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Do Kimchi and Cheonggukjang Probiotics as a Functional Food Improve Androgenetic Alopecia? A Clinical Pilot Study

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Purpose: Probiotic supplementation demonstrates beneficial effects on serum lipid profiles. We hypothesized that probiotics could benefit patients presenting with alopecia, secondary to improved blood flow to the scalp. Materials and methods: Our study included men with stage II to V patterns of hair loss based on the Hamilton-Norwood classification and women with stage I to III patterns of hair loss based on the Ludwig classification. All patients were administered 80 mL of Mogut® (a kimchi and cheonggukjang probiotic product) twice a day. Hair growth and numbers were measured using the Triple Scope System® (KC Technology, Korea) at baseline and after 1 and 4 months of administration of a kimchi and cheonggukjang probiotic product. Results: At baseline, the mean hair count was 85.98±20.54 hairs/cm² and the mean thickness was 0.062±0.011 mm in all patients (n=46). Hair count and thickness had significantly increased at 1 month (90.28±16.13 hairs/cm² and 0.068±0.008 mm, respectively) and at 4 months (91.54±16.29 hairs/cm² and 0.066±0.009 mm, respectively). In this study, we found that a kimchi and cheonggukjang probiotic product could promote hair growth and reverse hair loss without associated adverse effects such as diarrhea. Conclusions: We suggest that the observed improvements in hair count and thickness resulted from initiation of the anagen phase in hair follicles in response to probiotics.
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INTRODUCTION
Humans are usually born with approximately 5 mil-
lion hair follicles, and no new f ollicles are added after
birth [1]. The hair follicle cycle, which begins in utero,
comprises 3 stages: the anagen, telogen, and catagen
phases. Anagen represents the growth phase associ-
ated with extensive mitotic activity, and 90% to 95% of
all hair exists in the anagen phase at any given point
in time. Hair then involutes during the catagen phase
through apoptosis of the follicular keratinocytes and
is converted to club hair. Telogen is the resting phase
Received: Dec 16, 2018 Revised: Jun 4, 2019 Accepted: Jun 19, 2019 Published online Aug 5, 2019
Correspondence to: Ju Tae Seo https://orcid.org/0000-0001-6989-4549
Department of Urology, Cheil General Hospital & Women’s Healthcare Center, Dankook University College of Medicine 17 Seoae-ro 1-gil, Jung-
gu, Seoul 04619, Korea.
Tel: +82-2-2000-7585, Fax: +82-2-2000-7787, E-mail: jtandro@cgh.co.kr
*These authors contributed equally to this work as co-first authors.
Copyright © 2019 Korean Society for Sexual Medicine and Andrology
Do Kimchi and
Cheonggukjang
Probiotics as a
Functional Food Improve Androgenetic Alopecia?
A Clinical Pilot Study
Dong-Wook Park1,*, Hyo Serk Lee2,*, Myeong-Seung Shim3, Kyu Jin Yum3, Ju Tae Seo2
1Laboratory of Reproductive Medicine, 2Department of Urology, Cheil General Hospital & Women’s Healthcare Center, Dankook University
College of Medicine, Seoul, 3Coenbio R&D Center, Seongnam, Korea
Purpose: Probiotic supplementation demonstrates beneficial effects on serum lipid profiles. We hypothesized that probiotics
could benefit patients presenting with alopecia, secondary to improved blood flow to the scalp.
Materials and Methods: Our study included men with stage II to V patterns of hair loss based on the Hamilton–Norwood
classification and women with stage I to III patterns of hair loss based on the Ludwig classification. All patients were ad-
ministered 80 mL of Mogut® (a kimchi and
cheonggukjang
probiotic product) twice a day. Hair growth and numbers were
measured using the Triple Scope System® (KC Technology, Korea) at baseline and after 1 and 4 months of administration of a
kimchi and
cheonggukjang
probiotic product.
Results: At baseline, the mean hair count was 85.98±20.54 hairs/cm2 and the mean thickness was 0.062±0.011 mm in all
patients (n=46). Hair count and thickness had significantly increased at 1 month (90.28±16.13 hairs/cm2 and 0.068±0.008
mm, respectively) and at 4 months (91.54±16.29 hairs/cm2 and 0.066±0.009 mm, respectively). In this study, we found that
a kimchi and
cheonggukjang
probiotic product could promote hair growth and reverse hair loss without associated adverse
effects such as diarrhea.
Conclusions: We suggest that the observed improvements in hair count and thickness resulted from initiation of the anagen
phase in hair follicles in response to probiotics.
Keywords: Alopecia; Functional food; Leuconostoc; Probiotics; Scalp; Soybeans
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0)
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Original Article
pISSN: 2287-4208 / eISSN: 2287-4690
World J Mens Health Published online Aug 5, 2019
https://doi.org/10.5534/wjmh.180119
Health promotion, disease prevention, and lifestyle
https://doi.org/10.5534/wjmh.180119
2www.wjmh.org
associated with inactivity of the hair follicle. The club
hair is shed and new anagen hair growth begins, re-
suming the cycle [2-4].
Usually, approximately 50 to 100 hairs are shed
per day. Hair loss >100 hairs/d is defined as alopecia.
There are different types of alopecia that can cause
hair loss on the scalp or on other areas of the body [5].
