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AESTHETIC DERMAL | Research & Publications
HAIR RESTORATION
2014/2015 | Special edition
In this publication you cand find
CLINICAL STUDY
New aspects of the treatment of
ALOPECIA AREATA
XL Hair®
A new medical approach for alopecia areata
Frequent
Q&A
Enjoy healthy hair!
AESTHETIC DERMAL | Research & Publications
OUR NEW PROJECT
BEST COMPLEMENTS FOR PROFESSIONAL TREATMENT WITH
XL HAIR REPARESTIM HAIR AD DAILY CARE HAIR
N-Acetyl Cysteine 280,5 mg
Vit. B6 0,85 mg
Picolinate de Zinc 4,87 mg
Stearate 85,36 mg
Folic Acid 0,24 mg
Arginine 24,39 mg
Biotin 0,18 mg
Proline 1,95 mg
Nicotinamide 8,84 mg
Coming Soon
2 | XL HAIR®
AESTHETIC DERMAL | INDEX
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CLINICAL STUDY
Research & Publications
To evaluate the efficacy of a combined treatment with xl hair® in different baldness patterns
CASE REPORTS
Research & Publications
To evaluate the efficacy of a combined treatment with xl hair® in different baldness patterns
CLINICAL STUDY
Clinical study to evaluate the efficacy of a combined treatment
Microneedling device, xl hair®, ad daily care hair, in different baldness patterns.
XL HAIR®
What is it
How to inject
BEFORE & AFTER PICTURES
Clinical study to evaluate the efficacy of a combined treatment
Microneedling device, xl hair®, ad daily care hair, in different baldness patterns.
IN VITRO STUDY
Increased cell proliferation of human hair papillae cells increased by 23,3% after 48h
exposure to XL Hair®
New aspects of the treatment of
ALOPECIA AREATA
FOCUS ON HAIR COLORING
& SCALP PROBLEMS
XL Hair, Reparestim TD Hair, AD Daily care Hair
XL HAIR®
A new medical approach for
ALOPECIA AREATA
REPARESTIM® HAIR TD - AD DAILY CARE
New approach in hair loss treatment
Optimally prepare the skin before hair transplantation
FREQUENT Q&A
Questions & Answers
About XL Hair®, Reparestim® Hair TD & AD Daily care
INDEX | 3
AESTHETIC DERMAL | Research & Publications
CLINICAL STUDY
TO EVALUATE THE EFFICACY OF A COMBINED
TREATMENT WITH XL HAIR® IN DIFFERENT
BALDNESS PATTERNS
by Evgeniya Ranneva, phd, dermatologist (Spain) and Gabriel Siquier, aesthetic medicine practicioner (Netherlands)
The type of hair loss known in
dermatology as alopecia has been a
problem throughout human history,
regardless of gender or age. Hair
loss could be the symptom of a the
skin disease or a complementary
symptom of other internal illness.
Hair loss is very visible and a
blurred line between health and
illness.
It is a wellknown fact
that female
(picture 1) and
male (picture 2) pattern hair loss are
different in their etiological and
physiological processes, except
in regards to the androgenic factor,
clinical symptoms, and progression
of symptoms. We specially avoid
using the words illness or disease,
because, often, hair loss is a
condition of the person’s general
appearance. On the other hand,
such conditions could develop into
an illness easily and suddenly, a fact
that may instigate impressive and
dramatic changes in psychological
status of the people. Based on the
scientific research available for
our analyses we could present the
common view on the classification
of hair loss. Different classification
forms of alopecia (hair loss) are
reported in the literature, most of
them are based on androgenic and
non-androgenic types. Testosterone
activity is the most known and
well-studied etiopathology of hair
loss. The hormone testosterone
plays an important role, seemingly
independent of genetic predisposition.
Androgenic alopecia (AGA) is an
4 | XL HAIR®
androgen-mediated disorder that
causes hair thinning in a defined
pattern. In the hair follicle cells,
testosterone converts into the
biologically more active metabolite
dihydrotestosterone (DHT) catalysed
by the enzyme 5-alpha reductase.
