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Journal of Cosmetic Dermatology May 2024To provide dermatologists with more clinical experience in treating androgenetic alopecia, we evaluated the effect and safety of combined microneedling therapy for... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To provide dermatologists with more clinical experience in treating androgenetic alopecia, we evaluated the effect and safety of combined microneedling therapy for androgenetic alopecia.
METHODS
Studies on combined microneedling for hair loss were comprehensively searched by us in PubMed, Excerpta Medica Database, and the Cochrane Library Database. The literature search spanned the period from 2012 to 2022. Inclusion and exclusion criteria were developed, and the literature was screened according to this criteria. The Cochrane Risk of Bias Tool was used to assess the quality of the studies. The researcher applied Revman 5.3 and Stata 15.1 software to analyze the data after extracting information from the data.
RESULTS
Finally, 13 RCTs involving 696 AGA patients were included to compare the clinical effectiveness and adverse events of combined MN therapy with single MN therapy or single drug therapy for AGA. The results of meta-analysis showed as follows: (1) Hair density and diameter changes: The combined MN group was significantly better than any single treatment group, and the differences were statistically significant (MD = 13.36, 95% CI = [8.55, 18.16], Z = 5.45, p < 0.00001; MD = 18.11, 95% CI = [13.70, 22.52], Z = 8.04, p < 0.00001; MD = 13.36, 95% CI = [8.55, 18.16], Z = 5.45, p < 0.00001; MD = 2.50, 95% CI = [0.99, 4.02], Z = 3.23, p = 0.001); (2) the evaluation of satisfaction for efficacy: The doctor satisfaction rating of the combined MN group was significantly higher than that of any single treatment group, with statistical difference (RR = 2.03, 95% CI = [1.62, 2.53], Z = 6.24, p < 0.00001). The difference between the two groups regarding patients satisfaction was not significant (RR = 3.44, 95% CI = [0.67, 17.59], Z = 1.49, p = 0.14). (3) Safety: There was no statistical difference in the incidence of adverse reactions between combination therapy and monotherapy (RR = 0.83, 95% CI = [0.62, 1.12], Z = 1.22, p = 0.22).
CONCLUSION
The combined MN group showed statistically significant improvement in hair density and diameter, and good safety compared with monotherapy.
Topics: Humans; Alopecia; Combined Modality Therapy; Cosmetic Techniques; Dry Needling; Hair; Needles; Patient Satisfaction; Percutaneous Collagen Induction; Treatment Outcome
PubMed: 38239003
DOI: 10.1111/jocd.16186 -
Journal of Cosmetic Dermatology Apr 2024Smoking-which often refers to recreational consumption of the nicotine-containing tobacco-is deemed a risk factor for both the development of and worsening of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Smoking-which often refers to recreational consumption of the nicotine-containing tobacco-is deemed a risk factor for both the development of and worsening of androgenetic alopecia (AGA). However, there is no published meta-analysis study on the effect of smoking on AGA; so, we quantitatively synthesized the evidence base pertaining to the recreational activity and this form of hair loss in men.
METHODS
We systematically searched PubMed and Scopus to identify published studies with suitable data, and pairwise meta-analyses were conducted.
RESULTS
Our search identified eight studies-and the data thereof were used across four meta-analyses. We found that ever smokers are significantly (p < 0.05) more likely, than never smokers, to develop AGA (pooled odds ratio (OR) = 1.82, 95% confidence interval (CI): 1.55-2.14). Our results showed that the odds of developing AGA are significantly (p < 0.05) higher in men who smoke at least 10 cigarettes per day, than in their counterparts who smoke up to 10 cigarettes per day (pooled OR = 1.96, 95% CI: 1.17-3.29). For men with AGA, the odds of disease progression are significantly (p < 0.05) higher among ever smokers than in never smokers (pooled OR = 1.27, 95% CI: 1.01-1.60). We found no significant (p ≥ 0.05) association between smoking intensity and disease progression.
CONCLUSIONS
Findings from the current study-which is the first meta-analysis to our knowledge reviewing the association between AGA and the extent of smoking, can guide further research and update clinical practice guidelines.
