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y & Tran ap sp r la e n h t T a r t i i o a n H Hair : Therapy & Transplantation Jaffe et al, Hair Ther Transplant 2016, 6:2 DOI: 10.4172/2167-0951.1000144 ISSN: 2167-0951 Research Article Open Access Hair Regrowth Following Topical HairUpTM Treatment in Subjects with Alopecia Totalis (AT) and Alopecia Universalis (AU): A Retrospective Analysis of Efficacy and Cosmetic Acceptability Jaffe A1, Nir Y2*, Zbar AP3, Gonen-Shahar M4 and Gonen S4 1Hillel Yaffe Medical Center, Hadera, Israel 2SPRIG Consulting LLC, Wilmette, IL, USA 3Department of Anatomy, University, Melbourne, Australia 4Shmuel Gonen Technologies, Ramat Gan, Israel *Corresponding author: Nir Y, 1020 Ashland Ave, Wilmette IL 60091, USA, E-mail: [email protected] Received date: September 15, 2016; Accepted date: September 28, 2016; Published date: October 4, 2016 Copyright: © 2016 Jaffe A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Objective: Alopecia areata is a common disorder 5-30% of cases representing alopecia totalis (AT) or alopecia universalis (AU), the most severe forms of the disorder. In the absence of any FDA-approved treatments, topical Hair UpTM has shown promising results but has not been subject to formal study. The following study reports the initial use of a customized natural topical treatment-Hair UpTM in an unselected population of AT and AU patients. It includes a cohort of patients with an intention to treat and aims to serve as a pilot study to a prospective study. Methods: A retrospective analysis of AT/AU patients treated with topical Hair UpTM was conducted. The study assessed type of hair growth and the percentage hair regrowth using the severity alopecia tool (SALT) scoring system with a subjective determination of the cosmetic acceptability of response over a 2 year follow-up period. Results: Of 109 subjects, 53 with available data were eligible for analysis including 26 minors <18 years of age (mean age 10.8+4.7 years) and 27 adults (mean age 39.1+12.2 years). There were 34 subjects with AU and 19 with AT. Treatment appeared to be very safe with minimal contact reactivity. Almost all subjects achieved vellus hair growth (96%; 51/53) with 43% (23/53) developing full abundant hair and 81% (43/53) showing a return to quality vellus hair as early as 3 months after commencement of treatment. SALT scores exceeded 75% in 75% (21/28) of cases. Overall, 94% (17/18) of minors ultimately achieved a subjective cosmetically acceptable result compared with 58% (11/19) of adults (p=0.02). Conclusion: Topical Hair UpTM treatment of subjects with Alopecia totalis (AT) and Alopecia universalis (AU) is effective and safe with a high rate of terminal hair regrowth and cosmetic acceptability, particularly in minors. Keywords: Alopecia totalis; Alopecia universalis; Alopecia areata; disease lasting up to one year, will recover although most patients will SALT score; Hair regrowth; Severity alopecia tool; Topical treatment experience relapse with variable hair growth during follow-up with up to one-quarter progressing to a diagnosis of AT [6]. The pathogenesis Introduction of AA and its variants is controversial, reflecting a combined derangement of the normal hair cycle and an impairment of the status Hair loss is a common problem in the community affecting up to of protected immunological privilege enjoyed by the follicle [7]. On the 50% of both men and women during their lives. It may occur anywhere one hand an unknown signal or injury results in a premature telogen on the body but is most common on the scalp, often being divided into phase with follicular arrest so that there is cycle shortening with scarring and non-scarring types or described as focal or diffuse [1]. repeated arrest of cells in the anagen (growth) phase. This disturbance Alopecia areata (AA) is one of the commoner non-scarring hair loss occurs in tandem with an up regulation of MHC class I antigen disorders with a genetic predisposition in 20% of cases and a expression in the proximal hair follicle epithelium probably triggered prevalence rate of 2% in the overall population [2]. There is no gender by an infectious focus, bacterial super antigens, skin micro trauma or predilection where about two-thirds of cases develop before 20 years of psycho-emotional stressors and permits follicle destruction by nearby age. Severe forms of AA include Alopecia totalis (AT), a loss of all scalp immunocompetent cytotoxic T cells [8]. hair and Alopecia universalis (AU), the loss of all scalp and body hair. Both AT and AU are less common than patchy AA accounting for only There are currently no FDA-approved topical treatments for AA 5-30% of all treated alopecia cases [3]. Both AT and AU have a less with many management alternatives but no definitive curative or favorable outcome