This hormone binds to androgenic
receptors in the hair follicle and
the specific bond
triggers cellular
processes which
reduce the anagen
phase of the hair
cycle. For this reason the hair
passes earlier into the telogen
phase and falls out. Gradually,
over succeeding cycles, large,
thick, pigmented terminal hair
converts into thinner, shorter,
indeterminate hairs and finally to
short, wispy, non-pigmented vellus
hair (i.e. the retrograde phase
of the cycle) and the hair follicle
becomes minute ( picture 3 ). The
density of the androgenic receptors
in the hair follicles varies according
to location in a manner that is
genetically determined. However, the
pathogenetic mechanisms underlying
AGA are not fully understood.
Age factors too play an important
role in AGA. The first manifestation
usually occurs in the third decade.
The prevalence of AGA increases
with ageing, from 31% at age
40–55 years to 53% at age 65–69
years .
Female pattern hair loss (FPHL),
or female patterned alopecia, is a
form of non-scarring alopecia that
might also be linked with androgen
dysfunction. Androgenic alopecia
pict 1. Female pattern hair loss (FPHL)
pict 2. Male pattern hair loss (MPHL)
pict 3. Hair follicle cycle
The hormone
testosterone plays
an important
role, seemingly
independent of genetic
predisposition.
AESTHETIC DERMAL | Research & Publications
in women is less frequent, though the etiology
is in principle the same as in men.
The actual statistic of female pattern hair loss
(FPHL) does not reflect the actual state of the
problem, as complaints of “hair loss” or “thinning
hair” are not a priority for the patients compared
to other diseases detected at the same time.
Diffuse, rapid onset, non-scarring alopecia
is not common in patterned alopecia and
should raise suspicion to the existence of iron
deficiency, thyroid disease or other endocrine
disorders such as polycystic ovarian syndrome,
medication exposure; or an autoimmune etiology.
The relationship of FPHL with pregnancy and
maternity is by now widely known.
FPHL that occurs commonly in postmenopausal
adult women is characterized by a progressive
reduction in hair density on the crown of the
scalp with sparing of the frontal hairline (Ludwig
scale). Temporal recession occurs to a lesser
degree in females compared to than in males.
After extensive research on PubMed, we were
surprised not to find any information about “the
aging process of hair”, which can be explained as
genetically determined shortening of the anagen
phase of growth with a constant telogen phase
leading to a gradual conversion of terminal hairs
into vellus hairs.
What is the clinical
difference?
The FPHL pattern varies among individuals. The
majority demonstrate mid-frontal thinning, while
others have temporal and/or vertex involvement
(the male type). Although uncommon in FPHL
as compared to male pattern (MPHL), temporal
thinning can be present and may be a first
manifestation.
In MPHL symmetric fronto-parietal retraction
of the hairline usually occurs. The hair in the
central part of the vertex is rarefied and thin. The
alopecia progresses and sooner or later results
in a bald spot on the vertex. The remaining hair is
distributed in crown-like pattern above the ears
and at the scruff of the neck. However, it also
becomes gradually thinner and silky, and grows
more slowly.
Who is suffering
more?
Despite a significantly large prevalence, many
women feel the condition is rare and are affected
socially and psychologically.
Relative to control subjects, women with
FPHL completing a standardized questionnaire
possessed a more negative body image and
a pattern of less adaptive functioning. FPHL
is solely a cosmetic concern which fosters
psychological distress for patients, as it has a
notable impact on quality of life; thus, women
seeking evaluation want successful treatments
that can minimize further hair loss while also
stimulating new hair growth or regrowth of
previously lost hairs.
Therapy
Unfortunately, no current therapy is curative
and only one FDA-approved treatment is
available at this time. Heightened interest and
demand for improved, successful treatments
have stimulated an expansion of treatments.
When presenting the existing treatments we
specify: pharmacological activity (PhA), legal
status (LS) of pharmacological substances, well
known commercial name (CN) of the product(s),
negative information & side effects (NISE).
Minoxidil - vasodilator through the stimulation
of potassium channels (PhA), medication (LS),
approved FDA.
• Topical minoxidil 2% (Rogaine, Johnson and
Johnson, New Brunswick, NJ, USA) (CN)
• Clinical effects are unpredictable. Facial
hypertrichosis (picture 4), allergy contact dermatitis
(picture 5) (NISE)
Finasteride - specific inhibitor of type II 5reductase (PhA).
• Finasteride 1 mg daily dose (Propecia, Merck
and Co, Inc, White House Station, NJ, USA) (CN)
• MPHL: Erectile dysfunction (NISE)
• FPHL: Off-label treatment (LS)
Dutasteride - inhibitor of both types I and II 5reductase (PhA).