Hair loss can be attributed to multiple factors, includ-
ing dandruff, hormonal deficiencies, dietary or nutri-
ent deficiencies, certain diseases, chemotherapy, and/
or psychological issues, such as stress and depression
[6]. In most men, androgenetic alopecia develops with
a distinctive “patterned” hair line recession. In women,
the presentation may be less clear; typically women
will develop a diff use thinning over the top of the scalp,
yielding a “Christmas tree” pattern with more thin-
ning towards the front, although the frontal hairline is
maintained [7]. Occasionally, men may develop a female
presentation of hair loss and women, primarily those
experiencing excess androgen activity, may develop a
more men-like hair loss pattern [8]. Five-α reductase
inhibitors are used to treat androgenetic alopecia, and
are effective for preventing hair loss progression and
induction of hair regrowth in androgenetic alopecia in
men. However, they are not recommended for women,
and side eff ects, such as erectile dysfunction and de-
creased libido have been reported [9,10]. Additionally,
alopecia may result from sun exposure, consumption of
junk food, use of styling tools, and/or extreme weight
loss [11]. Alopecia is associated with significant psycho-
social consequences and can af f ect patients’ lives and
social behavior, often triggering psychological problems
[12]. No robust evidence supports the consistent eff icacy
of topical treatments, including topical corticosteroids,
tacrolimus, cryotherapy, minoxidil, anthralin, or ultra-
violet light A combined with oral psoralens in treating
alopecia [13], and those options are usually not suitable
for patients presenting with extensive alopecia because
of their minimal efficacy [14,15]. Minoxidil is a topi-
cal vasodilator that prolongs the anagen phase and
increases the size of smaller hair follicles [1]. Its exact
mechanism of action has not yet been determined,
although a few research studies have presented data
suggesting that an improved nutritional supply to the
scalp secondary to vasodilation may play a key role in
its demonstrated ef f icacy [16,17]. Despite positive effects
on alopecia, several adverse eff ects of commercial hair
restorers have been reported, limiting their use for
treatment of patients with alopecia [18,19].
Recently, several experimental and clinical studies
have reported that probiotic supplementation demon-
strated beneficial effects on serum lipid profiles, indi-
cating improvements in peripheral blood flow [20,21].
Based on these research data, we hypothesized that
dietary supplementation of probiotics could benefit
patients presenting with alopecia secondary to im-
proved blood flow to the scalp. We investigated the ef-
fect of administration of a kimchi and cheonggukjang
probiotic product on patients with hair loss. Kimchi
and cheong guk jang (a Korean traditional fermented
soybean product) are traditional Korean foods, but en-
suring optimal intake of probiotics f rom kimchi and
cheong guk jang is dif f icult, for two main reasons. First,
the amount of probiotics varies depending on the rip-
ening period of kimchi, as different ripening periods
lead to dif ferences in pH that could aff ect personal ap-
petite. Koreans consume cheongguk jang as a boiled hot
soup, so it contains no live probiotics. Thus, administra-
tion of live probiotics f rom kimchi and cheongguk jang
as a drinkable yogurt would be a more efficient way
to obtain the beneficial ef fects of kimchi and cheong-
guk jang. The primary ingredients in this product are
the probiotic-rich kimchi and cheongguk jan g. All pa-
tients were administered a kimchi and cheong guk jang
probiotic product over the course of 4 months, and hair
thickness and count were measured at 1 and 4 months.
MATERIALS AND METHODS
1. Study population
Patients were enrolled in the study between January
2017 and Jun e 2017. Men aged 46.52±10.14 ( standard
deviation, SD) years showing stage II to V patterns of
hair loss based on the Hamilton–Norwood classifica-
tion and women aged 44.17±10.20 years showing stage I
to III patterns of hair loss based on the Ludwig classi-
fication were included in this study [22]. The exclusion
criteria were: use of any topical medication (such as
minoxidil or other solutions for hair growth), intake of
oral medication (f inasteride, dutasteride, or anti-andro-
gens), laser therapy or chemotherapy within 12 months
prior to enrollment in the study, smoking, a history of
hair transplantation, pregnant or lactating women, and
any chronic active scalp condition other than alopecia.
According to a rule of thumb, the sample size was de-
termined to be 23 for each sex [23].
Dong-Wook Park, et al: Androgenetic Alopecia and Kimchi Probiotics
3
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2. Ethics statement
The present study protocol was reviewed and ap-
proved by the Institutional Review Board of Cheil
General Hospital (Reg. No. CGH-IRB-2016-57). Inf ormed
consent was provided by all subjects when they were
enrolled.
3. Study design and intervention
All patients were administered 80 mL of a kimchi
and cheong guk jang probiotic product (Mogut®; Coen-
bio, Seongnam, Korea) twice a day (before breakfast
and bedtime). The ingredients of the kimchi and cheon-
ggukjang probiotic product were: culture medium with
fermented bacilli of kimchi and cheongguk jang (Leu-
conostoc holza pf elii, Leuconostoc mesenteroides, and
Lactobacillus sakei; 99.7%), pe rsimmon v inegar (0.1%),
Hasuo extract ( Pleuropterus multiflorus; 0.1%), and
extract of Korean black soybean (Rhynchosia volubilis
Lour; 0.1% ).
4. Efficacy evaluation
Hair growth and numbers were measured using the
Triple Scope System® (KC Technology, Seoul, Korea)
after 0 (baseline), 1, and 4 months of administration
of the kimchi and cheonggukjang probiotic product.
All patients were instructed to wash their hair before
visiting the hospital and strictly advised against use
of hair treatment using cosmetics such as styling gels.
The analysis was performed on the top of the patient’s
head, and the scalp was tattooed to identify the areas
for the next measurement. The hair density (number
of hairs/cm2) was measured at 5 different sites using
a scope at ×60 magnification, and hair thickness (mm)
was measured in 5 individual hair strands using a
scope at ×100 magnification.
5. Statistical analysis
The Student t-test was used to assess the statistical
significance of diff erences. All statistical analyses were
performed using SPSS ver. 12.0 (SPSS Inc., Chicago, IL,
USA). A p<0.05 was considered to indicate statistical
significance. Data are presented as mean±SD.
RESULTS
Forty-six patients were enrolled in this study. All pa-
tients completed the study. The patients’ characteristics
are shown in Table 1. The hair parameters measured
after 1 and 4 months of administration of a kimchi and
cheong guk jang probiotic product were compared with
the baseline (0-month) values. At baseline, in all pa-
tients (n=46), the hair count was 85.98±20.54 hairs/cm2
and thickness was 0.062±0.011 mm. As shown in Table
2, hair count and thickness had significantly increased
at 1 month (90.28±16.13 hairs/cm2 and 0.068 ±0.008
mm, respectively) and at 4 months (91.54±16.29 hairs/
cm2 and 0.066±0.009 mm, respecti vely) compared to
the baseline value (p<0.001). We observed that after
1 month of administration of the kimchi and cheong-
guk jang probiotic product, 63.0% of the total patients
(n=29) showed improvements in the measured hair
parameters (thickness and count), and 21.8% (n=10) and
4.3% (n=2) of all patients showed improvements in only
hair thickness and count, respectively. In 10.9% (n=5)
of the total patients, no improvement was observed in
either hair parameter that was assessed (Fig. 1). Afte r
4 months, 54.3% (n=25) of all patients showed improve-
ment in both assessed parameters, while 21.8% (n=10)
and 17.4% (n=8) of the total patients showed improved
hair thickness and count, respectively, and 6.5% (n=3)
of the total patients showed no improvement in either
assessed parameter (Fig. 2).
