New Dermarolling Study

[M1A1]

You can find the study in The International Journal of Trichology- Volume : 5 | Issue : 1 | Page : 6-11

 

The results are very strong-Enjoy

 

 

Ninety four of the 100 subjects completed the 12 week study period of which 50 were treated with both Microneedling and 5% Minoxidil lotion (Microneedling group) and 44 were treated with only 5% Minoxidil lotion (Minoxidil group) (6 subjects lost to follow-up and they were not considered for efficacy evaluation). Patients demographic and hair loss features at base line were similar among the both groups.

 

Demographic characteristics

 

The mean age of the population was 28.6 years. Patients had hair loss for a mean average of 4.5 years (range: 3-10 years).

 

In Microneedling group, 23 had grade III vertex and 27 had grade IV hair loss. Similarly, in the Minoxidil group, 21 had grade III vertex and 23 had grade IV hair loss.

 

A total of 94 patients, 20 had been treated with Finasteride and Minoxidil in the past for 6 months to 1 year duration and had reported no improvement, of which twelve were randomized to the Microneedling group and eight to the Minoxidil group.

 

Efficacy assessment

 

Hair count

 

Change from baseline hair count at 12 weeks was a primary efficacy variable. There was steady increase in target area hair count over 12 weeks in subjects of Microneedling group.

 

The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs. 22.2 respectively, P = 0.039) [Figure 5] and [Table 1]. Figure 5: Mean hair counts at baseline and at end of 12 weeks in the Microneedling and Minoxidil treated group

 

Click here to viewTable 1: Change from baseline hair count at 12 weeks

 

Click here to view

 

Investigator evaluation

 

Investigator evaluation of hair growth at week 12 was a primary efficacy variable.

 

Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group [Table 2], [Figure 6] and [Figure 7]. Figure 6: Grade 3 response on 7‑point evaluation scale in the Microneedling treated group

 

Click here to viewFigure 7: Grade 0 response on 7‑point evaluation scale in patient no. 1 and grade + 1 response in patient no. 2 in the Minoxidil treated group

 

Click here to viewTable 2: Investigator evaluation of hair growth at week 12

 

Click here to view

 

Patient evaluation

 

Patient subjective evaluation of hair growth at week 12 was a primary efficacy variable. In the Microneedling group, 41 (82%) patients versus only 2 (4.5%) patients in the Minoxidil group reported more than 50% improvement [Table 3]. Table 3: Patient subjective evaluation of hair growth at week 12

 

Click here to view

 

There was no significant adverse effect in both Microneedling and Minoxidil group.

 

Other notable findings during the study period were

 

 

 

• Initiation of new hair growth was noticeable by around 6 weeks in Microneedling group and by 10 weeks in Minoxidil group.
  
• Rapid growth in the existing hair was seen at week 1 in the Microneedling group than Minoxidil group [Figure 8]. Figure 8: Earlier and faster hair re‑growth at 1 week noted in Microneedling treated group
   
  Click here to view
  
• Twelve men, unsatisfied with Finasteride and Minoxidil in the past, had +1 and +2 responses (4 and 8 men respectively) in Microneedling group on investigator's evaluation. Similar eight unsatisfied men to the previous treatment, showed no change after 12 week study period in the Minoxidil group.
  

 

Discussion

 

Minoxidil and Finasteride are the only FDA approved treatment modalities for AGA.

 

Minoxidil is a potassium channel blocker, which leads to new hair growth by causing vasodilatation of scalp blood vessels. In animal studies, topical Minoxidil shortens telogen, causing premature entry of resting hair follicles into anagen, and it probably has a similar action in humans. Minoxidil may also cause prolongation of anagen and increases hair follicle size. [7]

 

Minoxidil and Finasteride show their greatest efficacy in reducing loss of hair with small percentage of new hair growth seen after at least 4 months of daily usage. [8],[9]

 

Efficacy of Minoxidil varies from 20% to 40% as per various studies. Patients using monotherapy continue to go bald in spite of therapy. Insignificant cosmetic effect of Minoxidil causes discontinuity of treatment in majority of patients. [10]

 

DP is the site of expression of various hair growth related genes and a major target for androgen mediated events. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. [11]