• Dutasteride (Avodart, GlaxoSmithKline,
Research Triangle Park, NC, USA) (CN)
• MPHL: Erectile dysfunction (NISE)
CLINICAL STUDY | 5
AESTHETIC DERMAL | Research & Publications
• FPHL: Off-label treatment (LS),
teratogenicity (NISE)
Spironolactone reduces adrenal
androgen production and exerts
competitive blockade on androgen
receptors in target tissues (PhA).
• Spironolactone (Aldactone, Pfizer
Inc, New York, NY, USA) (CN)
Unfortunately, no current
therapy is curative and
only one FDA-approved treatment
is available at this time.
• MPHL: Erectile dysfunction
(NISE)
• FPHL: Teratogenicity, menstrual
irregularities. (NISE)
• Side effects of spironolactone
are dose-dependent, primarily
resulting from aldosterone effects
on the renal system, and include
hypotension, hyperkalemia, fatigue,
headache, weight loss, increased
urinary frequency, and dry skin.
(NISE)
• Off-label for both genders (LS)
Cyproterone acetate - synthetic
steroid with antiandrogen and
antigonadotropic properties with
weak progesterone activity (PhA).
• Androcur ( Schering GmbH
und Co. Produktions KG, Weimar,
Germany) (CN)
• Weight gain, menstrual
irregularities, decreased libido,
breast tenderness, feminization of a
male fetus (NISE)
• Off-label treatment for both
genders (LS)
Prostaglandin analogs (PGAs)induction of the anagen phase
in telogen hair follicles through
targeting the dermal papilla (PhA).
• Latanoprost (Xalatan, Pfizer
Inc), Travoprost (Travatan, Alcon
Laborato-ries Inc, Fort Worth, TX,
USA) (CN)
• Folliculitis, erythema, and
burning sensation (NISE)
• Off-label treatment for both
genders (LS)
6 | XL HAIR®
*Bimatoprost (Latisse, AllerganInc)
is the only FDA-approved topical
treatment for hypotrichosis of the
eyelashes.
Ketoconazole - imidazole antifungal
agent with anti-inflammatory
effects, antiandrogen effects,
inhibits steroid biosynthesis of
testicular and adrenal androgens
(PhA).
• Off-label treatment for both
genders, except direct relation with
seborrhea (LS)
Estrogens decrease the duration of
the telogen phase and increase the
duration of the anagen phase in the
human scalp (PhA).
• FPLH: the estrogen receptor beta
and the polymorphism in the gene
encoding aromatase (CYP19A1) in
hair suggest estrogen’s influence on
the hair follicle growth cycles (PhA)
• Europe : topical estrogens are
available for FPHL treatment (LS)
Hair transplant surgery
Surgical treatment of alopecia has
been successfully performed for the
past 4 decades (LS).
• The main problem is covering the
bald area with donor plugs (or follicles)
sufficient in number to be effective
(NISE) Micro-grafting produces a
more natural appearance than the old
technique of transplanting plugs.
• Scalp reduction has been attempted
to decrease the size of the scalp to be
covered by transplanted hair.
• Transplantation procedures are
often time consuming, uncomfortable,
and expensive, and may not give an
ultimate cure even after multiple
treatments (NISE) (Table1) (pictures 6/7)
Micropigmentation - pigment
implantation into the area of hair
loss with decorative & camouflage
functions (picture 8). Micro
pigmentation is not a medical
procedure (LS)
• Infection, folliculitis, and
allergic dermatitis (NISE)
pict 4. Facial hypertrichosis by
resource google.com
pict 5. Allergy contact dermatitis
pict 6. Side effect after hair
transplant surgery
pict 7. Folliculitis after hair
transplant surgery
Side effects after hair
transplant surgery
Scars
Skin infection
Folliculitis
Swelling/edema
Post treatment pain
Headache
Irregular or uneven or
delayed hair growth
Bleeding
Numbness of the scalp
Table 1. Side effect after hair transplant surgery
AESTHETIC DERMAL | Research & Publications
Hair loss is a cosmetically
and psychologically
distressing problem
It is important to diagnose early and start
treatment immediately. It has always problematic
deciding who is to treat patients experiencing hair
loss, especially because a lot of cases are due to
hormonal dysfunction falling under the purview
of gynecologists, urologists, endocrinologists,
and dermatologists. Although few medications
are currently approved for the medical treatment
of both genders, there are not many other options
that can be utilized with relatively minimal side
effects.
