Clinical, Trichoscopic And Immunohistochemical Evaluation of Autologous Adipose Derived Adult Stem Cell Injection in The Treatment of Female Pattern Hair Loss

Abstract

Female pattern hair loss (FPHL) is the preferred synonym for androgenetic alopecia in women. It is characterized by progressive replacement of terminal hairs by miniaturized vellus-like follicles. It occurs due to shortening of the hair cycle and miniaturization of hair follicle. However, FPHL pathophysiology is still not fully understood (Ramos et al., 2015). One of the most noninvasive tools for diagnosis of early FPHL is trichoscopy (the dermoscopy of hair and scalp). The main trichoscopic findings are: Hair shaft diameter diversity with increased number of miniaturized thin vellus hair especially in the fronto-parietal region, predominance of single and double hair pilo-sebaceous units, and reduction of the number of terminal hairs, increase in the number of vellus hairs (Rakwoska et al., 2009; Ramos et al., 2012). These signs are more pronounced in the frontal area when compared to the occipital area (Mubki et al., 2014). Initial treatment for FPHL is usually medical and the two FDA approved medications are minoxidil and finasteride. Apart from these, in the past several years there has been an increased interest in intervention trichology which offers an opportunity for regenerative therapy such as microneedling, platelet rich plasma (PRP) and stem cell treatments (Garg et al., 2019). Stem cell therapy, especially the use of adipose tissue and Adipose Derived Stem Cells (ADSCs) is growing in all fields of medicine. Their role in the hair growth cycle has been shown effective (Chen et al., 2011). ADSCs maintain the ability to differentiate into mesenchymal lineage cells but also secrete various growth factors that seem to play a role in neovascularization, which is important in treating various hair loss conditions (Festa et al., 2011). Moreover, addition of adipose tissue in the scalp thickens the subcutaneous layer that is typically associated with thinning in androgenetic alopecia (Kuka et al., 2020).