We analyzed data based on sex (23 male and 23 fe-
male) to determine whether the ef ficacy of the kim-
chi and cheong guk jang probiotic product dif fered by
sex. In male patients, hair count increased steadily
from baseline to 4 months (86.91±22.21 hairs/cm2 at
the initial visit, 88.117.50 hairs/cm2 at 1 month, and
Table 1. Characteristics of the study patients with alopecia
Characteristic Male patients
(n=23)
Female patients
(n=23)
Age (y) 46.52±10.14 44.17±10.20
Past history of alopecia treatment None None
Menopause (%) N/A 52.1
Values are presented as mean±standard deviation or percent only.
N/A: not available.
Table 2. Results of hair parameters in all patients
Variable Initial
(n=46)
1 month
(n=46)
4 months
(n=46) p-value
Counts (/cm2) 85.98±20.54 90.28±16.13 91.54±16.29 <0.001
Thickness (mm) 0.062±0.011 0.068±0.008 0.066±0.009 <0.001
Values are presented as mean±standard deviation.
https://doi.org/10.5534/wjmh.180119
4www.wjmh.org
90.78±17.65 h airs /cm 2 at 4 months; p<0.001). Thick-
ness had also increased at 1 month (0.064±0.007 mm)
and 4 months (0.063±0.006 mm ) compared to baseline
(0.058±0.009 mm, p=0.002 ) ( Table 3). In female patients,
hair count had increased at 1 month (92.39±14.72 hairs/
cm2) and 4 months (92.30±15.17 hairs/cm2) compared to
the initial visit (85.04±19.18 hairs/cm2) (p<0.001). Af-
ter 1 and 4 months, hair thickness in female patients
was observed to have increased (0.072±0.006 mm and
0.072±0.010 mm, respectively) compared to baseline
(0.066±0.011 mm, p=0.001) (Table 4). We observed that
52.2% (n=12) of male and 73.9% (n=17) of female pa-
tients showed improvement in both parameters (hair
thickness and count) af ter 1 month of administration
of the kimchi and cheonggukjang probiotic product. In
39.1% (n=9) of male patients, we observed an improve-
ment in only hair thickness, without any change in
hair count during the same period. In 8.7% (n=2) of
men, the hair parameters were unaffected f ollowing
administration of the kimchi and cheonggukjang pro-
biotic product over 1 month. After 1 month of probiotic
administration, 4.3% (n=1) and 8.7% (n=2) of female pa-
tients showed improved hair thickness and hair count,
respectively. We observed that in 13.1% (n=3) of female
Improvement in total
(n=46)
patients
All
Only
thickness
Only count
Neither
29 (63.0%)
10 (21.8%)
2 (4.3%)
5 (10.9%)
Fig. 1. Results of all patients at 1 month.
Improvement in total patients
(n=46)
All
Only
thickness
Only count
Neither
25 (54.3%)
10 (21.8%)
8 (17.4%)
3 (6.5%)
Fig. 2. Results of all patients at 4 months.
Table 3. Results of hair parameters in male patients
Variable Initial
(n=23)
1 month
(n=23)
4 months
(n=23) p-value
Counts (/cm2) 86.91±22.21 88.17±17.50 90.78±17.65 <0.001
Thickness (mm) 0.058±0.009 0.064±0.007 0.063±0.006 0.002
Table 4. Results of hair parameters in female patients
Variable Initial
(n=23)
1 month
(n=23)
4 months
(n=23) p-value
Counts (/cm2) 85.04±19.18 92.39±14.72 92.30±15.17 <0.001
Thickness (mm) 0.066±0.011 0.072±0.006 0.072±0.010 0.001
Improvement in male
(n=23)
patients
All
Only thickness
Only count
Neither
12 (52.2%)9 (39.1%)
2 (8.7%)
Improvement in female
(n=23)
patients
All
Only thickness
Only count
Neither
17 (73.9%)
1 (4.3%)
2 (8.7%)
3 (13.1%)
0 (0%)
Fig. 3. Results by sex at 1 month.
Dong-Wook Park, et al: Androgenetic Alopecia and Kimchi Probiotics
5
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patients, both hair parameters were unaffected after 1
month of kimchi and cheong guk jang probiotic product
administration (Fig. 3). An improvement in both hair
parameters was noted after 4 months of probiotic prod-
uct administration in 39.1% (n=9) of male and 69.6%
(n=16) of female patients. Hair thickness had improved
in 30.5% (n=7) of male and 13.0% (n=3) of female pa-
tients af ter 4 months of administration of the kimchi
and cheongguk jang probiotic product. We observed
that 26.1% (n=6) of male and 8.7% (n=2) of female pa-
tients showed an improved hair count during the same
period. No improvement in either hair parameter was
observed in 4.3% (n=1) of male and 8.7% (n=2) of female
patients af ter 4 months of probiotic administration (Fig.
4). Fig. 5 presents a vertex view of female and male pa-
tients with alopecia showing that administration of the
kimchi and cheonggukjang probiotic could increase
hair density and number af ter 4 months when com-
pared with baseline (0 month).