New medical
approach
One of the new potential treatments for hair
loss (androgenic and non-androgenic) is to use
medical devices CE class III for injections into
the scalp area or applying it using microneedling
devices. The main medical proposal for the new
therapeutic approach is to be safe, minimize
side effects during long-term therapy, and be
effective.
XL Hair® is a new opportunity for the treatment
of different baldness patterns and symptomatic
hair loss made in conformity with EU Regulation
(picture 9 ). The product is tested as being
implantable, non-allergenic, non-teratogenic,
non-cytotoxic, non-carcinogenic.
XL Hair® formula, designed for superficial
and deep dermal injections, are based on
the purest and most effective ingredients,
with synergetic actions. Non cross-linked HA
from biotechnological non-animal origin
provides:
antioxidant
effect,
turnover
stimulation
&
matrix
reorganization.
Hyaluronic acid is associated in XL Hair ®
with active biorevitalization solution and
helps to improveing the transport function of
the actives from BS. The complex actives of
BS are: growth factors GF (Rh-Polipeptide1,Copper peptide),deoxyribonucleic acid,
amino acids (Alanine, Folic Acid, Leucine,
Valine,Tyrosine ,Glycine, Histidine, Isoleucine,
Lysine, Methionine, Phenylalanine, Proline,
Serine, Threonine and etc),trace elements (Ca,
Fe, K, Mg, Mn, Na, P, Se and etc),vitamins (Vit
A,PP, B,H and etc),terpenes (Quercetin),fatty
acids (Oleic Acid ,Linoleic Acid), flavonoids
(Rutin, Kaempferol), antioxidants (Quercetin,
Citric Acid, Ginkgolides A- B- C- M), NAD,
NADP. The final target of the actives is to repair
and to stimulate hair growth, increase the
thickness of hair by improving skin nutrition
and skin defence against internal & external
stress and damage factors. Fibroblast growth
factors (FGFs) and their receptors control a
wide range of biological functions, regulating
cellular proliferation, survival, migration and
differentiation. Added to this is the delivery of
copper peptide to the base of follicles, which
helps strengthen hair while stimulating hair
follicles to produce a strong hair shaft, help
blood circulation in the scalp, and revitalize hair
follicles. Another group known as nutritional
supplementation including vitamins, minerals,
and/or antioxidants may help in hair growth and
health. Vitamins are necessary components and
play important roles in cellular metabolism.
Vitamins are considered “micronutrients” and
occur in only very small amounts within cells,
but are critically important as coenzymes.
Amino acids have several functions: the energy
storage function (proteins can be degraded into
acetyl-CoA and “cycle” the Krebs cycle) , the
endocrine integration function (hormones), the
CLINICAL STUDY | 7
AESTHETIC DERMAL | Research & Publications
informative function (membrane
receptors, intracellular signals)
Trace elements ( XL Hair® content:
Ca, Fe, K, Mg, Mn, Na, P, Se and etc)
have an influence on the binding,
transport and release of oxygen,
donate or accept electrons in
reaction of reduction or oxidation,
compensate cells nutrition and play
the structural role to important
biological molecules. The biggest
group of bioreviatlization solution
of XL Hair® is antioxidants. The
mechanisms by which these
antioxidants act at the molecular and
cellular level include roles in gene
expression and regulation, apoptosis,
and signal transduction. Antioxidants
are involved in fundamental metabolic
and homeostatic processes and help
repairing damaged biomolecules and
defence antioxidant enzymes, which
are mostly intracellular. Thanks to
their unique formula, the products
XL Hair® & Reparestim Hair® &
AD daily care Hair® are capillary
regenerators which revitalize and
strengthen capillary fiber via a greater
contribution of essential nutrients for
capillary growth and a stimulating
action of hair growth factors. The
topical (Reparestim Hair ®) and
daily care (AD daily care Hair®) are
analogs (similarly formulated) of
injectable XL Hair®, recommended
for use as complementary products
for the treatment of hair loss.
Clinical study
A multi-center, open label,
non-comparative pilot study was
performed in medical clinics in Spain,
the Netherlands, and Romania , with
47 patients (32 women and 15 men)
who had sought medical attention for
hair loss. The diagnosis of alopecia
is a combination of a detailed inquiry
into the patient’s history, including
family, social, and medical histories,
8 | XL HAIR®
as well as a comprehensive physical
examination with appropriate testing.
