Scalp micropigmentation (tattoo)

Scalp micropigmentation (SMP) is a relatively new, creative technique that some people are using to conceal hair loss and camouflage scalp scars. SMP is a tattoo applied to the scalp that mimics hair follicles cut close to the scalp.(1) This is generally done by using a stippling effect where differences in densities of ink create shading and the impression of texture. The results can be quite natural provided that the ink is added in an irregular pattern (vs. a straight line) and the pattern is in the direction of hair growth.(2) SMP is thought to be most effective for people with some hair coverage or in addition to hair transplants.(2) It may also be an option for people with no long-term solution for hair loss.(1)

SMP may be a preferred choice for people with many different conditions(1), including:

• Scalp scars or hair loss from scarring alopecias, alopecia areata, or alopecia totalis
• Women with thinning hair or balding that have not responded to minoxidil or other treatments and do not qualify for a hair transplantation
• Neurosurgery scars or scars from head trauma
• Complications from older hair restoration techniques that led to thin hair in donor areas or scarring
• Chemotherapy patients who do not grow back most of their hair following treatment
• People who do not want to use wigs or topical concealers

This technique has been used in 43 Korean patients without complications.(3) However, it should be cautioned that as with any procedure, there are potential risks. Universal risks with tattoos are infections and allergies, so it is important to use a trusted, experienced tattoo artist who follows proper hygienic procedures and outlines all risks. Often trusted tattoo artists performing SMP work alongside physicians. It is also important to use an experienced tattoo artist to avoid pigment bleeding from placing the pigment in the wrong depth of the scalp (i.e. dots become larger and unnatural looking).(1) Different areas of the scalp may also react differently to ink. For example, areas with hair loss generally have less blood flow and fat, and therefore retain pigment differently than hair-bearing areas of the scalp.(1) Over time, the colours will fade and most patients will need a touch-up every few years.(2)

Tattoos have become more popular and are becoming more socially acceptable. However, it should be recognized that SMP is a permanent concealer that is performed using an artist; therefore, every person will have a different experience. These procedures are generally long (up to 8 hours) and occur over multiple sessions. As this is a relatively new technique, it is important to consult with your doctor before visiting a tattoo artist to set realistic expectations.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Rassman WR, Pak JP, Kim J, Estrin NF. Scalp micropigmentation: a concealer for hair and scalp deformities. J Clin Aesthetic Dermatol. 2015 Mar;8(3):35–42.
2. Lampeter W. Editor’s invited commentary: Micropigmentation: camouflaging scalp alopecia and scars in Korean patients. Aesthetic Plast Surg. 2014 Feb;38(1):205–6.
3. Park JH, Moh JS, Lee SY, You SH. Micropigmentation: camouflaging scalp alopecia and scars in Korean patients. Aesthetic Plast Surg. 2014 Feb;38(1):199–204.

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Looking toward the future: stem cell therapies and their role in hair loss

Hair loss can be caused by several different conditions, including androgenetic alopecia, alopecia areata, and scarring alopecia. Current strategies to prevent hair loss and restore hair include two FDA-approved drug therapies (finasteride and minoxidil) and hair transplants, although other treatment options such as laser light therapy and alternative treatments (e.g. pumpkin seed oil and rosemary oil) may be used in some cases. Stem cell therapies are increasingly being discussed as possible alternatives for hair loss treatment.(1)

Stem cells are young cells that can self-renew and develop into one of many different types of cells (e.g., fat, heart, or brain cells). Cells that have not yet differentiated into fat cells, also called pre-adipocytes or adipose-derived stem cells (ASCs) are thought to be involved in hair regeneration. For example, young fat cells play a role in activating hair stem cells while older cells regulate their activity.(2) The hair growth cycle is closely tied to fat cells; for example, the fat between layers in the skin is thicker when the hair follicle is in a growth phase (anagen) than when the hair follicle is in resting phase (telogen).(2) These fat cells secrete growth factors that can increase blood flow to the hair cells, which helps regenerate hair follicles.(2)

There is currently no conclusive data demonstrating that ASCs can increase hair growth but some studies in mice have shown that they are involved in forming hair follicles, blood vessels, and fat tissue.(2) Furthermore, a recent study examined the use of ASCs in 22 male and female patients with hair loss by administering a solution containing ASCs through an injection in the scalp every 3-5 weeks for 6 doses.(3) The number of hairs increased in both men and women (by 29 hairs and 16 hairs, respectively) within a spot circled on the scalp before treatment. In the same study, 10 patients were injected on one side of their scalp for the same amount of time. Although hair growth on the entire head was observed, more hair grew on the side where the injection was given. The ASC injection was effective in both patients taking finasteride and those not taking it, although the combination of finasteride and injection was thought to be preferable.