 

Mechanisms of hair re-growth induced by Microneedling include: [5],[6],[12]

 

 

 

1. Release of platelet derived growth factor, epidermal growth factors are increased through platelet activation and skin wound regeneration mechanism
   
2. Activation of stem cells in the hair bulge area under wound healing conditions which is caused by a dermaroller
   
3. Overexpression of hair growth related genes vascular endothelial growth factor, B catenin, Wnt3a, and Wnt10 b.
   

Studies on repeated Microneedling stimulation by Jeong et al. [5] and Kim et al. [6] showed the enhanced expression of hair related genes and stimulation of hair in mice.

 

Kim et al. [6] also noted earlier and faster hair re-growth with more shiny texture of the hair in micro needle treated group than the untreated mice group. The authors also suggested that micro needle roller could be useful to treat hair loss refractory to Minoxidil therapy.

 

The present 12-week study showed that dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair count and patient/investigator assessment of hair growth/scalp coverage.

 

On retrospective questioning of patients after 8 months of completion of the study, at the time of writing the manuscript, all patients in the Microneedling group reported a sustainable response.

 

The results of this study show that Microneedling is a safe and a promising tool in hair stimulation both for male and female AGA and also is useful to treat hair loss refractory to Minoxidil therapy. We opine that Microneedling procedure should be offered to patients with AGA along with the existing therapeutic modalities for faster hair re-growth and better patient compliance.

 

However, issues regarding Microneedling viz; different sizes of needles of the dermaroller, frequency, duration and end point of the procedure are yet to be answered.

 

This is the first study of use of Microneedling in male AGA.

 

References

1.Kwack MH, Sung YK, Chung EJ, Im SU, Ahn JS, Kim MK, et al. Dihydrotestosterone-inducible dickkopf 1 from balding dermal papilla cells causes apoptosis in follicular keratinocytes. J Invest Dermatol 2008;128:262-9.

2.Chen D, Jarrell A, Guo C, Lang R, Atit R. Dermal β-catenin activity in response to epidermal Wnt ligands is required for fibroblast proliferation and hair follicle initiation. Development 2012;139:1522-33.

3.Reddy S, Andl T, Bagasra A, Lu MM, Epstein DJ, Morrisey EE, et al. Characterization of Wnt gene expression in developing and postnatal hair follicles and identification of Wnt5a as a target of Sonic hedgehog in hair follicle morphogenesis. Mech Dev 2001;107:69-82.

4.Plikus MV, Mayer JA, de la Cruz D, Baker RE, Maini PK, Maxson R, et al. Cyclic dermal BMP signalling regulates stem cell activation during hair regeneration. Nature 2008;451:340-4.

5.Jeong K, Lee YJ, Kim JE, Park YM, Kim BJ, Kang H. Repeated microneedle stimulation induce the enhanced expression of hair-growth-related genes. Int J Trichology 2012;4:117.

6.Kim BJ, Lim YY, Kim HM, Lee YW, Won CH, Huh CH, et al. Hair follicle regeneration in mice after wounding by microneedle roller. Int J Trichology 2012;4:117.

7.Messenger AG, Rundegren J. Minoxidil: Mechanisms of action on hair growth. Br J Dermatol 2004;150:186-94.

8.Tosti A, Duque-Estrada B. Treatment strategies for alopecia. Expert Opin Pharmacother 2009;10:1017-26.

9.Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G. Efficacy and safety of finasteride therapy for androgenetic alopecia: A systematic review. Arch Dermatol 2010;146:1141-50.

10.Schweiger ES, Boychenko O, Bernstein RM. Update on the pathogenesis, genetics and medical treatment of patterned hair loss. J Drugs Dermatol 2010;9:1412-9.

11.Zimber MP, Ziering C, Zeigler F, Hubka M, Mansbridge JN, Baumgartner M, et al. Hair regrowth following a Wnt- and follistatin containing treatment: Safety and efficacy in a first-in-man phase 1 clinical trial. J Drugs Dermatol 2011;10:1308-12.

12.O'Toole1 EA, Mellerio JE. Wound healing. In: Burns TB, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology 8 th . Blackwell Publishing. 2010. p14.1-27.