Topics: Humans; Male; Smoking; Risk Factors; Alopecia; Disease Progression
PubMed: 38174368
DOI: 10.1111/jocd.16132 -
Lasers in Medical Science Dec 2023Procedural management, including fractionated laser therapy, has been increasingly investigated for the management of androgenetic alopecia (AGA). However, no... (Meta-Analysis)
Meta-Analysis Review
Procedural management, including fractionated laser therapy, has been increasingly investigated for the management of androgenetic alopecia (AGA). However, no comprehensive resources exist detailing the efficacy of fractionated laser therapies used for the treatment of AGA. A systematic review investigating fractionated laser use for AGA was performed, separated into each distinct fractionated laser modality. A meta-analysis was performed to examine improvement in hair counts and hair shaft diameter. Fourteen studies were included for systematic review, which identified the use of erbium-glass, thulium, erbium-ytrrium:aluminum garnet (YAG), and carbon dioxide (CO) fractionated laser for the treatment of AGA. In the meta-analysis, fractionated laser combination therapy showed significant improvement in hair shaft diameter (2.51, 95% CI 2.37-2.65, I = 90.54). Fractionated laser monotherapy alone significantly improved hair shaft diameter (2.28 95% CI 2.03-2.52, I = 91.20%). This effect was durable on subgroup analysis for both erbium-glass (2.36 95% CI 2.01-2.71, I = 92.05%) and thulium (1.61 95% CI 1.08-2.15, I = < 0.00%). There was no improvement in hair shaft count for any laser modality. Erbium-glass laser is an effective modality as either monotherapy or combination with topical/injectable therapies to improve hair shaft diameter in AGA.
Topics: Humans; Erbium; Thulium; Alopecia; Hair; Laser Therapy; Treatment Outcome
PubMed: 38087122
DOI: 10.1007/s10103-023-03946-4 -
Annals of Dermatology Dec 2023
PubMed: 38086361
DOI: 10.5021/ad.22.095 -
Skin Appendage Disorders Dec 2023Combination treatments may improve the utility of approved agents for the treatment of pattern hair loss (PHL); however, head-to-head comparisons are lacking. (Review)
Review
BACKGROUND
Combination treatments may improve the utility of approved agents for the treatment of pattern hair loss (PHL); however, head-to-head comparisons are lacking.
OBJECTIVE
The aim of the study was to compare the efficacy of 5% minoxidil, platelet-rich plasma (PRP), and microneedling across adults with PHL insofar as change in total hair density at 24 weeks.
METHODS
We conducted a literature search in July 2022. Through our Bayesian network meta-analysis, we estimated treatments' surface under the cumulative ranking distribution (SUCRA) values and relative effects - in terms of mean difference (MD).
RESULTS
Data from 27 trials, totaling 1,110 patients, were extracted. Interventions were ranked based on the probability of inducing hair density improvements: 5% minoxidil plus microneedling (SUCRA = 95.8%), 5% minoxidil plus PRP (SUCRA = 64.7%), 5% minoxidil (SUCRA = 53.9%), PRP (SUCRA = 34.9%), microneedling (SUCRA = 27.8%), and PRP with microneedling (SUCRA = 22.9%). The efficacy of 5% minoxidil plus microneedling in improving total hair density was significantly greater ( < 0.05) than 5% minoxidil monotherapy (MD = 13 hairs/cm), PRP monotherapy (MD = 16 hairs/cm), and microneedling monotherapy (MD = 17 hairs/cm).
CONCLUSION
Five percent minoxidil plus microneedling is an effective treatment option for improving hair density at 6 months in adult PHL patients.
PubMed: 38058547
DOI: 10.1159/000534196 -
JPRAS Open Dec 2023Hair loss is a common condition with significant impact globally, yet its treatment efficacy and safety remain debated. Botulinum toxin A (BoNT-A) has emerged as a... (Review)
Review
BACKGROUND
Hair loss is a common condition with significant impact globally, yet its treatment efficacy and safety remain debated. Botulinum toxin A (BoNT-A) has emerged as a potential therapeutic option, but a comprehensive review on this topic is lacking
OBJECTIVE
This review critically evaluates the current evidence on BoNT-A for hair loss treatment, highlighting the gaps in previous reviews and providing a comprehensive analysis of its efficacy, safety, and future prospects.
METHODS
A systematic search of electronic databases identified relevant studies published up to September 2022
RESULTS
Prior reviews primarily focused on androgenetic alopecia and lacked the evaluation of other alopecia types and underlying mechanisms. Our review addresses this gap, incorporating a broader spectrum of hair loss conditions. Mechanisms of BoNT-A in hair growth modulation, potential side effects, and future research directions are discussed.
