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Clinical Microneedling For Hairloss

By May 5, 2022May 17th, 2022Hair

Micro needling is a minimally invasive process that involves creating micro punctures in the skin with many small needles (1). The act of making these two to four cell-wide puncture holes sets off a chain reaction of neovascularization, growth factor release, and stimulation of Wnt protein expression (2). Orentreich and Orentreich proposed “subcutaneous incisionless surgery” for skin depressions in 1995, which became the first notion of MN (scars and wrinkles). The first modern MN gadget was released around 20 years later. Following these repeated microtraumas, the method is based on “collagen induction.” Micro needling is thought to promote hair regeneration by causing platelets and neutrophils to release growth factors (TGF-alpha, TGF-beta, and platelet-derived growth factor [PDGF]). In the papillary dermis, fibroblasts produce collagen and elastin as a result (3,4). 

Read our comprehensive guides on hairloss, their causes and solutions here first.

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Procedure for Microneedling in Alopecia

A local mixture of lidocaine and prilocaine/tetracaine cream is used to anaesthetize the patient. The scalp is prepared with betadine and regular saline solutions an hour before the treatment.

The end goal is minor erythema and pin point bleeding, which is achieved by rolling with a derma roller with a needle length of 1.5 mm (about 0.06 in) over the afflicted areas eight times in each direction.

Each operation takes about 20 to 25 minutes to complete. The scalp is washed with antiseptic solution after rolling, and antibiotic cream is given to the treated area. For the next 24 hours, the patient should refrain from washing his or her hair (5).

Benefits of Microneedling Pens vs Rollers

Microneedling Pens and Microneedling Rollers are two types of microneedling devices that needle the skin to encourage the generation of new collagen. Both are microneedling devices that aid in skin rejuvenation, however the dermapen is a more advanced equipment that has various advantages over the dermaroller. The angle at which a Derma roller must be used can increase the probability of micro tears appearing on the skin’s surface.

Microneedling pens, on the other hand, are applied vertically on the skin, making the technique far more comfortable and healing-friendly.

Efficacy of Microneedling for Androgenetic Alopecia

Micro needling has been studied extensively in AGA and has been found to have beneficial therapeutic effects.

A pilot study was conducted that was open label, nonrandomized, single group, and single center. The study was split into two parts: a screening/inclusion phase and a six-month follow-up phase. 50 patients were enrolled in this study, 36 females (29 with Androgenetic alopecia (AGA) and 7 with Telogen effluvium (TE) and 14 males (with AGA) after obtaining informed consent. All the patients had been on AGA or TE therapies for at least a year. We evaluated the efficacy and tolerability of micro needling before and after 6 months using a pull test, clinical iconography, and trichoscopy; digital images were obtained at 20, 40, and 70 magnifications at the vertex and central hairline of the scalp, and the number and diameter of the hairs were measured using Trichoscan software.

Outcome assessment:

 Between January 2017 and December 2018, A research study was conducted. A total of 36 females, 29 with AGA and 7 with TE, and 14 males with AGA participated in the study, all of whom were treated with three sessions of micro needling at four-week intervals during a six-month period. During the therapy period, no severe unfavorable side effects were observed, prompting the patients to discontinue the operations. All patients tolerated the pain of the micro needling treatment well. During derma roller therapy, there was some transient localized bleeding. A minor erythema developed in the treated area, which went away within 24 hours. 

After 6 months of treatment, all the patients reported a partial or complete reduction in hair loss, which was supported by a negative pull test, as well as a perception of increased hair density and thickening of the hair shaft diameter. Based on trichoscopical inspection, all patients had a 36.64 percent and 35.10 percent increase in frontal and vertex median density over time, respectively, indicating a clinically evident improvement (Figure 1) 
 
When the data from the separate groups was analyzed, it was shown that hair density improved dramatically in the seven patients with TE, with an increase of 52.4 percent in the frontal area and 51.97 percent at the vertex. Patients with AGA, however, demonstrated a rise in hair diameter to a lower extent, with percentage increases of 25.16 percent in the frontal area and 17.45 percent at the vertex for males and 32.35 percent at the frontal area and 35.88 percent at the vertex for females (Figure 2). (6) 

FIGURE 1 Androgenetic alopecia in a 33‐y‐old male. Clinical picture (A) and corresponding dermoscopic image (C) at baseline before derma roller treatment and clinical picture (B) and corresponding dermoscopic image (D) with increased of hair density after 6 months (Starace M, Alessandrini A Et al)
 

FIGURE 2 Androgenetic alopecia in a 28‐y‐old female. Clinical picture (A) and corresponding dermoscopic image (C) at baseline before derma roller treatment and clinical picture (B) and corresponding dermoscopic image (D) with increased of hair density after 6 months ( Starace M, Alessandrini A Et al)

Citations

1- Hou A, Cohen B, Haimovic A, Elbuluk N. Micro needling: a comprehensive review. Dermatol Surg 2017; 43: 321–339. 
2- Dhurat R, Sukesh M, Avhad G, Dandale A, Pal A, Pund P. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichology 2013; 5: 6–11. 
3- Singh A, Yadav S. Microneedling: advances and widening horizons. Indian Dermatol Online J 2016; 7: 244–254. 
4- El-Deen Yassin FE-ZS, El-Dawela R, Kerim M. Picrosirius red staining assessment of collagen after dermal roller application: a minimally invasive percutaneous collagen induction therapy. Indian J Dermatopathol Diagn Dermatol 2014; 1: 68. 
5- Alster TS, Graham PM. Microneedling: a review and practical guide. Dermatol Surg. 2018; 44:397-404 
6- Starace M, Alessandrini A, Brandi N, Piraccini BM. Preliminary results of the use of scalp microneedling in different types of alopecia. J Cosmet Dermatol. 2019; 00:1–5. 
Dr Taimur Iqbal

Dr Taimur Iqbal, MBBS Khyber Medical College, Peshawar.