DISCUSSION
As their health benefits have become known, probi-
otics are being widely used globally. Probiotics primar-
ily include bacteria f rom the genera Stre ptococcus,
Enterococcus, Pediococcus, W eissell a, and Lactobacillus,
although the most commonly used probiotics belong to
Lactobacillus and Bi f id obacterium spp. [24]. Probiotics
are live organisms that are primarily used to improve
the signs and symptoms of gastrointestinal disorders
such as diarrhea, irritable bowel syndrome, constipa-
tion, and lactose intolerance, as well as to inhibit the
excessive proliferation of pathogenic intestinal bacte-
ria. However, recent studies have suggested that probi-
otics could have beneficial ef fects that extend beyond
gastrointestinal health, as they have demonstrated
eff icacy in improving certain metabolic disorders such
as hypertension [25], hypercholesterolemia [21], and
atherosclerosis [26]. The suggested mechanisms of pro-
biotic action in metabolic disorders include inhibition
of pathogen adhesion to the gut mucosa, stabilization
Improvement in male
(n=23)
patients
All
Only thickness
Only count
Neither
Improvement in female
(n=23)
patients
All
Only thickness
Only count
Neither
16 (69.6%)
3 (13.0%)
2 (8.7%)
2 (8.7%)
9 (39.1%)
7 (30.5%)
6 (26.1%)
1 (4.3%)
Fig. 4. Results by sex in 4 months.
Fig. 5. Response to administration of a
kimchi and cheonggukjang probiotic
product at baseline (0 month) and 4
months were measured by the Triple
Scope System® (×20 magnification).
https://doi.org/10.5534/wjmh.180119
6www.wjmh.org
of microbial f lora, and/or improvement of mucosal
integrity and barrier function, which can improve
energy metabolism and insulin sensitivity [27]. Meta-
bolic diseases such as hypercholesterolemia negatively
aff ect microvascular function, which can be reversed
with use of cholestyramine lipid-lowering therapy [28].
Based on these data, intake of appropriate quantities
of probiotics could lead to a beneficial effect on periph-
eral vascular blood f low and hair growth.
The kimchi and cheong guk jang probiotic product
analyzed in this study included various kinds of pro-
biotics and prebiotics obtained f rom kimchi, cheon g-
guk jang, and natural herbs. Choi et al [5] reported
that ultra-high molecular weight poly-γ-glutamic acid
(UHMW γ-PGA) isolated f rom Bacillus subtilis (used to
ferment cheongguk jang) could improve hair growth in
vivo. The authors showed that UHMW γ-PGA inhibited
activity of 5-α reductase, an enzyme produced in the
prostate, adrenal glands, and scalp, which metabolizes
the male hormone testosterone into dihydrotestoster-
one [29], resulting in an improvement of alopecia in
men. Thus, in that study, we concluded that the diff er-
ence in the pattern of improvement observed between
men and women was secondary to the difference in its
ef fect on the 5-α reductase present in the scalp.
In our present study, all enrolled patients were ad-
ministered a kimchi and cheong guk jang probiotic
product over a maximum period of 4 months. Overall,
93% of all patients demonstrated beneficial effects in
terms of the hair parameters that were assessed (thick-
ness and hair count); furthermore, the proportion of
those who experienced no effects decreased over time
(10.9% vs. 6.5%) (Fig. 1, 2). These effects were evident
within a month of intake of the kimchi and cheong-
guk jang probiotic product. The effectiveness of the
kimchi and cheonggukjan g probiotic product varied
between men and women. Men were more likely to
experience an effect on only hair thickness (30.4%) or
only hair count (26.1%) than an effect on both param-
eters (39.1%). In contrast, most women showed a posi-
tive effect on both hair parameters that were assessed
(65.2%), and only 13.0% and 8.7% of women showed
improvements in only hair thickness or only hair
count, respectively. We observed that administration of
the kimchi and cheongguk jang probiotic product was
ineff ective in 4.3% of men and 8.7% of women (Fig. 4).
Cheong guk jang is a known source of thrombolytic en-
zymes. Jeong et al [30] studied the characterization of
a f ibrinolytic enzyme from Bacillus subtilis CH3-5 that
was isolated from cheongguk jang. This thrombolytic
enzyme could increase the peripheral blood flow, in-
cluding to the scalp, and increase the amount of nutri-
tion provided to hair follicles.
In this study, the efficacy of the kimchi and cheong-
guk jang probiotic product was diff erent between male
and female patients, as improvements in both criteria
(thickness and count) at 1 month (73.9% vs. 52.2%) a nd
4 months (65.2% and 39.1%) were more common than
in male patients in the same period. However, male
patients were more likely to experience improvements
in only hair thickness at 1 month (39.1% vs. 4.3%) an d
4 months (30.4% vs. 13.0%) than female patients in the
same period. The prevalence of androgenetic alopecia
in Korean shows a sex bias, as 10.8% of Korean men
and 3.8% of Korean women in their 40s are diagnosed
with androgenetic alopecia [31]. According to our data,
we suggest that kimchi and cheongguk jang probiot-
ics exert limited effects on androgenetic alopecia, and
further study is therefore needed to verif y the dif fer-
ent effects of kimchi and cheong guk jang probiotics on
men and women.
The use of drugs associated with hair regrowth such
as f inasteride and minoxidil is limited and temporary,
due to adverse eff ects associated with their use, such as
irregular heartbeat and weight gain [32]. In this study,
we f ound that a kimchi and cheonggukjang probiotic
product could promote hair growth and reverse hair
loss without associated adverse effects such as diar-
rhea. Thus, we conclude that the use of natural probi-
otic products is a safer treatment strategy for patients
presenting with alopecia.
This study has some limitations. First, we did not
measure changes in the blood flow of the scalp and or
blood lipid profiles of all patients enrolled this study.
Second, we did not use a placebo group as a negative
control. However, we did compare the ef fects of probi-
otics before and after administration. Third, the obser-
vation period was relatively short, and the number of
patients was relatively small; therefore, we were not
able to establish whether the probiotic eff ects on alo-
pecia would be reversed or maintained during a longer
period.
CONCLUSIONS
To summarize, we suggest that the observed im-
Dong-Wook Park, et al: Androgenetic Alopecia and Kimchi Probiotics
7
www.wjmh.org
provements in hair count and thickness resulted from
initiation of the anagen phase in hair follicles second-
ary to the improved blood flow and modulation of
androgenetic effects by probiotics. However, ours is a
clinical study. Therefore, further studies investigating
the mechanism of action of probiotics and their role in
hair growth are warranted.
ACKNOWLEDGEMENTS
This study was financially supported by the Coenbio
R&D Center.
