How to Deal with the Issues of Fertility, Malignancies, and the Postfinasteride Syndrome while Prescribing Finasteride for Male Pattern Hair Loss

Oral finasteride represented a breakthrough for treatment of male pattern hair loss (MPHL), with clinical studies having demonstrated high efficacy of treatment and a favorable safety profile. And yet, fertility issues, malignancy, and postfinasteride syndrome have been concerns of users and prescribers of the drug. Pre-existing mental health disorder may put patients at an increased risk of nocebo, while the prevalence of personality disorders in subjects with MPHL is known to be higher than in the general population, specifically histrionic personality disorder. We devised a system for patient selection and risk assessment, including fertility issues, regular PSA determinations, and specific mental health assessment. For those who choose regular prostate cancer screening, the use of finasteride meaningfully reduces the risk of prostate cancer. While gynecomastia is a known, rare adverse effect of finasteride, so far, studies support the view that exposure to finasteride is not associated with male breast cancer risk. Patient understanding and involvement are central to optimal treatment selection and active patient role in treatment.

Is Every Patient of Hair Loss a Candidate for Hair Transplant?—Deciding Surgical Candidacy in Pattern Hair Loss

Patterned hair loss which includes both male pattern hair loss (MPHL) or androgenic alopecia (AGA) and female pattern hair loss (FPHL) is the most common indication for hair transplant surgery. However, not all such patients are candidates for hair transplants. There are eight conditions that cause patients to not be appropriate candidates. These are: diffuse unpatterned alopecia (DUPA), cicatricial alopecia (CA), patients with unstable hair loss, patients with insufficient hair loss, very young patients, patients with unrealistic expectations, patients with psychologic disorders such as body dysmorphic disorder (BDD) and trichotillomania, and patients who are medically unfit. In addition, there are patients who are poor candidates and who should undergo hair transplantation only if they understand and accept limited results. The key to identifying these patients involves performing careful and detailed history and examination at the time of consultation.

Significance of iron levels in patients with non-cicatricial alopecias: a cross sectional study

<p class="abstract"><strong>Background: </strong>Among all the nutritional causes of hair loss, iron levels are found to be important key nutrient. Synthesis of hair involves many steps which require iron as a cofactor. The intention of present study is to evaluate relationship between iron and hair loss. The objectives of the study are to study the clinical patterns, demographic and epidemiological factors associated with hair loss and to find association between iron study parameter (Hb, serum iron, serum ferritin, TIBC) and hair loss.</p><p class="abstract"><strong>Methods: </strong>The study was a cross section- observational study, conducted among the patients with diagnosed non-cicatricial alopecias from June 2018 to April 2019. A total of 50 study participants were recruited. Specific investigations like hair pull test and trichogram were done. Chi square test was applied and p&lt;0.05 was considered significant.</p><p class="abstract"><strong>Results:</strong> Among the total 50 participants 35 (70%) were males and 15 (30%) were females. Mean (±SD) age was 44 (±9.5) years. Mean (SD) of haemoglobin, serum iron, TIBC and ferritin are 9.6 (±2.6), 75.5 (±50), 365 (±54) and 106 (±87) respectively. Trichogram result proves telogen hair- 22 (44%), dystrophic hair loss- 14 (28%) and anagen hair loss-14 (28%). Hair pull test was positive in 27 (54%). Higher proportion of male pattern hair loss was associated with lower haemoglobin and low serum ferritin levels. (p value -0.046, 0.031)</p><p class="abstract"><strong>Conclusions:</strong> Significant association was found between the diagnosis of non cicatricial alopecia and mean values of haemoglobin and serum ferritin with lower haemoglobin and low serum ferritin was mostly associated with male pattern hair loss.</p>

Efficacy and Tolerability of N-Acetyl-Cysteine for Treatment of The Early-onset Androgenetic Alopecia in Men

Background Androgenetic alopecia (AGA), the most common form of hair loss in men, involves the progressive loss of visible pigmented terminal hair on the scalp in response to circulating androgens. AGA is an autosomal disorder which begins in puberty in genetically predisposed individuals. Aim of the Work To study the effectiveness and safety of the reactive oxygen species scavenger Nacetyl-cysteine (NAC) as a single therapy and in combination with the topically applied minoxidil for treatment of the early-onset androgenetic alopecia in men. Patients and Methods The present study included 100 patients with male pattern hair loss whose age ranged from 18 to 30 years old, recruited from dermatology clinics in Ain Shams University Hospital and Kafr El Sheik University Hospital. Results Overall, all treatments could improve significantly some of the trichoscopic parameters as compared to the control group who did not receive any treatment. The number of terminal hair count increased and the vellus hair count decreased in response to either of treatments; minoxidil, NAC, or both as compared to control. These changes were noticed at both the vertex and frontotemporal sites. The treatment was generally tolerable and the side effects encountered did not necessitate stoppage of the treatment course. Conclusion On the basis of the findings of current study we can conclude that, the role of trichoscopy in increasing the accuracy for diagnosing hair disorders as well as to detect response or failure to treatment, N-acetylcysteine (NAC) improved significantly most of the trichoscopic features of AGA and it was was generally tolerable and the side effects encountered did not necessitate stoppage of the treatment course.

