Hair Regeneration Treatment Using Adipose-Derived Stem Cell Conditioned Medium: Follow-up With Trichograms

METHODS

RESULTS

Numbers of hairs in the same area of the same patient were accurately counted using trichograms before and after treatment (Fig 1). The number of hairs increased significantly after treatment in both male (n = 11) and female (n = 11) patients (Fig 2). The mean increase in the number of hairs was 29 ± 4.1 in male patients and 15.6 ± 4.2 in female patients. No significant difference was observed between men and women. In male patients, groups with (n = 6) and without (n = 5) finasteride administration were compared. The number of hairs increased significantly after treatment in both groups (Fig 3). No significant difference was observed between groups with or without finasteride administration. Representative clinical courses are shown in Figure 4 (a male patient) and Figure 5 (a female patient).

Figure 1. TrichoScope images of a 24-year-old male patient. (A) Before treatment. The number of hairs in the circle is 126. (B) After treatment (7 months after initial treatment). The number of hairs in the circle is 141.

Figure 2. Changes in the number of hairs before and after treatment in male and female patients. *P < .01.

Figure 3. Changes in the number of hairs before and after treatment in male patients with or without finasteride administration. *P < .05.

Figure 4. A 49-year-old male patient. (A) Before treatment. (B) During treatment (4 months after initial treatment). (C) After treatment (10 months after initial treatment). (D) Final follow-up (2 years and 1 month after initial treatment).

Figure 5. A 44-year-old female patient. (A) Before treatment. (B) After treatment (7 months after initial treatment). (C) Final follow-up (1 year and 10 months after initial treatment).

In the half-side comparison study, the number of hairs was significantly increased after treatment on both the left (adipose-derived stem cell-conditioned medium) and right (placebo) sides (Fig 6). However, the increase in the number of hairs was significantly higher on the left (adipose-derived stem cell-conditioned medium) side than on the right (placebo) side (Fig 7).

Figure 6. Changes in the number of hairs before and after treatment in the half-side comparison study. *P < .05 and †P < .01.

Figure 7. Increases in the number of hairs in the half-side comparison study. *P < .01.

DISCUSSION

This study used trichograms to objectively show the positive effects of adipose-derived stem cell-conditioned medium on alopecia. To obtain accurate data, shaving and marking the area for the trichogram is important. We believe that trichograms, particularly as used in this study, offer a reliable and useful method for assessing the treatment of alopecia, although the method is semi-invasive for patients.

Treatment with adipose-derived stem cell-conditioned medium was effective, even in patients who did not take finasteride. We believe that this treatment may offer an alternative to finasteride administration and thus appears particularly useful for female patients. Although no significant difference in improvement of alopecia was seen between male patients treated using adipose-derived stem cell-conditioned medium with and without finasteride administration, we got the impression that the combination of adipose-derived stem cell-conditioned medium and finasteride is preferable to single treatment. The combination therapy was effective in our previous study as well.⁶ We believe that hairs are regulated by various factors, including androgen and cytokines. The efficacy of combination therapy should be elucidated in a future study.

Adipose-derived stem cell-conditioned medium is rich in growth factors such as vascular endothelial growth factor, hepatocyte growth factor, platelet-derived growth factor, and insulin-like growth factor 1.^2,9 Vascular endothelial growth factor controls hair growth and follicle size through angiogenesis.¹⁰ Hepatocyte growth factor is involved in the cyclic growth of hair follicles.^11,12 Platelet-derived growth factor induces and maintains the anagen phase of hair follicles.¹³ Insulin-like growth factor 1 controls the hair growth cycle and differentiation of hair shafts.¹⁴ In treatment with adipose-derived stem cell-conditioned medium, each growth factor seems likely to activate hair follicles and contribute to increasing the number of hairs in patients with alopecia. Because growth factors dose-dependently affect cells, the dose dependence of the effects of adipose-derived stem cell-conditioned medium on alopecia should be examined in a future study.

In the half-side comparison study, the finding that the number of hairs increased even on the right (placebo) side was somewhat surprising. This result might suggest that the injection itself activates hair growth via tissue injury, or that adipose-derived stem cell-conditioned medium injected on one side can affect the other side, perhaps through the local circulation.

Contraindications for adipose-derived stem cell-conditioned medium treatment are similar to those for general mesotherapy, including local skin disease, inflammation, infection, allergic disease, autoimmune disease, pregnancy, cancer, and current anticoagulant therapy. The most common complication is pain during and after injection, but this can be prevented or managed with supraorbital nerve block, occipital nerve block, local anesthesia, cooling, or administration of nonsteroidal anti-inflammatory drugs.

In conclusion, treatment using adipose-derived stem cell-conditioned medium appears highly effective for alopecia and may represent a new avenue of therapy for hair regeneration. More details about adipose-derived stem cell-conditioned medium treatment, such as long-term (over a period of years) effects and histological changes, should be elucidated in the future.