Conflicts of Interest
Myeong-Seung Shim and Kyu Jin Yum are advisers and Ju
Tae Seo is non-executive director of the Coenbio R&D Center,
Seongnam, Korea, but they had no influence on this work in re-
lation with the company or its products. The other authors have
no potential conflicts of interest to disclose.
Author Contribution
Conceptualization: JTS, HSL. Data curation: HSL. Formal
analysis: HSL. Funding acquisition: JTS. Investigation: JTS,
HSL. Methodology: JTS. Project administration: JTS, HSL. Re-
sources: JTS. Supervision: KJ Y, MSS. Validation: JTS, HSL. Vi-
sualization: HSL. Writing–original draft: DWP, HSL. Writing–
review & editing: DWP, HSL.
Data Sharing Statement
The data required to reproduce these findings cannot be
shared at this time as the data also forms part of an ongoing
study.
REFERENCES
1. Qi J, Garza LA. An overview of alopecias. Cold Spring Harb
Perspect Med 2014;4:a013615.
2. Jang SK, Kim ST, Lee DI, Park JS, Jo BR, Park JY, et al. Decoc-
tion and fermentation of selected medicinal herbs promote
hair regrowth by inducing hair follicle growth in conjunction
with Wnts signaling. Evid Based Complement Alternat Med
2016;2016:4541580.
3. Kwon OS, Oh JK, Kim MH, Park SH, Pyo HK, Kim KH,
et al. Human hair growth ex vivo is correlated with in vivo
hair growth: selective categorization of hair follicles for
more reliable hair follicle organ culture. Arch Dermatol Res
2006;297:367-71.
4. Rile N, Liu Z, Gao L, Qi J, Zhao M, Xie Y, et al. Expression
of Vimentin in hair follicle growth cycle of inner Mongolian
Cashmere goats. BMC Genomics 2018;19:38.
5. Choi JC, Uyama H, Lee CH, Sung MH. In vivo hair growth
promotion effects of ultra-high molecular weight poly-γ-
glutamic acid from Bacillus subtilis (Chungkookjang). J Mi-
crobiol Biotechnol 2015;25:407-12.
6. Stefanato CM. Histopathology of alopecia: a clinicopathologi-
cal approach to diagnosis. Histopathology 2010;56:24-38.
7. Shapiro J. Clinical practice. Hair loss in women. N Engl J Med
2007;357:1620-30.
8. McElwee KJ, Shapiro JS. Promising therapies for treating
and/or preventing androgenic alopecia. Skin Therapy Lett
2012;17:1-4.
9. Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol
V, Spuls PI, et al.; European Dermatology Forum (EDF). Evi-
dence-based (S3) guideline for the treatment of androgenetic
alopecia in women and in men. J Dtsch Dermatol Ges 2011;9
Suppl 6:S1-57.
10. Gur S, Kadowitz PJ, Hellstrom WJ. Effects of 5-alpha reduc-
tase inhibitors on erectile function, sexual desire and ejacula-
tion. Expert Opin Drug Saf 2013;12:81-90.
11. Gordon KA, Tosti A. Alopecia: evaluation and treatment.
Clin Cosmet Investig Dermatol 2011;4:101-6.
12. Campo D, Pisani A. Psychogenic alopecia. G Ital Dermatol
Venereol 2008;143:283-7.
13. Renert-Yuval Y, Guttman-Yassky E. The changing landscape
of alopecia areata: the therapeutic paradigm. Adv Ther
2017;34:1594-609.
14. Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J.
Interventions for alopecia areata. Cochrane Database Syst Rev
2008;(2):CD004413.
15. Shapiro J. Current treatment of alopecia areata. J Investig
Dermatol Symp Proc 2013;16:S42-4.
16. Gümüş N, Odemiş Y, Yılmaz S, Tuncer E. Effect of topically
applied minoxidil on the survival of rat dorsal skin flap. Aes-
thetic Plast Surg 2012;36:1382-6.
17. Gupta AK, Charrette A. Topical minoxidil: systematic review
and meta-analysis of its efficacy in androgenetic alopecia.
Skinmed 2015;13:185-9.
18. Hagemann T, Schlütter-Böhmer B, Allam JP, Bieber T, Novak
N. Positive lymphocyte transformation test in a patient with
allergic contact dermatitis of the scalp after short-term use of
topical minoxidil solution. Contact Dermatitis 2005;53:53-5.
19. Motofei IG, Rowland DL, Georgescu SR, Tampa M, Paunica S,
Constantin VD, et al. Post-finasteride adverse effects in male
https://doi.org/10.5534/wjmh.180119
8www.wjmh.org
androgenic alopecia: a case report of vitiligo. Skin Pharmacol
Physiol 2017;30:42-5.
20. Poller WC, Berger A, Dreger H, Morgera S, Enke-Melzer K.
Lipoprotein apheresis in patients with peripheral artery dis-
ease and lipoprotein(a)-hyperlipoproteinemia: 2-year follow-
up of a prospective single center study. Atheroscler Suppl
2017;30:174-9.
21. Shimizu M, Hashiguchi M, Shiga T, Tamura HO, Mochizuki
M. Meta-analysis: effects of probiotic supplementation on
lipid profiles in normal to mildly hypercholesterolemic indi-
viduals. PLoS One 2015;10:e0139795.
22. Bouhanna P. Multifactorial classification of male and female
androgenetic alopecia. Dermatol Surg 2000;26:555-61.
23. Julious SA. Sample size of 12 per group rule of thumb for a
pilot study. Pharm Stat 2005;4:287-91.
24. Mathipa MG, Thantsha MS. Probiotic engineering: towards
development of robust probiotic strains with enhanced func-
tional properties and for targeted control of enteric patho-
gens. Gut Pathog 2017;9:28.
25. Lye HS, Kuan CY, Ewe JA, Fung WY, Liong MT. The improve-
ment of hypertension by probiotics: effects on cholesterol, di-
abetes, renin, and phytoestrogens. Int J Mol Sci 2009;10:3755-
75.
26. Tsai TY, Chu LH, Lee CL, Pan TM. Atherosclerosis-prevent-
ing activity of lactic acid bacteria-fermented milk-soymilk
supplemented with Momordica charantia. J Agric Food Chem
2009;57:2065-71.
