic backgrounds.
Results:
This study showed that hair shedding was significantly reduced in the first 3-6 months of daily consumption of the oral supplement. Moreover, phototrichogram image analysis revealed a statistically significant increase in the mean vellus-like hair diameter after 6 months of supplement consumption, when compared to the mean vellus-like hair diameters measured at baseline.
Discussion:
These results support the view that a nutritional supplement approach may be useful for women in this age group to deal with subclinical hair thinning or hair loss conditions, and those components of this marine extract-based oral supplement may be a useful adjunct.
Older patients suffer from a variety of conditions that affect the hair, i.e. nutritional deficiency, endocrine disorders, psychologic problems, and drug-related adverse effects. The quantity and quality of hair are closely related to the nutritional, general, and mental health state of the individual. Sometimes, symptoms of overt pathologic conditions are misinterpreted as signs of normal aging, ignored and left untreated. In taking care of older patients with hair problems, it is therefore important to be suspicious of the possibility of a more general problem underlying the patient's complaint. The increasing number of chronic conditions per patient and the increasing amount of multimorbidity in the elderly population lead to a more complex approach to successful therapy of hair problems in the elderly.
Background:
Androgenetic alopecia (AGA) is one of the most common chronic problems seen by dermatologists worldwide. It is characterized by progressive hair loss, especially of scalp hair, and has distinctive patterns of loss in women versus men, but in both genders the central scalp is most severely affected. It often begins around puberty and is known to effect self-esteem and the individual's quality of life. In contrast to the high prevalence of AGA, approved therapeutic options are limited. In addition to the scarce pharmacologic treatments, there are numerous nonprescription products claimed to be effective in restoring hair in androgenetic alopecia.
Objectives:
The purpose of this paper is to review published medical and non-medical treatments for male and female AGA using the American College of Physicians evidence assessment methods. MEDLINE, EMBASE and Cochrane Library were searched for systematic reviews, randomized controlled trials, open studies, case reports and relevant studies of the treatment of male and female AGA. The relevant articles were classified according to grade and level of evidence.
Results:
The medical treatments with the best level of evidence classification for efficacy and safety for male AGA are oral finasteride and topical minoxidil solution. For female AGA, topical minoxidil solution appears to be the most effective and safe treatment. The medical treatments corresponding to the next level of evidence quality are some commonly used therapeutic non-FDA-approved options including oral and topical anti-hormonal treatments. Surgical treatment of follicular unit hair transplantation is an option in cases that have failed medical treatment although there is high variation in outcomes.
Limitations:
Some articles, especially those concerning traditional herbs claimed to promote hair regrowth, were published in non-English, local journals.
Conclusions:
An assessment of the evidence quality of current publications indicates that oral finasteride (for men only) and topical minoxidil (for men and women) are the best treatments of AGA.
BACKGROUND: Dietary supplements are traditionally used over-the-counter products for the treatment of hair loss.
OBJECTIVES: We aim to examine the effect of a specific L-cystine, medicinal yeast, pantothenic acid complex-based dietary supplement (Pantogar®) on telogen effluvium in healthy women.
METHODS: A randomized, double-blind, placebo-controlled study was conducted over 6 months in 30 healthy women suffering from telogen effluvium. The efficacy of the supplement was evaluated by means of digitalized epiluminescent microscopy (TrichoScan) performed before treatment and after 3 and 6 months. Additionally, global photographs were taken and evaluated by independent investigators.
RESULTS: Active compound led to a statistically significant improvement and normalization of the mean anagen hair rate within 6 months of treatment (p = 0.003), while there was no significant change in the placebo group (p = 0.85). These changes of the anagen hair rates were significantly different (p = 0.008). The appearance of hair growth in the global photographic assessment was judged better in the active compound than in the placebo group.
CONCLUSIONS: This is the first study performed combining epiluminiscence microscopy with digital image analysis to demonstrate that a dietary supplement influences hair growth. The mode of action is not known, although it seems to result from an induction of anagen.