CONCLUSION
This review adds to the existing body of knowledge by providing a comprehensive evaluation of BoNT-A in hair loss treatment. The findings will serve as a foundation for further research and guide clinicians in making informed decisions, ultimately improving the outcomes and quality of life for individuals suffering from hair loss.
PubMed: 38021319
DOI: 10.1016/j.jpra.2023.09.006 -
Journal of Cosmetic Dermatology Apr 2024Non-scarring alopecia mainly includes androgenetic alopecia (AGA), female pattern hair loss (FPHL), alopecia areata (AA), telogen effluvium (TE), anagen effluvium (AE)... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Non-scarring alopecia mainly includes androgenetic alopecia (AGA), female pattern hair loss (FPHL), alopecia areata (AA), telogen effluvium (TE), anagen effluvium (AE) and so on. Many studies had investigated the serum 25-hydroxyvitamin D level and vitamin D deficiency of patients with these diseases, but opinions varied, and no conclusion was reached.
METHODS
Relevant articles were retrieved through PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other databases. Serum 25-hydroxyvitamin D [25(OH) D] levels and vitamin D deficiency were used as our primary outcome. The odds ratio (OR) and the standardized mean difference (SMD) with 95% confidence interval were both examined for vitamin D deficiency and levels.
RESULTS
Our meta-analysis had included a total of 3374 non-scarring alopecia patients and 7296 healthy controls from 23 studies through the inclusion criteria and exclusion criteria. We found non-scarring alopecia had decreased serum 25(OH)D level (WMD -7.29; 95% CI -9.21, -5.38) and increased vitamin D deficiency incidence (OR 3.11 95% CI 2.29, 4.22), compared with healthy controls. This meta-analysis chose to conduct random-effect model and subgroup analysis, because of the high heterogeneity (serum 25(OH)D level: I 95%, vitamin D deficiency: I = 0%).
CONCLUSION
Patients with non-scarring alopecia (including AA, FPHL, AGA and TE) have insufficient serum level of 25(OH)D and increased incidence of vitamin D deficiency. Vitamin D supplementation and monitoring for vitamin D deficiency may be helpful in treating non-scarring alopecia.
Topics: Humans; Female; Alopecia; Vitamin D; Alopecia Areata; Vitamin D Deficiency; Calcifediol
PubMed: 38010941
DOI: 10.1111/jocd.16093 -
Journal of Plastic, Reconstructive &... Jan 2024Alopecia is a common and distressing medical condition that has been related to psychiatric disorders. Stem cell-derived conditioned medium (CM), a novel therapy for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alopecia is a common and distressing medical condition that has been related to psychiatric disorders. Stem cell-derived conditioned medium (CM), a novel therapy for hair regeneration, has shown effectiveness in several trials.
METHODS
This meta-analysis aims to explore the effectiveness of stem cell-derived CM in improving hair growth for patients of alopecia. We prospectively registered this systematic review and meta-analysis in PROSPERO (CRD42023410249). Clinical trials that the enrolled participants suffering from alopecia applied stem cell-derived CM were included. We calculated the mean and standard deviation for the hair density and thickness.
RESULTS
Ten clinical trials were included in our analysis. On the basis of eight clinical trials (n = 221), our pooled results indicate that stem cell-derived CM is effective in increasing hair density (mean difference [MD]: 14.93, confidence interval [95% CI]: 10.20-19.67, p < 0.0001) and thickness (MD: 18.67, 95% CI: 2.75-34.59, p < 0.0001) (μm) in patients with alopecia. Moreover, our findings suggest that longer treatment duration is associated with significantly greater improvement than shorter treatment duration (p = 0.02). Three of the included studies were randomized controlled trials (RCTs), and when we specifically analyzed these RCTs; statistical significance could also be observed in terms of hair density (MD: 9.23, 95% CI: 1.79-16.68, p < 0.00001).
KEY MESSAGES
Stem cell-derived conditioned medium can effectively increase hair density and thickness for alopecia, and there is no difference between each method (topical application, microneedling, or injection).
