The Value of Trichoscopy in the Follow-up of Treatment Response in Patients With Androgenetic Alopecia

Seçil Yigen Iritaş; Deren özcan

doi:10.5826/dpc.1401a1

Authors

Seçil Yigen Iritaş Department of Dermatology, Medipol University Faculty of Medicine, Istanbul, Turkey
Deren özcan Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey

Keywords:

Trichoscopy, Androgenetic Alopecia, Follow-up of Treatment Response, hair loss, dermoscopy

Abstract

Introduction: Although trichoscopy has been used successfully in the diagnosis of androgenetic alopecia (AGA), its utility in monitoring the therapeutic outcome is not clear.

Objectives: To investigate the value of trichoscopy in the follow-up of treatment response in patients with AGA.

Methods: Ninety-five patients with AGA were included. Trichoscopic images were obtained on a 1 cm² circular area in the left frontoparietal scalp pre- and post-treatment in all and in 61 patients, respectively. Two doctors evaluated those images who are less experienced (doctor A) and experienced (doctor B) in hair diseases and trichoscopy. Terminal, vellus and total hair count (THC, VHC, ToHC) and terminal to vellus hair (T/V) ratio were determined. These numerical data were also calculated by TrichoScan analysis of the same area. The agreement between trichoscopy and TrichoScan data was assessed.

Results: The agreement between doctor A and TrichoScan was moderate for THC and ToHC pre-treatment and good post-treatment; poor for VHC and T/V ratio pre- and post-treatment. The agreement between doctor B and TrichoScan was excellent for THC, VHC and ToHC; good for T/V ratio pre- and post-treatment.

Conclusions: Trichoscopy, when performed by a doctor experienced in hair diseases and trichoscopy, can be used as a sensitive method in monitoring the treatment response in patients with AGA which is based on the determination of THC, VHC, ToHC and T/V ratio. If it is to be performed by a less experienced doctor, it can be preferred as a sensitive follow-up method using THC and ToHC.

References

Rossi A, Ferranti M, Magri F, et al. Clinical and Trichoscopic Graded Live Visual Scale for Androgenetic Alopecia. Dermatol Pract Concept. 2022;12(2):e2022078. DOI:10.5826/dpc.1202a78. PMID: 35646460. PMCID: PMC9116551.

Kanti V, Messenger A, Dobos G, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version. J Eur Acad Dermatol Venereol. 2018;32(1):11-22. DOI:10.1111/jdv.14624. PMID: 29178529.

Sperling LC, Cowper SE, Knopp EA. An atlas of hair pathology with clinical correlations. CRC Press ; 2012: 42,43.

Alessandrini AM, Bruni F, Piraccini BM, Starace M. The Effectiveness and Tolerability of Preformed Growth Factors Vehiculated Through Iontophoresis on Patients with Androgenetic Alopecia and Telogen Effluvium: A Clinical Study. Dermatol Pract Concept. 2021;11(3):e2021082. DOI:10.5826/dpc.1103a82. PMID: 34123571. PMCID: PMC8172030.

Chamberlain AJ, Dawber RP. Methods of evaluating hair growth. Australas J Dermatol. 2003;44(1):10-18. DOI:10.1046/j.1440-0960.2002.t01-1-00631.x. PMID: 12581076.

Rolf Holmann, TrichoScan: A Novel Tool For The Analysis of Hair Growth InVivo, JID Symposium Proceedings 2003;8(109):115.

Shapiro J. Hair Loss: Principles of Diagnosis and Management of Alopecia. London; 2002: 83-121.

Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. 2012;67(5):1040-1048. DOI:10.1016/j.jaad.2012.02.013. PMID: 22405573.

Elmaadawi İH, Mohamed BM, Ibrahim ZAS, et al. Stem cell therapy as a novel therapeutic intervention for resistant cases of alopecia areata and androgenetic alopecia. J Dermatolog Treat. 2018;29(5):431-440. DOI:10.1080/09546634.2016.1227419. PMID: 27553744.

Jha AK, Udayan UK, Roy PK, Amar AKJ, Chaudhary RKP. Original article: Platelet-rich plasma with microneedling in androgenetic alopecia along with dermoscopic pre- and post-treatment evaluation. J Cosmet Dermatol. 2018;17(3):313-318. DOI:10.1111/jocd.12394. PMID: 28771982.