Female pattern hair loss, or androgenic alopecia, is the most common type of hair loss affecting women. It is characterised by progressive shortening of the duration of the growth phase of the hair with successive hair cycles, and progressive follicular miniaturisation with conversion of terminal to vellus hair follicles (terminal hairs are thicker and longer, while vellus hairs are soft, fine, and short). The frontal hair line may or may not be preserved. Hair loss can have a serious psychological impact on people.
To determine the effectiveness and safety of the available options for the treatment of female pattern hair loss in women.
We searched the following databases up to October 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 4), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), AMED (from 1985), LILACS (from 1982), PubMed (from 1947), Web of Science (from 1945), and reference lists of articles. We also searched several online trials registries for ongoing trials.
Randomised controlled trials that assessed the effectiveness of interventions for female pattern hair loss in women.
Two review authors independently assessed trial quality and extracted data.
Twenty two trials, comprising 2349 participants, were included. A wide range of interventions were evaluated, with 10 studies investigating the different concentrations of minoxidil. Pooled data from 4 studies indicated that a greater proportion of participants (121/488) treated with minoxidil reported a moderate increase in their hair regrowth when compared with placebo (64/476) (risk ratio (RR) = 1.86, 95% confidence interval (CI) 1.42 to 2.43). In 7 studies, there was an important increase of 13.28 in total hair count per cm(2) in the minoxidil group compared to the placebo group (95% CI 10.89 to 15.68). There was no difference in the number of adverse events in the twice daily minoxidil and placebo intervention groups, with the exception of a reported increase of adverse events (additional hair growth on areas other than the scalp) with minoxidil (5%) twice daily. Most of the other comparisons consisted of single studies. These were assessed as high risk of bias: They did not address our prespecified outcomes and provided limited evidence of either the efficacy or safety of these interventions.
Although more than half of the included studies were assessed as being at high risk of bias, and the rest at unclear, there was evidence to support the effectiveness and safety of topical minoxidil in the treatment of female pattern hair loss. Further direct comparison studies of minoxidil 5% applied once a day, which could improve adherence when compared to minoxidil 2% twice daily, are still required. Consideration should also be given to conducting additional well-designed, adequately-powered randomised controlled trials investigating several of the other treatment options.
Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80 % Caucasian men and 42 % of women.
Patients diagnosed with androgenetic alopecia may undergo significant impairment of quality of life. Despite the high prevalence and the variety of therapeutic options available, there have been no national or international evidence-based guidelines for the treatment of androgenetic alopecia in men and women so far. Therefore, the European Dermatology Forum (EDF) initiated a project to develop an evidence-based S3 guideline for the treatment of andro-genetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference.
The purpose of the guideline is to provide dermatologists as well as general practitioners with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.
Diffuse hair loss is a common complaint and cause of significant emotional distress particularly in women. The best way to alleviate the anxiety is to effectively treat the hair loss. It is paramount to address the symptom systematically. In addition to its psychological impact, hair loss may be a manifestation of a more general medical problem. The diagnosis can be established with a detailed patient history focussing on chronology of events, examination of the scalp and pattern of hair loss, a pull test with examination of bulbs of shed hairs, trichoscopy, and few pertinent screening blood tests. In selected cases a scalp biopsy may be required. The most important differential diagnoses include acute and chronic telogen effluvium, female pattern hair loss, and diffuse alopecia areata. Occasionally, patients seeking advice are not necessarily losing hair. In the absence of convincing evidence of hair loss, they are suffering of psychogenic pseudoeffluvium, and thought should be given to an underlying psychological disorder. Once the diagnosis is established, treatment appropriate for that diagnosis is likely to control the hair loss. Finally, appropriate psychological support and education about the basics of the hair cycle, and why considerable patience is required for effective cosmetic recovery, are essential to help limit patient anxiety.
In a placebo-controlled, double-blind clinical study, 60 patients with reduced nail quality without biotin deficiency were treated over a period of 6 months with 2.5 mg of oral biotin daily. The changes in nail quality were documented technically by measuring the swelling behavoir of nail keratin after incubation with NaOH, the transonychial water loss as well as by clinical judgment of the investigator and the patient himself. All evaluation parameters showed improvement of nail quality. Correlation of clinical judgment with the swelling behavior after incubation with NaOH indicates the value of this technical procedure for evaluation of nail quality.