Topics: Humans; Culture Media, Conditioned; Alopecia; Hair; Stem Cells; Duration of Therapy
PubMed: 37983981
DOI: 10.1016/j.bjps.2023.10.060 -
JAMA Dermatology Jan 2024Janus kinase (JAK) inhibitors are an effective treatment option for patients with certain skin-related conditions, such as atopic dermatitis, alopecia areata, and... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Janus kinase (JAK) inhibitors are an effective treatment option for patients with certain skin-related conditions, such as atopic dermatitis, alopecia areata, and vitiligo, but there is a current US Food and Drug Administration (FDA) boxed warning label for oral and topical JAK inhibitors regarding increased risk of major adverse cardiovascular events (MACE), venous thromboembolism (VTE), serious infections, malignant neoplasm, and death. However, this boxed warning was precipitated by results of the Oral Rheumatoid Arthritis Trial (ORAL) Surveillance study, which only included patients with rheumatoid arthritis, and the same association may not be observed in dermatologic conditions.
OBJECTIVE
To determine the risk of all-cause mortality, MACE, and VTE with JAK inhibitors in patients with dermatologic conditions.
DATA SOURCES
PubMed and ClinicalTrials.gov were searched from database inception to April 1, 2023.
STUDY SELECTION
This review included phase 3 randomized clinical trials with a placebo/active comparator group of JAK inhibitors used for a dermatologic indication with FDA approval or pending approval or with European Union or Japanese approval. Studies without a comparison group, case reports, observational studies, and review articles were excluded.
DATA EXTRACTION AND SYNTHESIS
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Adverse events using odds ratios (ORs) and 95% CIs were calculated using a random-effects model and the DerSimonian-Laird method. Studies were screened, data abstracted, and quality assessed by 2 independent authors. The protocol was prospectively registered with PROSPERO.
MAIN OUTCOMES AND MEASURES
Primary outcomes were a composite of adjudicated MACE and all-cause mortality, and VTE.
RESULTS
The analysis included 35 randomized clinical trials with 20 651 patients (mean [SD] age, 38.5 [10.1] years; male, 54%) and a mean (SD) follow-up time of 4.9 (2.68) months. Findings did not show a significant difference between JAK inhibitors and placebo/active comparator in composite MACE and all-cause mortality (OR, 0.83; 95% CI, 0.44-1.57) or VTE (OR, 0.52; 95% CI, 0.26-1.04).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, use of JAK inhibitors was not associated with increased risk of all-cause mortality, MACE, and VTE compared to the placebo/active comparator groups. Additional trials with long-term follow-up are needed to better understand the safety risks of JAK inhibitors used for dermatologic indications.
Topics: Humans; Male; Adult; Janus Kinase Inhibitors; Venous Thromboembolism; Arthritis, Rheumatoid; Dermatitis, Atopic; Treatment Outcome
PubMed: 37910098
DOI: 10.1001/jamadermatol.2023.4090 -
Skin Appendage Disorders Oct 2023Alopecia areata (AA) is a chronic autoimmune disease that causes non-scarring alopecia. A few studies have shown increased odds of AA in Black individuals compared to...
BACKGROUND
Alopecia areata (AA) is a chronic autoimmune disease that causes non-scarring alopecia. A few studies have shown increased odds of AA in Black individuals compared to White individuals and increased odds of AA in Latinos compared to non-Latinos. Another study showed that Asians have lower odds of AA compared to Whites. Baricitinib, a Janus kinase inhibitor (JAKi), became the first Federal Drug Administration (FDA)-approved medication for adult patients with severe AA in June 2022.
OBJECTIVES
The aim of this review was to analyze published JAKi AA randomized controlled trials to characterize and assess the racial and ethnic representation of participants. Animal studies, studies unrelated to AA, and studies not investigating JAKis were excluded.
METHODS
PubMed and clinicaltrials.gov were searched for systematic reviews of clinical trials between 1990 and 2022.
RESULTS
Six clinical trials were included with a total of 1,690 subjects. Four trials were industry-sponsored, while two were university-sponsored. The three largest races represented included White (59.9%), Asian (28.0%), and African American/Black (8.1%). Three out of the 10 patients identified as Hispanic. None of the trials included sub-analyses of clinical efficacy based on race and/or ethnicity.
CONCLUSIONS
Our results show that populations with lower odds of AA (Whites and Asians) are overrepresented in JAKi AA clinical trials compared to Black and Hispanic/Latino patients.
PubMed: 37900778
DOI: 10.1159/000531219