27. Hur KY, Lee MS. Gut microbiota and metabolic disorders.
Diabetes Metab J 2015;39:198-203.
28. Abularrage CJ, Sidawy AN, Aidinian G, Singh N, Weiswasser
JM, Arora S. Evaluation of the microcirculation in vascular
disease. J Vasc Surg 2005;42:574-81.
29. Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka
K, Kawashima M, Tsuboi R, et al. A randomized, active- and
placebo-controlled study of the efficacy and safety of differ-
ent doses of dutasteride versus placebo and finasteride in the
treatment of male subjects with androgenetic alopecia. J Am
Acad Dermatol 2014;70:489-98.e3.
30. Jeong SJ, Kwon GH, Chun J, Kim JS, Park CS, Kwon DY, et
al. Cloning of fibrinolytic enzyme gene from Bacillus subtilis
isolated from Cheonggukjang and its expression in protease-
deficient Bacillus subtilis strains. J Microbiol Biotechnol
2007;17:1018-23.
31. Paik JH, Yoon JB, Sim WY, Kim BS, Kim NI. The prevalence
and types of androgenetic alopecia in Korean men and wom-
en. Br J Dermatol 2001;145:95-9.
32. Park KS, Park DH. Comparison of Saccharina japonica-
Undaria pinnatifida mixture and minoxidil on hair growth
promoting effect in mice. Arch Plast Surg 2016;43:498-505.
... 33 Some examples of flavonoids are genistein, fistein, quercetin, daidzein, kaempferol, myricetin, baicalein, and biochanin A. 33 Probiotics have also been shown to have beneficial effect in AGA. 34 Soya bean drinks, which are a source of flavonoids, were found to have beneficial effect in AGA, with an optimal intake of 3 drinks per week. 35 ...
... Botanical antiandrogens Evidence exists that these function as type 2, 5-alpha reductase inhibitors. [33][34][35] Level 2b ...
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Background While a plethora of literature continues to be published on the role of nutritional agents both in lay press and indexed journals, the data is not on a firm footing and leaves the dermatologist in a quandry and the patient confused. The various agents include vitamins, minerals, amino acids, antioxidants, diets & gluten. A proper knowledge of the role of nutritional supplements in dermatological diseases can be a useful tool in advising the patients and in certain cases ameliorating the disorder. Patients/Methods Literature review of last 15 years was made using the terms “diet in dermatology,” “nutrition and skin,” “nutritional supplements in dermatology,” “nutritional agents and acne,” “nutritional agents and alopecia,” and “nutritional agents and psoriasis.” Results While there are multiple publications on the use of nutritional supplements for amelioration of skin diseases, most of them are based on either associations or in vitro studies, but very few transcend the rigors of a clinical trial or the holey grail of a double-blinded randomized controlled trial. There seem to be some evidence in acne, psoriasis, telogen effluvium, urticaria & vitiligo. Coeliac disease and dermatitis herpetiformis have a strong link with diet. Rosacea has a strong link with certain foods, but the other disorders like melasma, aphthous stomatitis do not have any scientifically validated association with diet. Conclusions Our updated review examines the role of nutritional supplements and antioxidants in various dermatological disorders. We have found that there are varying levels of evidence with notable associations of low glycemic diet & acne, fish oil & weight loss with psoriasis, fish oils & probiotics with atopic dermatitis & vitamins & botanical extracts with vitiligo. The evidence for diet and nutrition in bullous disorders and photoageing is scarce. The role of low histamine diet in urticaria is useful in select cases of episodic urticaria. Rosacea is triggered by hot and spicy food . Apart from gluten and Dermatitis Herpetiformis, no diet can be considered disease modifying in our reveiw. The lack of comparison of nutritional or dietary modiffication with conventional validated agents, makes the data difficult to translate in real world patient management.
... In comparison, most women demonstrated a beneficial impact on both hair parameters that were assessed (65.2%), and only 13.0% and 8.7% of women showed corresponding improvements in either only hair thickness or only hair count. The researchers of this work noted that the administration of the cheonggukjang and kimchi probiotic product was ineffective in 8.7% of women and 4.3% of men [187]. ...
... With a basis on the research performed by Park and colleagues, the consumption of adequate amounts of probiotics might produce a beneficial effect on peripheral vascular blood flow that impacts hair growth. The kimchi and cheonggukjang probiotic product analyzed in this study included different kinds of probiotics (Leuconostoc holzapfelii, Leuconostoc mesenteroides, and Lactobacillus sakei; 99.7%) and prebiotics obtained from kimchi, cheonggukjang, and natural herbs [187], where persimmon-vinegar was also included. ...
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... In addition to the various activities mentioned above, CGJ also demonstrates antityrosinase, anti-proliferative, syringic acid-mediated estrogen [166], anti-atopic dermatitis [167,168], anti-androgenetic alopecia [169], and anti-asthmatic activities (Table 11) [170]. Additionally, CGJ decreased toxic effects in the liver and kidneys by regulating various enzymes and reducing blood urea nitrogen and serum creatinine levels in ICR mice [132]. ...
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Cheonggukjang (CGJ, fermented soybean paste), a traditional Korean fermented dish, has recently emerged as a functional food that improves blood circulation and intestinal regulation. Considering that excessive consumption of refined salt is associated with increased incidence of gastric cancer, high blood pressure, and stroke in Koreans, consuming CGJ may be desirable, as it can be made without salt, unlike other pastes. Soybeans in CGJ are fermented by Bacillus strains (B. subtilis or B. licheniformis), Lactobacillus spp., Leuconostoc spp., and Enterococcus faecium, which weaken the activity of putrefactive bacteria in the intestines, act as antibacterial agents against pathogens, and facilitate the excretion of harmful substances. Studies on CGJ have either focused on improving product quality or evaluating the bioactive substances contained in CGJ. The fermentation process of CGJ results in the production of enzymes and various physiologically active substances that are not found in raw soybeans, including dietary fiber, phospholipids, isoflavones (e.g., genistein and daidzein), phenolic acids, saponins, trypsin inhibitors, and phytic acids. These components prevent atherosclerosis, oxidative stress-mediated heart disease and inflammation, obesity, diabetes, senile dementia, cancer (e.g., breast and lung), and osteoporosis. They have also been shown to have thrombolytic, blood pressure-lowering, lipid-lowering, antimutagenic, immunostimulatory, anti-allergic, antibacterial, anti-atopic dermatitis, anti-androgenetic alopecia, and anti-asthmatic activities, as well as skin improvement properties. In this review, we examined the physiological activities of CGJ and confirmed its potential as a functional food.
