Microneedling Redness Reduction. Hairline Tressless Makeup?
Indian J Dermatol. 2015 May-Jun; lx(3): 260–263.
Response to Microneedling Handling in Men with Androgenetic Baldness Who Failed to Respond to Conventional Therapy
Rachita Dhurat
From the Department of Dermatology, LTM Medical Higher and General Hospital, Sion, Mumbai, Maharashtra, India
Sukesh Mathapati
From the Department of Dermatology, LTM Medical College and General Infirmary, Sion, Mumbai, Maharashtra, India
Received 2014 Jul; Accepted 2014 November.
Abstruse
Introduction:
The efficacy of conventional therapy viz. finasteride and minoxidil in androgenetic alopecia (AGA) that is based on both preventing pilus loss and promoting new hair growth, varies betwixt 30% and 60%. This has led to a large number of patients unsatisfied who demand for a better corrective coverage over the scalp. Microneedling has recently been reported to exist promising, constructive and a safety treatment modality in the treatment of AGA. This augments the response of conventional therapy.
Materials and Methods:
Four men with AGA were on finasteride and 5% minoxidil solution since 2 to 5 years. Though there was no worsening in their respective AGA stages with the therapy, they showed no new hair growth. They were subjected to microneedling procedure over a period of 6 months along with their ongoing therapy. Patients were assessed with the use of the standardized 7-point evaluation scale and patients' subjective hair growth assessment calibration. The patients were followed up for eighteen months mail microneedling procedure to assess the sustainability of the response.
Results:
All patients showed a response of + 2 to + iii on standardized 7-point evaluation calibration. The response in the form of new hair growth started after 8-10 sessions. The patients' satisfaction was more 75% in three patients and more 50% in ane patient, on patients' subjective pilus growth cess scale. The obtained results were sustained post procedure during 18 months follow-upwardly period.
Conclusion
Treatment with microneedling showed an accelerated response with addition of microneedling procedure leading to significant scalp density. This is the offset case series to written report the boosting result of microneedling with respect to new hair follicle stimulation in patients with androgenetic alopecia who were poor responders to conventional therapy.
Keywords: Androgenetic alopecia, finasteride, microneedling, minoxidil, new hair growth
What was known?
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Efficacy of conventional therapies (viz. finasteride and minoxidil) in the treatment of androgenetic alopecia with respect to new pilus growth is moderate.
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Microneedling has recently been reported to be promising and safe treatment modality in the handling of AGA.
Introduction
Androgenetic alopecia (AGA) is the most common blazon of alopecia in men. Although the pathogenesis of androgenetic alopecia revolves around androgens, genes, inflammation and signalling pathways; the conventional therapy options (finasteride and minoxidil) mainly target the androgens. About 40% of men with AGA go bald despite on conventional therapy.[one,2,3] Microneedling is a recent advancement to the handling modality for AGA. Its efficacy has been established by the authors recently.[4] In the nowadays instance series, we report four men with AGA, who had no/minimal new hair growth with conventional therapy, and responded to add-on of microneedling treatment leading to significant scalp density. Nosotros take modified our microneedling protocol to reduce frequent visits of the patients to the clinic
Instance Reports
Instance 1 — A thirty-twelvemonth-old male was suffering from AGA since 8 years. He was on oral finasteride and topical 5% minoxidil regularly since four years and besides had underwent hair transplantation surgery 2 years agone. He reported an arrest in hair loss but was unsatisfied in terms of cosmetic scalp coverage. On examination, he had grade V Hamilton Norwood pattern of hair loss with few transplanted hairs seen on frontal area and thin hairs on the temporal and midscalp area [Figure 1].
A xxx-twelvemonth-old male with Course V Hamilton Norwood pattern of pilus loss with few transplanted hairs seen on frontal expanse and thin hairs on the temporal and midscalp area
Case 2 — A 28-year-old male with grade VII hair loss was treated with finasteride and minoxidil for over 5 years. He was also treated with xl sessions of mesotherapy (cocktail of minoxidil and amino acids). Despite all this, he was non satisfied with new hair growth and hence he underwent hair transplantation 2 years ago. Minimal new pilus regrowth was noted with hair transplantation but not to the patient'south satisfaction. He presented to us with a desire to increase the density of hair [Figure 2a- c]
(a, b, c) A 28-twelvemonth-former male with grade Vii hair loss with minimal new hair regrowth noted after hair transplantation
Instance 3 — A 35-yr-old male with class V pilus loss was on finasteride and minoxidil for over ii years. He had no significant comeback with respect to new hair growth. He wished for a better scalp coverage of hair [Effigy 3a- c].
(a, b, c) A 35-twelvemonth-sometime male with form V hair loss was on finasteride and minoxidil for over 2 years
Case 4 — A twoscore-year-onetime male with female pattern type III of hair loss was taking conventional therapy for over 3 years but unsatisfied with respect to new hair growth [Figure four].
