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THE ALOPECIAS DIAGNOSIS AND TREATMENTS EDITED BY PIERRE BOUHANNA ERIC BOUHANNA THE ALOPECIAS Previous Books by Pierre Bouhanna Soigner et préserver ses cheveux : Les nouveaux traitements du cheveu, Editions ALPEN, Paris, 2006. Les alopécies: de la clinique au traitement, Collection Guide Pratique de Dermatologie, Editions MED’COM, Paris, 2004. Capelli e calvizie: I nuovi trattamenti, Springer Italia, Rome, 2001. Garder et retrouver ses cheveux: Les nouveaux traitements, Editions Springer, Paris, 2000. Pathologie du cheveu et du cuir chevelu, Editions Masson, Paris, 1999. Cabello y Calvicie, Las novedades médicas y quirurgicas para un problema que afecta a hombres y mujeres, Garsi, Madrid, 1998. Cabello e Calvicie, As novidades médicas cirurgicas na mulher e no homem, Andréi, Sao Paulo, 1997. Hair Replacement Surgery: Textbook and Atlas, Springer-Verlag, Berlin, Heidelberg, 1996. Cheveux et Calvitie, Les nouveautés médicales et chirurgicales chez la femme et chez l’homme, Editions SIMEP, Masson, Paris, 1994. Chirurgie de la Calvitie, Editions Springer Verlag, Paris, 1994. THE ALOPECIAS DIAGNOSIS AND TREATMENTS EDITED BY PIERRE BOUHANNA, MD, FISHRS Private Practice in Hair Restoration Surgery Director, University Diploma, Hair Pathology and Scalp Surgery (Paris VI) Consultant, Hôpital Saint-Louis de Paris (Centre Sabouraud) Paris, France ERIC BOUHANNA, MD Private Practice in Plastic Surgery and Hair Restoration Surgery Paris, France Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2016 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20150831 International Standard Book Number-13: 978-1-4822-1277-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright.com (http:// www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface Contributors vii ix 1 Biology of the hair follicle Ulrike Blume-Peytavi, Varvara Kanti, and Annika Vogt 2 Hair and scalp investigations Pierre Bouhanna 11 3 Trichoscopy Lidia Rudnicka 27 4 Hair dysplasias Juan Ferrando, L. Alheli Niebla, and Gerardo A. Moreno-Arias 33 5 Alopecia classifications Pierre Bouhanna 51 6 Management of male androgenetic alopecia Ralph M. Trüeb 59 7 Management of female androgenetic alopecia Bianca Maria Piraccini and Aurora Alessandrini 67 8 Management of diffuse alopecia Pierre Bouhanna 71 9 Management of noncicatricial circumscribed alopecia Ralph M. Trüeb 79 1 10 Traumatic alopecia Pierre Bouhanna 91 11 Management of acquired primary cicatricial alopecia Salvador Villablanca and Juan Ferrando 99 12 Management of definitive alopecia in African Americans Pierre Bouhanna 119 13 Management of definitive hair alopecia in Asians Damkerng Pathomvanich 131 14 Hair transplantation in the reconstruction of the face and scalp Alfonso Barrera 151 v c ont ent s 15 Hair Transplantaion for aesthetic surgery of the scalp and body hair Pierre Bouhanna and Eric Bouhanna 163 16 Follicular cell implantation: Research update on “hair cloning” Jerry E. Cooley 189 17 Platelet-rich plasma and stem cells Gilbert Amgar, Joseph Greco, and Fabio Rinaldi 195 18 Adjuvant therapy for alopecia: Synthetic hair implant, dermopigmentation, hair prosthesis, and hair camouflage Pierre Bouhanna and Sophie Casadio 19 Hair cosmetology Claude Bouillon and Michèle Verschoore vi 211 225 Preface The appearance of hair plays an important role in a person’s overall physical appearance and self-perception. Physicians frequently encounter patients complaining about hair alterations and alopecia of various types, while the etiology of these conditions often remains unclear. In fact, disorders of hair growth are among the most common problems confronted in the practice of dermatology. In this book, we review basic hair biology, the clinical features and pathophysiology of the major disorders of hair growth including alopecia, and the medical and surgical therapies available. We are fortunate to have internationally recognized experts contributing to this volume, and to them we express our appreciation. Special concentration has been placed on ethnicity and hair diseases, and specific medical–surgical treatments have been emphasized. Most men and women with pattern baldness will seek a remedy, and virtually all would have a full head of hair if all they had to do was snap their fingers to obtain it. As a result, we have dedicated a large portion of our practice to the restoration of hair for this group of patients. This book is organized into 19 chapters that can be schematically divided into four major categories. The first category deals with biology and hair investigations. The second category is dedicated to clinical pathology; it describes various hair diseases including all major pathological conditions of the scalp affecting hair growth. The third category emphasizes the role of aesthetic and reconstructive hair transplantation or scalp surgery. The fourth category is devoted to hair cosmetology and hair cell treatments. With this book, dermatologists, students, internists, hair transplant surgeons, endocrinologists, pediatricians, obstetricians–gynecologists, those in the pharmaceutical and cosmetic industries, laboratory workers, and any physicians who see hair loss in their regular practice are given the opportunity to understand the basic pathophysiology, clinical presentation, and various effective treatment options for patients with hair growth disorders. It is hoped that the general mission of this textbook to make the diagnosis and treatment of hair disorders concise, clear, and eminently practical, has been accomplished. Pierre Bouhanna, MD, FISHRS