Medical Innovation for Hair loss Treatment

Introduction

Alopecia is a chronic hair loss condition characterized by active hair loss, affecting 80 % of men and 40 % of women. A bald scalp occurs when either the activator is absent or the presence of an inhibitor of the hair follicle (HF). Hair loss is a common grievance that makes a person stressful and challenging for practitioners to treat. Luckily, innovations in the field have added to growing evidence for several favorable topical, oral, light, and energy-based therapies.

What Are the Recent Advances in Hair Transplant?

The following are the recent advances that, in the future, will play an essential role in a high success rate in people with hair loss. They are:

1. Hair transplantation.

2. Autologous micro grafts from scalp tissue.

3. Platelet-rich plasma.

4. Laser and light therapy.

• Lower-level laser therapy.

• Fractional laser.

5. Laser-assisted drug delivery.

6. Exosomes derived from human dermal papilla cells.

7. Macrophage-derived extracellular vesicle.

Hair Transplantation:

Hair transplantation is another treatment option for hair loss. The two techniques to obtain a donor's hair include follicular unit transplantation (FUT) and follicular unit extraction (FUE). PRP is used in hair transplantation to treat the donor and recipient site, promote and maintain hair growth, and as a storage solution to maintain graft vitality. Once the donor's hair is collected, it is transplanted into the recipient site as separate follicular units producing the same cosmetic outcome. In follicular unit transplantation or elliptical donor harvesting, the donor area is cut out in elliptical strips. The strip is then divided into single follicular units leaving a linear scar in the donor area. Alternatively, the donor area is shaved to 1 mm in FUT in FUT before the individual follicle unit has to separate. It is not desirable for women as larger areas are trimmed out.

Autologous Micro Grafts From Scalp Tissue:

Micro-grafts containing human hair follicle mesenchymal stem cells (HF-MSCs) obtained from their own body were not adequate for satisfactory hair regrowth. Treatment procedures included topical minoxidil, oral finasteride, and hair transplant procedures. The autologous platelet-rich plasma (A-PRP) reduces hair loss and promotes new hair follicles, forming new small hairs in a hairless scalp. In addition, people’s satisfaction and computerized trichogram examination have acknowledged the outcome quality.

Platelet-Rich Plasma:

Plasma-rich plasma (PRP) contains higher platelets than normal blood. It activates the platelet to release signaling molecules like growth factors, cytokines, and chemokines. The signals from the growth factors alter the protein synthesis and gene expression, changing the hair follicle's microenvironment. The platelet-derived growth factors promote hair growth, lengthen the initial growth period, increase blood supply, inhibit cell death, and decrease inflammation around the hair follicle. PRP also contains other blood cells that increase matrix metalloproteinases, promoting new blood vessel formation, remodeling structures, and hair growth cycle. However, they may also damage hair follicles and cause scar formation and a burning sensation.

Laser and Light Therapy:

1. Lower-Level Laser Therapy (LLLT)

• LLLT uses red and near-infrared wavelengths (600-900nm).

• Lower-level laser therapy increases cell energy, reduces inflammation, improves gene transcription, upregulates the follicular cells, and improves blood flow.

• Absorption of these wavelengths by the tissue ATP is produced, promoting hair growth.

• There is an increase in hair density in areas treated by LLLT in both men and women.

• Laser emitting diodes (LED) are incorporated into the helmet, cap, and comb-type devices for short- and long-term treatment.

2. Fractional Lasers

• The fractional lasers include the ablative 2940nm Er: YAG laser, 1550nm erbium-glass laser, and the ablative carbon dioxide (CO2) laser. These are harmless and effective for hair regrowth.

• Fractional lasers upregulate the Wnt-catenin pathway to promote hair growth with proven improvement in hair density and growth rate.

• Some rare hair disorders, like ophiasis, autosomal recessive wooly hair, frontal fibrosing alopecia (FFA), scleroderma-induced secondary cicatricial alopecia, and perifolliculitis abscedens treated with fractional laser along with systemic antibiotics, steroids, and glucocorticoids showed improvement in areas of hair loss areas with partial hair regrowth.

• Side effects included transient pruritus and pain.

Laser-Assisted Drug Delivery (LADD)

• LADD is a progressing technology for hair loss. A laser destroys the tissue, and the topical drug is delivered over the destroyed tissue. This increases the penetration ability of the drug.

• Fractional CO2 laser therapy followed by immediate application of 5 % Minoxidil solution significantly increased the total hair count and thickening of thin hair.

• Fractional radiofrequency micro needling is also used as an adjuvant therapeutic option.

Exosomes Derived From Human Dermal Papilla Cells

• Dermal papillae (DP) located at the base of hair follicles is important for hair growth and restoration by regulating the activity of hair follicle cells. Exosomes derived from human dermal papilla cells

• Promoted the proliferation of dermal papilla cells, outer root sheath (ORS) cells, increased growth factors, and hair shaft elongation. Moreover, exosome treatment increased hair follicle regeneration.

Macrophage-Derived Extracellular Vesicle (EVs)

• Extracellular vesicles (EVs) are natural Nano vesicles released by most cells consisting of proteins, lipids, and nucleic acids.

• EVs play a vital role in cell-to-cell communication. Immune-cell-derived EVs are used as therapeutic agents for many diseases.

• Macrophage-derived extracellular vesicles have the following functions:

• Hair growth and regeneration.

• Perifollicular macrophages activate the skin stem cells and regulate hair follicle growth.

• Improves the hair-inductive properties of dermal papilla cells by increasing the levels of hair-inductive proteins and survival or proliferation markers.

• Accelerate hair growth by increasing the number of hair follicles and dermis thickness.

• The human hair follicle (HF) shaft elongation.

Conclusion

The complex nature of hair loss often requires a multifactorial treatment approach. These factors include hair loss severity, failure of previous treatments, cost, side effects, and person’s acceptance. Fortunately, there are more topical, oral, intralesional, and device-based treatment options. Current data suggest that many of these treatments are safe and promising. Future advances may allow for more safe, promising, efficient, and less traumatic ways to implant grafts while increasing the implant's thickness and survival rate.