Another study examined ASC use in 27 female patients with pattern hair loss.(4) The ASCs were given every week for 12 weeks using a micro-needle roller. After 12 weeks, they found a 16% increase in average hair density (from an average of 105.4 hairs to 122.7 hairs /cm²) and an 11% increase in average hair thickness.

ASCs can be obtained fairly simply, through liposuction and can be increased using laboratory cultures. Although further research needs to be done in order to understand how these stem cells are involved in hair regeneration before they are used clinically, it is an interesting potential avenue for therapy in the future.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Santos Z, Avci P, Hamblin MR. Drug discovery for alopecia: gone today, hair tomorrow. Expert Opin Drug Discov. 2015 Mar;10(3):269–92.
2. Zhang P, Kling RE, Ravuri SK, Kokai LE, Rubin JP, Chai J-K, et al. A review of adipocyte lineage cells and dermal papilla cells in hair follicle regeneration. J Tissue Eng. 2014;5:2041731414556850.
3. Fukuoka H, Suga H. Hair Regeneration Treatment Using Adipose-Derived Stem Cell Conditioned Medium: Follow-up With Trichograms. Eplasty. 2015;15:e10.
4. Shin H, Ryu HH, Kwon O, Park B-S, Jo SJ. Clinical use of conditioned media of adipose tissue-derived stem cells in female pattern hair loss: a retrospective case series study. Int J Dermatol. 2015 Jun;54(6):730–5.

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Scarring alopecias Pt. 2: Lichen planopilaris

Scarring alopecias encompass several medical conditions that destroy hair follicles and replace them with scar tissue, causing permanent hair loss. Lichen planopilaris (LPP) is the most common type of scarring alopecia in adults.(1) LPP was first described in 1895 by Pringle as a subtype of lichen planus (a chronic, recurrent rash caused by inflammation) that affects the hair follicles.(2) About 17-28% of people with LPP may also have lichen planus.(2) The cause of LPP is not well understood; there are theories that it is a hair specific autoimmune disorder that causes chronic inflammation.(1) It is a rare condition that mainly occurs in white women. The average age of onset is around 52 years, however cases have spanned from 16 to 76 years.(1,3) Less frequently it has also been reported in men with average age of onset of 36 years.(1) Additionally, it may also occur within families, suggesting a possible genetic link (4) and in children (5), although both of these scenarios are rare.

Symptoms of LPP may include scaly patches of hair loss randomly throughout the scalp or grouped hair loss in the centre and sides of the scalp, similar to the more well-known pattern baldness.(2) Additional areas, such as the eyebrows, arms, legs, and pubic area may also be affected.(1) Other common complaints involve itching, pain, and burning from the inflammation.

This pattern of hair loss may also mask or be confused with alopecia areata (an immune-related hair loss condition), especially in children.(5) Disease prognosis varies from gradual onset and spontaneous remission to a chronic condition, despite treatment.(1)

The treatment goal for LPP is to stop the progression of the lesions. Therapy generally entails topical and intralesional corticosteroids, antibiotics, and anti-malarials initially and can be increased to immunosuppressant drugs.(6) Further studies have also reported the use of thalidomide, antifungals, and minoxidil, all with varying effects.(2) Please talk to your physician or hair loss expert for diagnosis and individual treatment recommendations.

Article by: M.A. MacLeod, MSc., Mediprobe Research Inc.

References

1. Lyakhovitsky A, Amichai B, Sizopoulou C, Barzilai A. A case series of 46 patients with lichen planopilaris: Demographics, clinical evaluation, and treatment experience. J Dermatol Treat. 2015 Jun;26(3):275–9.
2. Soares VC, Mulinari-Brenner F, Souza TE de. Lichen planopilaris epidemiology: a retrospective study of 80 cases. An Bras Dermatol. 2015 Oct;90(5):666–70.
3. Tandon YK, Somani N, Cevasco NC, Bergfeld WF. A histologic review of 27 patients with lichen planopilaris. J Am Acad Dermatol. 2008 Jul;59(1):91–8.
4. Misiak-Galazka M, Olszewska M, Rudnicka L. Lichen planopilaris in three generations: grandmother, mother, and daughter – a genetic link? Int J Dermatol. 2015 Dec 23;
5. Christensen KN, Lehman JS, Tollefson MM. Pediatric Lichen Planopilaris: Clinicopathologic Study of Four New Cases and a Review of the Literature. Pediatr Dermatol. 2015 Oct;32(5):621–7.
6. Spano F, Donovan JC. Efficacy of oral retinoids in treatment-resistant lichen planopilaris. J Am Acad Dermatol. 2014 Nov;71(5):1016–8.