Surgical management of gynaecomastia by using cross chest liposuction and limited periareolar incision for gland excision: an interesting case report

Gynaecomastia is excessive or abnormal enlargement of male breast tissue. It is one of a common problem among young men. The term gynaecomastia means female like enlargement of male breast due to increase ductal tissue, stroma or fat. Most common cause of gynaecomastia is idiopathic. Surgical treatment of gynaecomastia involves liposuction and glandular excision and in few cases skin excision. Here author presents a case of 24 years old young healthy male with Simon’s grade 2B bilateral gynaecomastia. He had stubborn fat over bilateral chest which was resistant to exercise. Gynaecomastia was mixed type in characteristic having adipose tissue as well as glandular tissue enlargement. Bilateral liposuction and glandular excision by limited periareolar incision under general anesthesia as a day care procedure was done. In our procedure we used Cross chest liposuction. Patient was discharged at the same evening without any complications. After four months of follow up patient has male pattern chest with almost invisible scar and intact Nipple areolar complex (NAC) sensation.

Evidence for a functional interaction of WNT10A and EBF1 in male-pattern baldness

More than 300 genetic risk loci have been identified for male pattern baldness (MPB) but little is known about the exact molecular mechanisms through which the associated variants exert their effects on MPB pathophysiology. Here, we aimed at further elucidating the regulatory architecture of the MPB risk locus on chromosome (chr.) 2q35, where we have previously reported a regulatory effect of the MPB lead variant on the expression of WNT10A. A HaploReg database research for regulatory annotations revealed that the association signal at 2q35 maps to a binding site for the transcription factor EBF1, whose gene is located at a second MPB risk locus on chr. 5q33.3. To investigate a potential interaction between EBF1 and WNT10A during MPB development, we performed in vitro luciferase reporter assays as well as expression analyses and immunofluorescence co-stainings in microdissected human hair follicles. Our experiments confirm that EBF1 activates the WNT10A promoter and that the WNT10A/EBF1 interaction is impacted by the allelic expression of the MPB risk allele at 2q35. Expression analyses across different hair cycle phases and immunhistochemical (co)stainings against WNT10A and EBF1 suggest a predominant relevance of EBF1/WNT10A interaction for hair shaft formation during anagen. Based on these findings we suggest a functional mechanism at the 2q35 risk locus for MPB, where an MPB-risk allele associated reduction in WNT10A promoter activation via EBF1 results in a decrease in WNT10A expression that eventually results in anagen shortening, that is frequently observed in MPB affected hair follicles. To our knowledge, this study is the first follow-up study on MPB that proves functional interaction between two MPB risk loci and sheds light on the underlying pathophysiological mechanism at these loci.

THE EFFICACY OF PLATELET RICH PLASMA IN TREATMENT OF ANDROGENETIC ALOPECIA

Dermoscopy is a non-invasive diagnostic technique for the observation of pigmented skin lesions, permitting the recognition of morphologic structures not visible by the naked eye. The technique consists of placing mineral oil, alcohol or even water on the skin lesion that is subsequently inspected using a hand-held lens, a hand-held dermatoscope, a stereomicroscope, a camera, or a digital imaging system. The magnifications of these various instruments range from 6x even up to 100x.The fluid placed on the lesion eliminates surface reflection and renders the cornified layer translucent, thus allowing a better visualization of pigmented structures within the epidermis, the dermoepidermal junction and the superficial dermis. Male-pattern hair loss (MPHL), also known as androgenic alopecia and male pattern baldness, is hair loss that occurs due to an underlying susceptibility of hair follicles toshrinkage due to the influence of androgenic hormones. Male-pattern hair loss is the most common cause of hair loss and will affect up to 70% of men and 40% of women at some point in their lifetimes.Men typically present with progressive hair loss at the temples and vertex balding, whereas women typically present with diffuse hair loss over the top of their scalps.Platelet-rich plasma is defined as a volume of the plasma fraction of autologus blood with an above baseline platelet concentration usually more than 1,000,000 platelets/μL.PRPs regenerative potential depends on the levels of released GFs.Alpha granules of platelets contain GFs, which upon activation, are responsible for the initiation and maintenance of the healing response. PRP is known to carry more than 20 GFs and other protein molecules, such as adhesion molecules, chemokines, which interact to promote inflammation, cell proliferation, differentiation, and regeneration.In this study, the aim was to objectively assess the proposed therapeutic effect of PRP in treatment of AGA through measuring hair density using dermoscopic evaluation, hair pull test, gross pictures and patients satisfaction scale.The study included 30 patients of different grades of androgenetic alopecia, our patients were 15 males and 15 females ranging from grade Ι to ΙΙΙ by Ludwig classification for FPHL and from grade 3 to grade 6 for Norwood and Hamilton classification for male androgenetic alopecia of a total 6 sessions, 4 successive ones with 3 weeks apart of a total 12 weeks and 2 separate sessions, 24wk and the last evaluation was done 1 year later to the 1st session.The results were classified depending on the lasting effect of the PRP into short term results lasting up to 4 months from the start of the sessions which gave statistically positive values regarding the hair pull test results and hair follicles counted by dermoscope and the long term results starting from the 5th month up to 1 year duration from the start of the sessions which showed decline in both numbers of hair pull test and Which indicatesthe needfo retreatment or addition of another line o medical treatment e.g., minoxidil or finasteride. Also PRP can be considered ahumble tool in the treatment of AGA, as it is sufficient alone without the medical treatment.