A 40-year-erstwhile male with female pattern type 3 of hair loss
Microneedling procedure
The scalp was surgically cleansed with betadine and normal saline. A dermaroller of i.5 mm sized needles was gently rolled over the affected areas of the scalp in longitudinal, vertical, and diagonal directions until balmy erythema was noted; this was considered as the finish point of the procedure. Each procedure lasted for near 20-25 minutes. The patients were advised to keep with their ongoing therapy with finasteride and minoxidil.
All the patients were subjected to microneedling process weekly for 4 sessions initially and then fortnightly for subsequent 11 sessions. The total duration of microneedling treatment lasted for 24 weeks.
Evaluation
Baseline and mail service treatment photographs (at week 24) were taken on a tailor-made stereotactic device and the patients were assessed with the use of the standardized 7-point evaluation scale (–3 = greatly decreased, –ii = moderately decreased, –1 = slightly decreased, 0 = no change, +1 = slightly increased, +ii = moderately increased, +3 = greatly increased).
Patients also assessed their hair growth on subjective cess calibration of 0-iv (0: No improvement; 1: ane-25% improvement; 2: 26-50% comeback; three: 51-75% comeback; 4: 76-100% comeback)
Subsequently completion of 15 sessions of microneedling, all patients were advised to continue with finasteride and minoxidil. The patients were followed up for 18 months afterward the last microneedling procedure to assess the sustainability of the response.
Results
All patients reported subjective increase in thickness of thin pilus after a month of initiation of microneedling process.
After iii months, new hairs were noticed on scalp surface and by finish of six months pregnant scalp coverage was noted with the response of grade +2 to +3 on the standardised 7-point evaluation scale [Figures five- eight]. At end of 6 months, three patients rated more than than 75% improvement and 1 patient (Instance 2) reported more than fifty% improvement on patients' subjective evaluation of pilus growth and were highly satisfied with the response.
+3 response noted in patient one, at the end of six months
(a, b, c) Hair regrowth at the end of 1st month, 3rd month and at the end of six months (+3 response) noted in patient iv
(a, b, c) + ii response noted in patient 2, at the end of six months
(a, b, c) +2 response noted in patient 3, at the cease of half-dozen months
At the finish of xviii months of follow up, all patients had maintained the aforementioned response that was accomplished at the cease of last session of microneedling.
Discussion
AGA affects up to thirty% of men below the age of 30 years and approximately l% of men above l years of age.[5] There is a significant psycho-social impact associated with it.[6] At that place has also been a growing demand among the patients to seek treatment, not but to forbid the existing hair loss simply more and so to regain new hair with good thickness and density.
Cochrane review reports that the efficacy of finasteride and minoxidil for AGA varies betwixt 40% and lx%. This implies that a meaning number of patients go bald despite therapy. The reported efficacy is in terms of arresting of ongoing hair loss and new hair regrowth. Data on the efficacy with regards to but new hair regrowth with the above therapy is not documented. A large proportion of patients with AGA remain unsatisfied with respect to new pilus growth with the existing therapies. One of the reasons for this could be the multiple factors implicated in the pathogenesis of AGA which involves not only DHT only also inflammation, genes, signalling pathways[7] (stimulatory pathways like Wnt/B catenin, stat iii and Shh and inhibitory pathways of Dkk-i, Dickkopf-related protein 1 and BMP 4); growth factors, activation of stem cells of the hair bulge and improving vascularity. The existing conventional therapies (i.e. finasteride and minoxidil) neglect to target all of them.
Microneedling is a novel and safe tool in the treatment of androgenetic alopecia which induces hair regrowth by the following.[viii,9,10]
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Release of platelet-derived growth factor and epidermal growth factors are increased through platelet activation and skin wound regeneration mechanism
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Activation of stem cells in the hair bulge area under wound healing conditions which is acquired past a dermaroller
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Overexpression of pilus growth-related genes, vascular endothelial growth factor, B catenin, Wnt3a, and Wnt10 b as documented in animal studies.
Our start in man study demonstrated the augmented upshot of microneedling in promoting pilus growth in men with AGA.[4] We take modified our microneedling protocol to reduce frequent visits of the patients to the clinic.
The present case serial highlights the beneficial effect of microneedling in promoting new hair regrowth even in patients showing poor response to conventional therapy past targeting other pathogenetic mechanisms of AGA.
Determination
The pathogenesis of androgenetic baldness is multifactorial and is notwithstanding not clear. The efficacy of the conventional therapies with respect to new hair growth is unsatisfactory. The present example series shows that the addition of microneedling procedure augments the response fifty-fifty in poor responders to conventional therapy.
As microneedling targets multiple pathogenetic factors of AGA, nosotros are of the stance that this procedure should be offered to patients with AGA for new and faster pilus follicle stimulation.
Withal, the full number and frequency of sessions and long-term sustainability of response of microneedling need to exist evaluated inside a larger population.
Footnotes
Source of support: Cypher
Conflict of Interest: Nada.
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Microneedling Redness Reduction. Hairline Tressless Makeup?,
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458936/
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