... saboten) extract and L. rhamnosus showed significant results in increasing hairs' depth and number in mice without any side effect on body weight and food intake. Recently, Park et al. (2020) investigated the consequence of probiotic-enriched kimchi and cheonggukjang (a traditional Korean fermented soybean product), namely, two fermented vegetable products, on androgenetic alopecia. In this clinical study, 4 months probioticsenriched foods interventions significantly enhanced hair counts and hair thickness, through improving blood flow without any intestinal side effect, such as diarrhea. ...
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In this study, we describe the effects of Lactobacillus paracasei HY7015 (HY7015) on promoting mouse hair growth. Since our purpose was to increase hair growth through oral administration, medicinal yeast, at a suitable concentration for application in mice, was used as a positive control. First, experiments were conducted to determine the effect of HY7015 on proliferation of hair follicle dermal papilla cells (HFDPC), which are important contributors to hair growth. HY7015 stimulated HFDPC proliferation in vitro and increased their secretion of vascular endothelial growth factor and insulin-like growth factor-1. In mouse experiments, oral administration of HY7015 promoted hair growth and hair follicle maturation in the dorsal skin, as well as increasing growth factor levels in mouse serum. In summary, we demonstrate that L. paracasei HY7015 consumption can promote hair growth by stimulating HFDPC proliferation and growth factor secretion. Follow-up studies are warranted to determine the underlying mechanism, using various approaches, including investigation of changes in intestinal microbiota and alteration of gene and protein expression.
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In the present work, we report the complete genome sequence of Bacillus velezensis DKU_NT_04, isolated from cheonggukjang, which is a traditional Korean fermented soybean paste. The final genome assembly consists of a 4.328-Mbp chromosome with 4,134 coding sequences and a G+C content of 45.21%.
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Background: The growth of Inner Mongolian Cashmere goat skin hair follicle exhibits a periodic growth pattern. The hair growth cycle is distinguished as telogen, anagen, and catagen stages. The role of vimentin in the growth process of hair follicles is evident. To elucidate the mechanism underlying the vimentin activity in the growth cycle of hair follicles, transcriptome sequencing and liquid chromatography-tandem mass spectrometry were used to obtain the nucleic acid and amino acid sequences of VIIM gene and vimentin. The amino acid and nucleic acid sequences were analyzed by comparison. Real-time quantitative PCR, Western blot, and immunohistochemistry analyzed the expression level and sites of vimentin in the three growth stages of the Inner Mongolia Cashmere goat skin samples. Results: VIM gene cDNA, obtained by transcriptome sequencing, was aligned against that of the Capra hircus VIM gene. The amino acid sequence of vimentin revealed a high similarity rate across other species. The expressions of both VIM gene and vimentin were highest during the growth period and lowest in the rest period. Furthermore, vimentin was primarily expressed in the outer root sheath of the hair follicle as assessed by staining. Conclusions: The sequences of the gene and protein are similar to that of other species and identical to Capra hircus. However, the expression of VIM and vimentin was proportional to that of the growth of hair follicles. And vimentin expressed only in the outer root sheath of hair follicles. Thus, vimentin was speculated to participate in the regulation of the hair follicle growth cycle by affecting the outer root sheath.
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Background Algae have traditionally been used for promotion of hair growth. Use of hair regrowth drugs, such as minoxidil, is limited due to side effects. The aim of this study was to examine a mixture of Saccharina japonica and Undaria pinnatifida (L-U mixture) on hair growth and to compare the promoting effect of hair growth by a 3% minoxidil and a L-U mixture. Methods To evaluate the hair growth-promoting activity, saline, 50% ethanol, 3% minoxidil, and the L-U mixture were applied 2 times a day for a total of 14 days on the dorsal skin of C57BL/6 mice after depilation. Analysis was determined by using a high-resolution hair analysis system, real-time polymerase chain reaction, and H&E staining. Results On day 14, the hair growth effect of the L-U mixture was the same as that of the 3% minoxidil treatment. The L-U mixture significantly (P<0.05) stimulated hair growth-promoting genes, as vascular endothelial growth factor (VEGF) and insulin-like growth factor -1. Increase of VEGF was observed in the L-U mixture group compared with minoxidil and the negative control. In contrast, the L-U mixture suppressed the expression of transforming growth factor-β1, which is the hair loss-related gene. In histological examination in the L-U mixture and minoxidil groups, the induction of an anagen stage of hair follicles was faster than that of control groups. Conclusions This study provides evidence that the L-U mixture can promote hair growth in mice, similar to the effect from minoxidil, and suggests that there is potential application for hair loss treatments.
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Introduction: Recent experimental and clinical studies have suggested that probiotic supplementation has beneficial effects on serum lipid profiles. However, there are conflicting results on the efficacy of probiotic preparations in reducing serum cholesterol. Objective: To evaluate the effects of probiotics on human serum lipid levels, we conducted a meta-analysis of interventional studies. Methods: Eligible reports were obtained by searches of electronic databases. We included randomized, controlled clinical trials comparing probiotic supplementation with placebo or no treatment (control). Statistical analysis was performed with Review Manager 5.3.3. Subanalyses were also performed. Results: Eleven of 33 randomized clinical trials retrieved were eligible for inclusion in the meta-analysis. No participant had received any cholesterol-lowering agent. Probiotic interventions (including fermented milk products and probiotics) produced changes in total cholesterol (TC) (mean difference -0.17 mmol/L, 95% CI: -0.27 to -0.07 mmol/L) and low-density lipoprotein cholesterol (LDL-C) (mean difference -0.22 mmol/L, 95% CI: -0.30 to -0.13 mmol/L). High-density lipoprotein cholesterol and triglyceride levels did not differ significantly between probiotic and control groups. In subanalysis, long-term (>4-week) probiotic intervention was statistically more effective in decreasing TC and LDL-C than short-term (≤4-week) intervention. The decreases in TC and LDL-C levels with probiotic intervention were greater in mildly hypercholesterolemic than in normocholesterolemic individuals. Both fermented milk product and probiotic preparations decreased TC and LDL-C levels. Gaio and the Lactobacillus acidophilus strain reduced TC and LDL-C levels to a greater extent than other bacterial strains. Conclusions: In conclusion, this meta-analysis showed that probiotic supplementation could be useful in the primary prevention of hypercholesterolemia and may lead to reductions in risk factors for cardiovascular disease.