Hamilton referred to the mutual
interplay of androgens, genetic
and age factors in the origin of AGA
and elaborated a precise method
for the clinical assessment of
alopecia. Hamilton´s classification
was later modified by Norwood and
was used during the examination.
The pull test and non-invasive
method of microscopic hair
examination on portable video
system (Menard) was included
in the study. Exclusion criteria
included history of severe allergic
disorders, cutaneous infection or
skin alteration affecting the scalp,
known hypersensitivity or allergy,
history of autoimmune disease,
cortical or immunosuppressant
therapy, acute joint rheumatics,
repetitive angina, endocarditis, use
of anticoagulant therapy, cicatricial
alopecia, pregnancy and lactation.
The patients signed consent forms
and authorized the use of before
and after pictures.
XL Hair® (Aesthetic Dermal,
Spain) injectable CE class III
medical device for scalp area, 3 ml
per vial, single use; Reparestim
Hair® (Aesthetic Dermal, Spain) 3ml
sterile solution for topical aplication
by using sterile microneedling
medical device Class IIa AD Roll
TD® + Stamp (Aesthetic Dermal,
Spain) 0,5 mm, 600 needles by roll,
12 needles by stamp, single use;
and AD Daily Care Hair® (Aesthetic
Dermal, Spain) solution 100 ml for
personal use.
XL Hair ® injections and
Reparestim Hair application with
microneedling device AD Roll TD®
+ Stamp repeated once a week
on the area of hair loss, total 8
sessions (8 weeks) Spray AD Daily
Care Hair® recommended for
use directly onto the scalp and
with light massage ensuring the
product is well distributed over the
problematic area. Spray applied
pict 10/11 XL Hair® treatment result
before & after, front side.
pict 12/13 XL Hair® treatment result
before & after, front side.
AESTHETIC DERMAL | Research & Publications
twice a day, 3 times a week, during
minimum 12 to 24 weeks. Efficacy
was determined at the 3rd and 6th
months. Possible side effects were
assessed as well.
Patients and physicians rated
their satisfaction with the results
of the procedure at the end of
the treatment on a 4-point scale
(1=non satisfactory, 2=satisfactory,
3=good, 4=excellent).
women more than 2 years. 60 %
of women’s group had a special
diet or a nutritional deficit during 6
months/one year.
In both groups 0% of patients had
contact with any known toxin or
radiation.
More than 10% from both groups
had attacks of seborrhoeic
dermatitis more than once, but only
5 % confirmed the diagnosis by
dermatological consultation.
All patients concluded the study.
In the female group, aesthetic
improvement was significant,
starting at 8 to 12 weeks if
During clinical study we enrolled compared to before the treatment
47 patients (32 women and 15 men), (pictures 10/11) At 12 weeks 61% of
35-50 years old, who required hair female group stopped losing hair.
loss treatment targeting moderate- New hair growth was significantly
to-severe non-cicatricial alopecia increased within 24 weeks in 73%
affecting different areas, i.e. vertex, of the female group (picture 12/13).
In the male group 41% stopped
frontal and temporal. Inclusion
criteria for the study were clinical active hair loss in 12 weeks.
New hair growth was significantly
evidence of moderate-to-severe
non-cicatricial alopecia rated for increased in 24 weeks in 63%
men as grade IIa to V using the of the male group (pictures
Norwood-Hamilton classification 14/15/16/17/18/19/20/21)
60 % of both groups achieved a
and rated for women as grade I to
III using the Ludwig classification. high rate mark of satisfaction, from
Duration of progressive hair loss good to excellent. Surprisingly,
was from 5 to 10 years. 50% of more than 85% (only 61% of them
the patients previously received achieved good clinical results) of
different treatments, including 2% the male group declarated to be
Minoxidil (Rogaine), Finasteride, highly satisfied by the treatment
nutrition supplements or other included injections technique and
daily care without satisfactory daily care application, and are
motivated to continue or repeat
results.
After analyses of the anamnestic the treatment course.
data, the results are as follows:
more than 50 % of the patients have
SIDE EFFECTS
genetically related hair problems ,
32 % of the patients claim about Some patients presented untoward
a stressful life, 16% related the effects like swelling and ecchymosis
problem to pregnancy and 10 % that resolved within 24 and 48 hours.
were postmenopausal hair loss,
one patient has hypertension.