 

 

Figures

[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]

 

Tables

[Table 1], [Table 2], [Table 3]

[Fue123]

This is very interesting. This may support the theory of 'malnutriton' as discussed here:

 

**outside link removed by moderator**

 

I found this articles by Dr. Jeffrey very insightful too. Wonder if there is a connection here.

Edited August 1, 2013 by Future_HT_Doc

[greatjob]

This is very interesting. This may support the theory of 'malnutriton' as discussed here:

 

Hair Loss From Low Stomach Acid, by Jeffrey Dach MD

 

I found this articles by Dr. Jeffrey very insightful too. Wonder if there is a connection here.

The study with derma rolling isn't about malnutrition, its about wounding and up-regulating growth factors in the scalp leading to the activation of dormant stem cells in the hair follicles. It is based off of the discoveries of Dr. Cotsarelis from The University of Pennsylvania. It's basically a poor man's version of what Cotsarelis and Follica are currently studying in clinical trials. I'm not sure what stomach acid has to do with MPB.

 

I am going to order a derma roller and give this a shot. It's only one day a week and couldn't hurt anything. If I could get any regrowth in my non transplanted area it might keep me from having to undergo another procedure for a while. I have seen a few forum members on other boards getting pretty promising results and the study results are pretty impressive.

[Dr. Glenn Charles]

Interesting study. This may a helpful tool that many hair loss patients can add to their regimen. I cant imagine it causing any harm.

[Slickers]

The study with derma rolling isn't about malnutrition, its about wounding and up-regulating growth factors in the scalp leading to the activation of dormant stem cells in the hair follicles. It is based off of the discoveries of Dr. Cotsarelis from The University of Pennsylvania. It's basically a poor man's version of what Cotsarelis and Follica are currently studying in clinical trials. I'm not sure what stomach acid has to do with MPB.

 

I am going to order a derma roller and give this a shot. It's only one day a week and couldn't hurt anything. If I could get any regrowth in my non transplanted area it might keep me from having to undergo another procedure for a while. I have seen a few forum members on other boards getting pretty promising results and the study results are pretty impressive.

 

Pretty compelling study. Might give this a whirl myself. I see nanogen do their own version of a scalp roller. Greatjob could you PM the links to the other threads if you have them? Be interested to see what results their getting...

[Waterloo]

For what it is worth....I grew up in a working class neighborhood with milkmen, garbagemen etc. Garbage men carry the weight of a garbage loaded tub on their shoulder, either right or left, while walking from the customers house to the truck. Every one of those men had a large thatch of hair on the prominent shoulder used daily to carry the weight and bare the friction of the load. This struck me as a child into possibly a link to growing hair on bald pates.

[M1A1]

Dr. Charles,

Thank you for your response. At first when i read the study i was somewhat concerned as it was from India and alot of medicine from India is dubious at best.

 

But keeping an open mind and after further review of the study, it seemed at least on its own, fairly scientificaly process driven. With that said, what is your thoughts concerning the hair counts? Do they seem high? So, according to my math, this technique or modality was able to generate about the equivalent of 45 FU'S per sqaure centimeter?

 

I look forward to your response...Your time is greatly appreciated

Best,

[M1A1]

Slickers,

At this time i do not have the other links, however, other forums provide some very good information on dermarolling/microneedling-I hope my spelling is O.K. aND ONE PICTURE OF A SLICK BALD HEAD WITH WHAT APPEARS TO BE VERY GOOD EARLY GROWTH-ALMOST TO HARD TO BELIEVE.

[Ritwick]

What was the procedure of roller use in this study? How frequently did the patients use it and how? Can anyone shed some light on this?

[Ritwick]

Also, If you start use of this roller 2 months after an FUT procedure on your head, (donor and recipient areas) can that be a problem? Comment please

[M1A1]

Ritwick,

According to the study it was done once a week with a 1.5mm dermaroller. In addition, the day of microneedling, the participants in the study did not apply minox.

 

Unfortunately, the study did not specify the type of roller.

 

As far as using this after your transplant, it would be in your best interest to speak to your doctor. Hope this helps.