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Alopecia areata (AA), a prevalent inflammatory cause of hair loss, lacks FDA-approved therapeutics for extensive cases, which are associated with very poor rates of spontaneous hair regrowth and major psychological distress. Current treatments for severe cases include broad immune-suppressants, which are associated with significant adverse effects, precluding long-term use, with rapid hair loss following treatment termination. As a result of the extent of the disease in severe cases, topical contact sensitizers and intralesional treatments are of limited use. The pathogenesis of AA is not yet fully understood, but recent investigations of the immune activation in AA skin reveal Th1/IFN-γ, as well as Th2, PDE4, IL-23, and IL-9 upregulations. Tissue analyses of both animal models and human lesions following broad-acting and cytokine-specific therapeutics (such as JAK inhibitors and ustekinumab, respectively) provide another opportunity for important insights into the pathogenesis of AA. As reviewed in this paper, numerous novel therapeutics are undergoing clinical trials for AA, emphasizing the potential transformation of the clinical practice of AA, which is currently lacking. Dermatologists are already familiar with the revolution in disease management of psoriasis, stemming from better understanding of immune dysregulations, and atopic dermatitis will soon follow a similar path. In light of these recent developments, the therapeutic arena of AA treatments is finally getting more exciting. AA will join the lengthening list of dermatologic diseases with mechanism-targeted drugs, thus changing the face of AA.
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Objective Elevated plasma levels of lipoprotein(a) [Lp(a)], referred to as lipoprotein(a)-hyperlipoproteinemia [Lp(a)-HLP], are an independent risk factor for atherosclerosis. Lipoprotein apheresis (LA) enables an effective reduction of Lp(a) plasma levels. The present study investigates the effects of LA in patients with Lp(a)-HLP and peripheral artery disease (PAD). Methods Ten patients with isolated Lp(a)-HLP and severe PAD and who had recently undergone a revascularization (index procedure) were prospectively included in this observational single center study. All patients received weekly LA. Ankle-brachial-index (ABI), transcutaneous partial oxygen pressure (tcpO2), pain level, and walking distance were assessed at baseline and at the follow ups scheduled 1, 3, 6, 12, and 24 months after initiation of LA. The number of revascularizations within 12 months prior and within 24 months after the index procedure was determined. Results As early as 1 month after initiation of LA, all investigated parameters had improved significantly compared to baseline. This improvement was further substantiated under LA throughout the entire follow-up period. Comparing baseline results with the 24-month follow-up, the average ABI increased from 0.53 ± 0.15 to 0.97 ± 0.08 (P < 0.001). The mean tcpO2 also increased from 42.9 ± 2.3 mmHg to 61 ± 4.6 mmHg (P < 0.001). The improved perfusion led to a reduction of the mean pain level from 7.0 ± 1.5 to 1.1 ± 0.4 (P < 0.001) on a visual analogue scale (VAS) and an extension of the mean walking distance from 87 ± 60 m to 402 ± 119 m (P < 0.001). All patients suffered from severe PAD with a high number of revascularizations in the 12 months prior to the index procedure (35 procedures in 120 patient-months). Since initiation of LA, the number of revascularizations dropped significantly and remained very low during the entire follow-up period (2 procedures in 229 patient-months, P < 0.001). Conclusion In patients with Lp(a)-HLP and severe PAD, LA results in sustained improvement of circulation, pain level and walking distance. The number of repeat revascularizations is strongly reduced under LA treatment.
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Finasteride has proved to be relatively safe and effective in the therapeutic management of male androgenic alopecia. However, literature data report several endocrine imbalances inducing various adverse effects, which often persist after treatment cessation in the form of post-finasteride syndrome. Here we present the case of a 52-year-old man receiving finasteride (1 mg/day) who developed an uncommon adverse effect represented by generalized vitiligo 2 months after finasteride discontinuation. Associated adverse effects encountered were represented by mild sexual dysfunction (as determined by the International Index of Erectile Function, IIEF) and moderate depressive symptoms (according to DSM-V criteria), all of these manifestations aggregating within/as a possible post-finasteride syndrome. Further studies should develop and compare several therapeutic approaches, taking into account not only compounds that decrease the circulating dihydrotestosterone level but also those that could block the dihydrotestosterone receptors (if possible, compounds with selective tropism towards the skin). In addition, the possibility of predicting adverse effects of finasteride (according to hand preference and sexual orientation) should be taken into account.
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Topical minoxidil has become a mainstay in the treatment of androgenetic alopecia (AGA). Despite being a longstanding treatment for AGA, relatively few reviews of its efficacy have been published. The current study sought to synthesize the available efficacy data by performing a systematic review of the literature and conducting random-effects pairwise meta-analyses for the outcomes percent increase in hair count from baseline, investigator assessment, and patient self-assessment. Results showed that minoxidil is more effective than placebo in promoting total and nonvellus hair growth (mean difference [MD], 16.68; 95% confidence interval [CI], 9.34-24.03 and MD, 20.90; 95% CI, 9.07-32.74). A significantly higher proportion of participants in the minoxidil group had greater hair growth than participants in the placebo group as judged by both investigators and self-reports (relative risk [RR], 2.28; 95% CI, 1.58-3.31 and RR, 1.56; 95% CI, 1.34-1.80). Despite significant clinical efficacy, cosmetically acceptable results are present in only a subset of patients. Compliance is thought to be a major limiting factor and is being addressed by novel formulations and combinations.