30 % of the patients from the
women’s group have anemia of
varying grades. 50 % of the patients
The results of the study indicate
from the women’s group are
®
using and hormonal contraception that injections of XL Hair and
®
for more than 6 months, 40% of Reparestim Hair TD applied with
Results
pict 14/15 XL Hair® treatment result
before & after, front side.
Conclusion
pict 16/17 XL Hair® treatment result
before & after, back side.
CLINICAL STUDY | 9
AESTHETIC DERMAL | Research & Publications
a microneedling device (AD Roll
TD® + Stamp) and combined with
AD Daily Care Hair® are an efficient
treatment for hair loss in different
baldness patterns. The results
indicate that intradermal injections
of XL Hair® and microneedling with
Reparestim ® Hair TD combined
with AD Daily Care Hair® induce the
activation of the hair follicle which
promotes en enlargement of the
anagen phase and a shortening
of the telogen phase, reversing
the miniaturization of the hair
follicles, stopping hair loss and
promoting new hair growth.
The protocol of application and
frequency of treatment have been
adapted by gender. To optimize
results, the application of AD
Daily Care Hair® cannot be less
than 6 months in duration, which
means regular home daily care
is very important for maintaining
results. The best efficacy was
observed in case of symptomatic
hair loss in female pattern: after
pregnancy, nursing period, stress,
or died. In the male pattern, which
is related to androgenic alopecia,
results are satisfactory but require
further investigation. Patient with
androgenic alopecia should be
treated longer: once every one to
two weeks for a 12 weeks duration,
at minimum. 60% of the patients
from both groups were satisfied
with the results after 24 weeks
of treatment. The biological and
pharmacological functions of XL
HAIR® (Reparestim® Hair) have not
yet been fully investigated.
1. Banka N, Bunagan MJ, Shapiro J. Pattern hair loss in men: diagnosis and medical treatment. Dermatol Clin.
2013 Jan;31(1):129-40.
2. Birch MP, Messenger JF, Messenger AG. Hair density, hair diam-eter and the prevalence of female pattern hair
loss. Br J Dermatol. 2001;144(2):297–304.
3. Birch MP, Lalla SC, Messenger AG. Female pattern hair loss. Clin Exp Dermatol. 2002;27(5):383–388.
4. Blume-Peytavi U, Lonnfors S, Hillmann K, et al. A randomized doubleblind placebo-controlled pilot study to
assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in
healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2012 May;66(5):794-800.
5. Boyapati A, Sinclair R. Combination therapy with finasteride and low-dose dutasteride in the treatment of
androgenetic alopecia. Australas J Dermatol. 2013;54(1):49–51.
6. Budd D, Himmelberger D, Rhodes T, et al. The effects of hair loss in European men: a survey in four countries.
Eur J Dermatol. 2000 Mar;10(2):122-7.
7. Cash TF, Price VH, Savin RC. Psychological effects of androgenetic alopecia on women: comparisons with
balding men and with female control subjects. J Am Acad Dermatol. 1993;29(4):568–575.
8. Camacho FM, García-Hernández M. Psychological features of androgenetic alopecia. J Eur Acad Dermatol
Venereol. 2002;16(5): 476–480.
9. Cohen JL. Enhancing the growth of natural eyelashes: the mechanism of bimatoprost-induced eyelash growth.
Dermatol Surg. 2010;36(9):1361–1371.
10.Conrad F, Paus R. Estrogens and the hair follicle. J Dtsch Dermatol Ges. 2004;2(6):412–423.
11.Conrad F, Ohnemus U, Bodo E, et al. Substantial sex-dependent differences in the response of human scalp
hair follicles to estrogen stimulation in vitro advocate gender-tailored management of female versus male
pattern balding. J Investig Dermatol Symp Proc. 2005;10(3):243–246.
12.Dill-Muller D, Zaun H. Topical treatment of androgenetic alopecia with spironolactone. J Eur Acad Dermatol
Venereol. 1997 Sep;9(Suppl 1):31.
13.Eun HC, Kwon OS, Yeon JH, et al. Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male
patients with male pattern hair loss: a randomized, double-blind, placebo-controlled, phase III study. J Am
Acad Dermatol. 2010;63(2):252–258.