[Fue123]

Ritwick,

According to the study it was done once a week with a 1.5mm dermaroller. In addition, the day of microneedling, the participants in the study did not apply minox.

 

Unfortunately, the study did not specify the type of roller.

 

As far as using this after your transplant, it would be in your best interest to speak to your doctor. Hope this helps.

 

Wow a 1.5 is deep. I don't know how you can derma roll with that size needle without first numbing the area. I actually tried with my .5 on my crown and it killed. I used a topical numbing cream and it was tolerable but I can't imagine doing it with a 1.5.

[aramis69]

Tried it with a 0.5 mm and it was quite painful, brought tears to my eyes. Scalp was pretty sore for 2 days.

[Ritwick]

ok and Ouch

[DISpHAIR]

so the micro needling was done once a week, with minox applied twice daily every day other than the day of the micro needling?

[greatjob]

so the micro needling was done once a week, with minox applied twice daily every day other than the day of the micro needling?

correct

[HARIRI]

**link removed**

Edited August 6, 2013 by Future_HT_Doc

[scar5]

Calling Jotronic, calling Jotronic,

 

You are one of the best guys for pointing out picture deception and actual hair growth.

These pictures look ridiculous. The grown out pics are the biggest jokes. I mean from 0-60mph in 12 weeks?? Come on, these guys have got length on that hair that suggests that hair was stimulated and grew immediately, at turbo speed and reached the optimal length to blend in with the surrounding hair, all from being bald to full length in that time frame?

 

Secondly, the short ones are dodgy. Left side shows a beam of light coming in from the bottom left, bouncing off the hair shafts accenting their shape, where as the untreated pic, is just a dull, nebulous blur.

 

What do you make of this?

Edited August 5, 2013 by scar5
Spell

[greatjob]

Calling Jotronic, calling Jotronic,

 

You are one of the best guys for pointing out picture deception and actual hair growth.

These pictures look ridiculous. The grown out pics are the biggest jokes. I mean from 0-60mph in 12 weeks?? Come on, these guys have got length on that hair that suggests that hair was stimulated and grew immediately, at turbo speed and reached the optimal length to blend in with the surrounding hair, all from being bald to full length in that time frame?

 

Secondly, the short ones are dodgy. Left side shows a beam of light coming in from the bottom left, bouncing off the hair shafts accenting their shape, where as the untreated pic, is just a dull, nebulous blur.

 

What do you make of this?

I would generally agree with you, however this isn't some company trying to sell a product, it is a scientific study published in a respected journal. Furthermore the basic premise of this study is based on the work of Dr. Cotsarelis at the University of Pennsylvania, who is one of the top hairloss researchers in the world and is currently working with the company Follica to develop a treatment/cure based on the same principles of wounding and upregulating growth factors in order to reactivate dormant stem cells.

[HARIRI]

Guys million thanks for the information. I just ordered "Nanogen Microneedle Scalp Roller System". I have a strong belief that it will make my Minoxidil application more effective.

[HARIRI]

I have found a great study about Dermarolling:-

 

A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: A pilot study

 

**see original post**

Edited August 8, 2013 by Future_HT_Doc

[greatjob]

I have found a great study about Dermarolling:-

 

A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: A pilot study

 

A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: A pilot study Dhurat R, Sukesh M S, Avhad G, Dandale A, Pal A, Pund P - Int J Trichol

That's the same study M1A1 posted to start this tread, he just cut and pasted the text and hosted the images in the thread.

[scar5]

.. however this isn't some company trying to sell a product, it is a scientific study published in a respected journal.

 

Well, it just goes to show, doesn't it?

 

Let's face it. HT academia has many agendas, the noble ones, and among the others, written on the back of their cereal boxes, 'tacit assumption #1'. God help thee who yields to the temptation, easy as it may be, to point to elephants in the room at the dinner table that serves our collective reputation, by printing objections that can be quoted by miscreant or misaligned minds of the so called 'HT community'

 

Jotronic would bomb these pictures with napalm before adding the ketchup and mustard.

[Spartan300]

Does anyone think its safe to use a derma roller on the recipient hair, 5 months after transplant surgery?

[Dr. Glenn Charles]

I do not see any harm in using fern roller 5 months post-op