Minimally invasive procedures for the management of female pattern hair loss

Abstract

Background Female Pattern Hair Loss (FPHL) is one of the most common types of hair loss in women. It is characterized by progressive follicular miniaturization leading to diffuse hair thinning over the midfrontal scalp with a negative impact on quality of life. Pharmacological treatments are commonly used, and hair follicle transplantation is an option for those cases with adequate donor area. Minimally invasive procedures, such as microneedling, mesotherapy, microinfusion of drugs into the scalp with tattoo machines (MMP®), and platelet‐rich plasma (PRP) have been reported as adjuvant treatments. Aims This study aims to summarize and discuss the efficacy of minimally invasive procedures described for the management of FPHL. Methods Published articles indexed on the Pubmed database and Scopus that described minimally invasive procedures for the management of FPHL in humans were considered. Citations were reviewed and added for completeness. The search was for articles in English only. After excluding duplicate titles, 23 relevant articles were considered. Conclusion Minimally invasive procedures are promising options and may play a role in FPHL treatment. They can be used as adjunctive therapy for FPHL, in case of poor response to clinical therapy, or when patients prefer other care than the standard. We reinforce that these methods should be performed by an experienced medical professional following strict aseptic techniques. However, microneedling, mesotherapy, MMP, and PRP lack standardization and are supported by a low level of evidence yet. For the future, larger randomized clinical trials are essential to determine the efficacy and optimal protocols for these treatments.

Innovative Approaches and Advances for Hair Follicle Regeneration

“…There are still some limitations to the standardization of procedures regarding information such as the amount and frequency of application. 260 PRP contains a variety of growth factors and cytokines that stimulate follicle repair and regeneration, which may act synergistically in the treatment of hair loss in different ways including modulating wound repair and promoting angiogenesis. Calcium chloride or sonication induces plateletreleasing factors in PRP, and the resulting lysates and supernatants show better effects in activating telogen HFs and promoting follicle regeneration.…”

“…Yet, not all countries allow the use of blood products on an outpatient basis. There are still some limitations to the standardization of procedures regarding information such as the amount and frequency of application . PRP contains a variety of growth factors and cytokines that stimulate follicle repair and regeneration, which may act synergistically in the treatment of hair loss in different ways including modulating wound repair and promoting angiogenesis.…”

Scalp Microinfusion: A Novel Drug Delivery Technique for Hair Loss Treatment

“…The device then conveys it into the skin. The speed and needling depth can be adjusted depending on the condition to be treated and the endpoint [1][2][3][4][5][6]. Delivery with MMP ® is not affected by the medication's chemical properties [4,6].…”

“…Compared with intralesional injections, MMP ® requires less volume, reduces wasting and unwanted local side effects, and improves efficiency due to higher precision [1,2]. So far, severe side effects have not been reported [6].…”

“…Many drug delivery approaches for hair loss treatment have been developed in the last few years [1,2]. MMP ® (the Portuguese acronym for microinfusion of drugs into the skin) is a novel drug delivery technique that uses mi-cro-needling of professional tattoo machines to infuse drugs into the skin [1][2][3][4][5][6]. It was first described in the treatment of keloid and idiopathic guttate hypomelanosis [3].…”