14.Finner AM. Nutrition and hair: deficiencies and supplements. Dermatol Clin. 2013;31(1):167–172
15.Friedman ES, Friedman PM, Cohen DE, et al. Allergic contact dermatitis to topical minoxidil solution: etiology
and treatment. J Am Acad Dermatol. 2002 Feb;46(2):309-12.
16.Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Investig Dermatol
10 | XL HAIR®
pict 18/19 XL Hair® treatment result
before & after, front side.
pict 20/21 XL Hair® treatment result
before & after, back side.
AESTHETIC DERMAL | Research & Publications
Symp Proc. 2005 Dec;10(3):184-9.
17.Gassmueller J, Hoffmann R, Webster A. Topical fulvestrant solution has no effect on male and postmenopausal female androgenetic alopecia: results
from two randomized, proof-of-concept studies. Br J Dermatol. 2008;158(1):109–115)
18. Gormley GJ. Finasteride: a clinical review. Biomed Pharmacother. 1995;49(7–8):319–324.
19.Hoedemaker C. Treatment of female pattern hair loss with a combination of spironolactone and minoxidil. Australas J Dermatol. 2007;48(1):43–45
20.Inui S, Itami S. Reversal of androgenetic alopecia by topical ketoconzole: relevance of anti-androgenic activity. J Dermatol Sci. 2007 Jan;45(1):66-8.
21. Johnstone MA, Albert DM. Prostaglandin-induced hair growth. Surv Ophthalmol. 2002;47 Suppl 1:S185–S202.
22. Law SK. Bimatoprost in the treatment of eyelash hypotrichosis. Clin Ophthalmol. 2010;4:349-58.
23.Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977;97(3): 247–254.
24.Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004;150(2):186–194.
25. Messenger AG, Sinclair R. Follicular miniaturization in female pattern hair loss: clinicopathological correlations. Br J Dermatol. 2006;155(5): 926–930.
26. Mirmirani P. Hormonal changes in menopause: do they contribute to a ‘midlife hair crisis’ in women? Br J Dermatol. 2011;165 Suppl 3:7–11.
27.Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001;27(1):53–54.
28.Olsen EA, Hordinsky M, Roberts JL, Whiting DA; Dermatologic Consortium for Women’s Health. Female pattern hair loss. J Am Acad Dermatol.
2002;47(5):795.
29.Olsen EA, Messenger AG, Shapiro J, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005 Feb;52(2):301-11
30.Pierard-Franchimont C, De Doncker P, Cauwenbergh G, et al. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology.
1998;196(4):474-7.
31. Price VH. Treatment of hair loss. N Engl J Med. 1999;341(13): 964–973
32. Randall VA. Androgens and hair growth. Dermatol Ther. 2008;21(5): 314–328
33.Rathnayake D, Sinclair R. Innovative use of spironolactone as an anti-androgen in the treatment of female pattern hair loss. Dermatol Clin.
2010;28(3):611–618.
34. Rajput RJ. Controversy: is there a role for adjuvants in the man-agement of male pattern hair loss? J Cutan Aesthet Surg. 2010;3(2): 82–86.)
35. Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. 2008;59(4):547–566.
36. Sawaya ME, Price VH. Different levels of 5alpha-reductase type I and II, aromatase, and androgen receptor in hair follicles of women and men with
androgenetic alopecia. J Invest Dermatol. 1997;109(3): 296–300.
37.Sinclair RD, Dawber RP. Androgenetic alopecia in men and women. Clin Dermatol. 2001;19(2):167–178.
38.Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152(3):466–473.
39.Scheinfeld N. A review of hormonal therapy for female pattern (androgenic) alopecia. Dermatol Online J. 2008;14(3):1.
40. Shamsaldeen OS, Mubki TA, Shapiro J. Topical agents for hair growth promotion: what is out there? Skin Therapy Lett. 2013 Jun;18(4):5-7.
41.Unger WP, Unger RH. Hair transplanting: an important but often forgotten treatment for female pattern hair loss. J Am Acad Dermatol. 2003;49(5):853–
860
42.Whiting DA, Waldstreicher J, Sanchez M, Kaufman KD. Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts in
horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men and postmenopausal women. J Investig Dermatol Symp Proc.
1999;4(3):282–284.
43.Yip L, Rufaut N, Sinclair R. Role of genetics and sex steroid hormones in male androgenetic alopecia and female pattern hair loss: an update of what
we now know. Australas J Dermatol. 2011;52(2):81–88.