Director of the University Diploma of Paris for Scalp Pathology and Surgery v ii Contributors Aurora Alessandrini Department of Experimental Diagnostic and Specialty Medicine University of Bologna Bologna, Italy Gilbert Amgar Private Practice Paris, France Alfonso Barrera West Houston Plastic Surgery Clinic Houston, Texas Ulrike Blume-Peytavi Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité–Universitätsmedizin Berlin Berlin, Germany Eric Bouhanna Private Practice in Plastic Surgery and Hair Restoration Surgery Paris, France Pierre Bouhanna University Diploma of Hair and Scalp Surgery University Paris VI and Hair Bouhanna Center, Private Practice and Hospital Saint-Louis de Paris (Centre Sabouraud) Paris, France Claude Bouillon Paris, France Sophie Casadio Private Practice Marseille, France Jerry E. Cooley The Hair Center Charlotte, North Carolina Juan Ferrando Department of Dermatology Hospital Clínic Universitat de Barcelona Barcelona, Spain Joseph Greco Greco Medical Group Sarasota, Florida Varvara Kanti Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité–Universitätsmedizin Berlin Berlin, Germany Gerardo A. Moreno-Arias Department of Dermatology Hospital Clínic Universitat de Barcelona Barcelona, Spain L. Alheli Niebla Mexican Institute of Tijuana Tijuana, Mexico Damkerng Pathomvanich Center for Cosmetic and Hair Surgery Bangkok, Thailand Bianca Maria Piraccini Department of Experimental, Diagnostic, and Specialty Medicine University of Bologna Bologna, Italy Fabio Rinaldi Private Practice in Dermatology Milan, Italy Lidia Rudnicka Department of Dermatology Medical University of Warsaw Warsaw, Poland Ralph M. Trüeb Department of Dermatotrichology Center for Dermatology and Hair Diseases Zurich-Wallisellen, Switzerland Michèle Verschoore L’Oréal Research & Innovation Asnières sur Seine, France Salvador Villablanca Department of Dermatology Hospital Clinic University of Barcelona Barcelona, Spain Annika Vogt Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Charité–Universitätsmedizin Berlin Berlin, Germany ix 1 Biology of the hair follicle Ulrike Blume-Peytavi, Varvara Kanti, and Annika Vogt INTRODUCTION The spectrum of physiological functions of hair ranges from protection, e.g., from ultraviolet (UV) radiation, insulation against cold, and mechanical protection, to sensory and tactile as well as decorative and gender defining functions. Hair growth plays an important role in social and sexual communication, and hair loss may have a detrimental impact on quality of life, with significant impairment of life perceived by the affected patients. Understanding the biology of the hair follicle, its growth activity, including hair cycle regulation, is key for hair loss counseling and management. Despite the development of new treatments, hair cycle regulation and its dysregulation leading to alopecia are not yet fully understood and controllable. A greater understanding of hair biology and pathogenetic mechanisms of hair disorders could lead to new therapeutic approaches for the management of hair disorders. The majority of clinically relevant hair diseases are caused by disturbances of hair cycle regulation, differentiation and keratinization, pigmentation, and immunology of the hair follicle. Generally, the complex mechanisms of hair follicle biology are only rudimentarily understood; our current knowledge is predominantly based on structural and morphological investigations as well as on functional characterization of single cell populations. The identification of mediators and elucidation of the complex cell– cell interactions in hair cycle regulation could open up new diagnostic and therapeutic possibilities. The aim of this chapter is to present current aspects of hair follicle biology and pathophysiology and carve out their clinical relevance. HAIR FOLLICLE DEVELOPMENT The hair follicle is composed of epidermal and dermal components; the latter includes the dermal papilla and the dermal fibrous sheath that are derived from an ­aggregate of mesenchymal cells that forms directly beneath the epithelial hair germ at the onset of follicular development. The epidermal hair germ grows downward and forms the hair peg as a result of complex epidermal–­dermal interactions, which involve many pathways known from embryonic development, e.g., Hedgehog (Hh) and Wingless (Wnt) signaling. The full development of the hair follicle further requires a complex sequence of autocrine, paracrine, and endocrine signals both within and between the epidermis and the dermis. The development and differentiation of hair follicles during embryogenesis are classically divided into eight stages, characterized by distinct morphologies (Figure 1.1). ANATOMY OF THE PILOSEBACEOUS UNIT AND HAIR FOLLICLE TYPES More than 20 different cell populations are involved in the structure of the pilosebaceous unit, which includes the hair follicle, together with the sebaceous gland and the arrector pili muscle as well as the adjacent vascular supply of the hair follicle (Figure 1.2). Hair follicles compose a permanent upper segment of follicular infundibulum and isthmus and a Figure 1.1 Morphogenesis of the human hair follicle. Hair follicle formation is the result of complex sequential signaling events between the dermal mesenchyme and the overlying epithelium. Morphologically, induction, organogenesis, and cytodifferentiation phases can be determined. (With kind permission from Springer Science+Business Media: Hair Growth and Disorders, Biology of the hair follicle, 2008, 1–22, Berlin: Springer, Vogt A, McElwee KJ, and Blume-Peytavi U.) 1