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Rare Hair Disorders: Ringed Hair

Just as there are many reasons for hair loss, there are also many conditions which result in abnormal hair growth. In general, the less common a specific condition, the fewer the resources and information related to the disease. Moreover there are a plethora of examples of these rare hair disorders, including pili annulati.

Pili annulati is a rare hair disorder also known as ringed hair, after the cosmetic appearance of the condition. During progression of pili annulati, as the hair strand grows, abnormal spaces are created¹. Light reflects off of these spaces differently than properly formed portions of hair, making affected areas appear a different colour¹. The final result is alternating light and dark sections along the hair strand, generating the ringed appearance¹.

Pili annulati is generally restricted to scalp hair and leads to slower hair growth², although fragility does not seem to be an issue¹. It is a genetic disorder which can be inherited³ and is more noticeable in individuals with lighter hair. Therefore although the condition is present from infancy, it becomes more evident in later years as the hair whitens¹. A coincidental link to other hair disorders such as alopecia areata has also been established^1,4,5.

Fortunately, treatment is fairly simple and strait forward. The ringed look can be masked with appropriately coloured hair dye and is thus an effective treatment¹. In one documented case, therapy with traditional minoxidil and systemic steroids led to a disruption in the condition and resulted in regrowth of normal hair⁵.

Overall, although rare, pili annulati is one more cause for abnormal hair growth.

Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.

References

1. Moffitt DL, Lear JT, de Berker DA, Peachey RD. Pili annulati coincident with alopecia areata. Pediatr Dermatol 1998;15:271–3.
2. Dawber R. Investigations of a family with pili annulati associated with blue naevi. Trans St Johns Hosp Dermatol Soc 1972;58:51–8.
3. Selvåg E. [Structural abnormalities of the hair shaft]. Tidsskr Den Nor Lægeforen Tidsskr Prakt Med Ny Række 1996;116:965–7.
4. Price VH, Thomas RS, Jones FT. Pili annulati. Optical and electron microscopic studies. Arch Dermatol 1968;98:640–7.
5. Smith SR, Kirkpatrick RC, Kerr JH, Mezebich D. Alopecia areata in a patient with pili annulati. J Am Acad Dermatol 1995;32:816–8.

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Rare Hair Disorders: Beaded Hair

With the prevalence of pattern baldness, hair loss is a reasonably common phenomenon. Moreover many of the current hair restoration options as well as ongoing research is targeted to those with male, and sometimes female, pattern baldness. Despite this there are countless reasons for hair loss including congenital disorders.

Monilethrix, or beaded hair, is an inherited condition whereby strands of hair take on the appearance of beads on a necklace when viewed under a microscope¹. This very distinct shape is caused by the diameter of the hair shaft changing throughout the length of the hair. In many cases this is a result of an individual unable to produce proper keratin, the structural protein necessary for forming hair, skin and nails. Therefore, similar to alopecia areata, monilethrix may also lead to abnormalities in the nails. Additional symptoms include sparse hair growth as well as easily breakable short and brittle hair.

Monilethrix is a genetic disease which means it is passed through families. It can be recessive, meaning both parents would have to carry the mutation in order for the disease to appear in their child, or dominant, in which case just one parent with the disease could result in its appearance in the next generation. To confirm the diagnosis, hair is examined microscopically.

The most common treatment recommendations often include avoiding cosmetic damage such as exposure to sunlight, hair dye and heat styling. There has been some success with pharmaceutical treatment however, including use of retinoids² and minoxidil³. For more information, or individually suited treatment options, please speak with your physician or hair loss expert.

Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.

References

1. Zlotogorski A, Marek D, Horev L, Abu A, Ben-Amitai D, Gerad L, et al. An autosomal recessive form of monilethrix is caused by mutations in DSG4: clinical overlap with localized autosomal recessive hypotrichosis. J Invest Dermatol 2006;126:1292–6.
2. Karincaoglu Y, Coskun BK, Seyhan ME, Bayram N. Monilethrix: improvement with acitretin. Am J Clin Dermatol 2005;6:407–10.
3. Rossi A, Iorio A, Scali E, Fortuna MC, Mari E, Palese E, et al. Monilethrix treated with minoxidil. Int J Immunopathol Pharmacol 2011;24:239–42.

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