than AA, with a reported cure rate around 10% preventative therapies [9-11]. Different options have included intra- overall. The prognosis of which is worse if there is an onset prior to lesional or topical corticosteroids, topical Minoxidil, contact Anthralin, puberty, or if there is a either a positive family history of AA or topical sensitizer immunotherapies (such as squaric acid dibutylester- associated atopy [4,5]. Up to half of the AA patients with limited SADBE or diphenylcyclopropenone-DPCP) and topical psoralen-UVA Hair Ther Transplant, an open access journal Volume 6 • Issue 2 • 144 ISSN:2167-0951 Citation: Jaffe A, Nir Y, Zbar AP, Gonen-Shahar M, Gonen S (2016) Hair Regrowth Following Topical HairUpTM Treatment in Subjects with Alopecia Totalis (AT) and Alopecia Universalis (AU): A Retrospective Analysis of Efficacy and Cosmetic Acceptability. Hair Ther Transplant 6: 1000144. doi:10.4172/2167-0951.1000144 Page 2 of 6 phototherapy [12]. Hair UpTM (Ramat Gan, Israel) is an ointment targeted and extracted. Approval for analysis was provided by the local composed of 100% natural active ingredients (as defined by the US Hillel Yaffe Medical Centre Ethics Committee. At the first Personal Care Products Council) and approved for use by the Israeli consultation, subjects completed a questionnaire incorporating Ministry of Health since 1980 (approval number 1/90954/16) and the demographic data, disorder history and progression, general medical governor of the prefecture of Saga, Japan. history, the use of concomitant medications, family history regarding hair loss and any prior history of autoimmune disorders. Study The composition of Hair UpTM is shown in Table 1. It is suggested exclusion criteria were subjects using a wig attached with glue (unable that hair follicles are strengthened by an ability of some of the to be taken off daily), subjects previously treated with parenteral components to reduce local sebum secretion, whereas others have anti- corticosteroids or those without a follow-up of at least 3 treatment inflammatory or anti oxidative properties and some change the sessions. Following a cleansing shampoo, Hair UpTM was applied once nutrient milieu [13-15]. Hair Up™ has been used by a single dedicated daily over the entire scalp to include affected areas with removal after specialized clinic treating more than 20,000 subjects since 1993 where 2-3 hours. In some cases, Hair UpTM may be left on overnight and then approximately 16% of our patients suffer from Alopecia areata (AA). rinsed off in the morning. Follow-up visits were performed monthly Our previous findings with Hair UpTM (not published) have led to the until vellus hair growth was achieved (also noting return of eyebrow impression that it reduces hair loss and promotes the growth of new and/or eyelash hair with follow-up photography) and then tapered hair when follicles are still alive, resulting in an improvement in hair accordingly to every alternate month or until such time that there was appearance, hair thickening and an enhancement of hair vitality. Its cosmetically acceptable hair growth. Delayed reviews were then use appears to be safe in both sexes as well as when indicated in conducted twice yearly. The last treatment date and an overall minors. There are currently limited data concerning the long-term compliance measure were recorded. If the treatment was adjudged as outcome of AT/AU cases. A recent study with a mean follow-up of 17.7 ineffective over a period of 6 months, it was discontinued. years showed a direct relationship between the severity of Alopecia and the long-term prognosis. The study showed that despite the long follow The study used 4 methods of evaluation during follow-up. The up, among 11 patients with AT, 5 still had AT and one developed AU at methods used are the standard methods used in the literature. To the end of the study. Among the 27 patients with AU, 23 maintained minimize bias, 4 different methods of evaluation were used. their disease, while 2 developed AT; none of these patients achieved Determination of the type of hair regrowth labeled as vellus, total regrowth of hair. Out of 5 children with AU in this study, this intermediate, terminal (androgenic) or full abundant. Full abundant level of severity of the disease continued in 4 patients without regrowth was defined as hair that was terminal in type and covered the significant improvement [16]. whole scalp area. This end point was recorded as the composite of the clinic personnel’s assessment together with the patient’s response. Water (Aqua) Percentage regrowth was calculated based upon the photographic SD Alcohol 40 evidence obtained during the follow-up visits over the period of time during which the patient was treated at the clinic.
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