Nichols AJ, Hughes OB, Canazza A, Zaiac MN. An Open-Label Evaluator Blinded Study of the Efficacy and Safety of a New Nutritional Supplement in Androgenetic Alopecia: A Pilot Study. J Clin Aesthet Dermatol. 2017;10(2):52-56. PMID: 28367262. PMCID: PMC5367873.

Bilgiç Temel A, Gülkesen KH, Dicle Ö. Automated digital image analysis (TrichoScan) in male patients with androgenetic alopecia; comparison with manual marking of hairs on trichoscopic images. Skin Res Technol. 2018;24(3):515-516. DOI:10.1111/srt.12449. PMID: 29363174.

Gassmueller J, Rowold E, Frase T, Hughes-Formella B. Validation of TrichoScan technology as a fully-automated tool for evaluation of hair growth parameters. Eur J Dermatol. 2009;19(3):224-231. DOI: 10.1684/ejd.2009.0640. PMID: 19220982.

Gupta M, Mysore V. Classifications of Patterned Hair Loss: A Review. J Cutan Aesthet Surg. 2016;9(1):3-12. DOI:10.4103/0974-2077.178536. PMID: 27081243. PMCID: PMC4812885.

Ray R, Sharma A. Comparison of 5% minoxidil lotion monotherapy versus its combination with autologous platelet rich plasma in androgenetic alopecia in hundred males. Med J Armed Forces India. 2021;77(3):355-362. DOI:10.1016/j.mjafi.2020.11.010. PMID: 34305291. PMCID: PMC8282514.

Ghonemy S, Alarawi A, Bessar H. Efficacy and safety of a new 10% topical minoxidil versus 5% topical minoxidil and placebo in the treatment of male androgenetic alopecia: a trichoscopic evaluation. J Dermatolog Treat. 2021;32(2):236-241. DOI:10.1080/09546634.2019.1654070. PMID: 31403367.

Bao L, Gong L, Guo M, et al. Randomized trial of electrodynamic microneedle combined with 5% minoxidil topical solution for the treatment of Chinese male Androgenetic alopecia. J Cosmet Laser Ther. 2020;22(1):1-7. DOI:10.1080/14764172.2017.1376094. PMID: 29028377.

Suchonwanit P, Srisuwanwattana P, Chalermroj N, Khunkhet S. A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in the treatment of male androgenetic alopecia. J Eur Acad Dermatol Venereol. 2018;32(12):2257-2263. DOI: 10.1111/jdv.151717. PMID: 29972712.

El Taieb MA, El Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatol Ther. 2017;30(1):10.1111/dth.12437. DOI:10.1111/dth.12437. PMID: 27791311.

Kumar MK, Inamadar AC, Palit A. A Randomized Controlled, Single-Observer Blinded Study to Determine the Efficacy of Topical Minoxidil plus Microneedling versus Topical Minoxidil Alone in the Treatment of Androgenetic Alopecia. J Cutan Aesthet Surg. 2018;11(4):211-216. DOI:10.4103/JCAS.JCAS_130_17. PMID: 3088647. PMCID: PMC6371730.

Jha AK, Vinay K, Zeeshan M, Roy PK, Chaudhary RKP, Priya A. Platelet-rich plasma and microneedling improves hair growth in patients of androgenetic alopecia when used as an adjuvant to minoxidil. J Cosmet Dermatol. 2019;18(5):1330-1335. DOI:10.1111/jocd.12864. PMID: 30693667.

Faghihi G, Iraji F, Siadat AH, Saber M, Jelvan M, Hoseyni MS. Comparison between "5% minoxidil plus 2% flutamide" solution vs. "5% minoxidil" solution in the treatment of androgenetic alopecia. J Cosmet Dermatol. 2022;21(10):4447-4453. DOI:10.1111/jocd.14788. PMID: 35152531.

Nassar A, Abdel-Aleem H, Samir M, Khattab FM. Efficacy of botulinum toxin A injection in the treatment of androgenic alopecia: A Comparative Controlled Study. J Cosmet Dermatol. 2022;21(10):4261-4268. DOI:10.1111/jocd.14817. PMID: 35100493.

Suchonwanit P, Rojhirunsakool S, Khunkhet S. A randomized, investigator-blinded, controlled, split-scalp study of the efficacy and safety of a 1550-nm fractional erbium-glass laser, used in combination with topical 5% minoxidil versus 5% minoxidil alone, for the treatment of androgenetic alopecia. Lasers Med Sci. 2019;34(9):1857-1864. DOI:10.1007/s10103-019-02783-8. PMID: 30982177.