44. Yip L, Zaloumis S, Irwin D, et al. Gene-wide association study between
the aromatase gene (CYP19A1) and female pattern hair loss. Br J Dermatol. 2009;161(2):289–294.
EFFICIENCY CLINICALLY DEMONSTRATED
61%At 12 weeks stopped losing hair
73%New hair growth was significantly increased within 24 weeks in female group
60%of both groups achieved a high rate mark of satisfaction, from good to excellent
85%of the male group declarated to be highly satisfied by the treatment included injections technique and daily care application, and are motivated to continue or repeat the treatment course.
CLINICAL STUDY | 11
AESTHETIC DERMAL | Research & Publications
CASE REPORT
Main indication: Androgenic alopecia
Products: XL Hair®, AD daily care hair
Before
After
Patient age/sex: 34/Male
Area, pathology: scalp, androgenic alopecia
Type of treatment: intradermal injections, XL HAIR. Point by point injection, meso-gun
Average volume/frequency/sessions: injection of 3 ml, 1 treatment/week, average
8 treatments
Daily home care: AD daily care Hair, topical application 3 times/ week, 8 weeks
Combination treatment: Comments: exceptional improvement of hair density, stop of hair loss
Information about the doctor:
Name: Gabriel
Surname: Siquier
Country: Netherlands
Speciality: Aesthetic medicine practitioner
Web adress: [email protected]
The company Aesthetic Dermal S.L. thanks Dr. Gabriel Siquier for his ennergy and effort to participate
the study of RRS products
12 | XL HAIR®
AESTHETIC DERMAL | Research & Publications
CASE REPORT
Main indication: Hair line enlargement
Product: Reparestim® Hair TD, AD daily care hair
Before
After
Patient age/sex: 22/female
Area, pathology: scalp
Type of treatment: microneedling (AD Roll TD 0,5 mm) followed by topical application
of Reparestim® Hair TD
Average volume/frequency/sessions: 3 ml, 1 treatment/week, average 8 treatments
Daily home care: AD daily care Hair, topical application 3 times/ week, 8 weeks
Combination treatment: Comments: Evident improvement of hair density and appearance
Information about the doctor:
Name: Jane
Surname: Ranneva
Country: Spain
Speciality: Dermatologist, aesthetic medicine practitioner
Web adress: [email protected]
The company Aesthetic Dermal S.L. thanks Dr. Jane Ranneva for her enthusiasm in the development of
RRS products
CLINICAL STUDY | 13
AESTHETIC DERMAL | Research & Publications
CLINICAL STUDY TO EVALUATE THE EFFICACY OF A COMBINED TREATMENT:
MICRONEEDLING DEVICE, XL HAIR®, AD DAILY CARE HAIR, IN DIFFERENT BALDNESS PATTERNS.
HAIR PULL TEST
The hair pull test is a simple diagnostic test in which the physician lightly pulls a small amount of hair (approx 100
simultaneously) in order to determine if there is excessive loss (normal rante is 1 to 3-5 hairs per pull).
BEFORE TREATMENT
3 MONTHS AFTER TREATMENT
6 MONTHS AFTER TREATMENT
More than 5
More than 5
More than 5
More than 20
More than 20
More than 20
More than 50
More than 50
More than 50
More than 100
More than 100
More than 100
DIAGNOSTICS TESTS
Hormone levels (DHEAs, testosterone, androstenedione, prolactin, follicular
stimulating hormone, and leutinizing hormone)
Serum iron
Serum ferritin
Total iron binding capacity (TIBC)
Thyroid stimulating hormone (T3, T4, TSH)
VDRL (a screening test for syphilis)
Complete blood count (CBC)
SAVIN TEST - MEN (tick the type of alopecy)
14 | CLINICAL STUDY
NORMAL (lab)
RESULTS (pat)
AESTHETIC DERMAL | Research & Publications
CLINICAL STUDY TO EVALUATE THE EFFICACY OF A COMBINED TREATMENT:
MICRONEEDLING DEVICE, XL HAIR®, AD DAILY CARE HAIR, IN DIFFERENT BALDNESS PATTERNS.
SAVIN TEST - WOMEN (tick the type of alopecy)
Paresthesia in alopecia area
YESNO
RECOMMENDED SESSIONS: 1 per week, 8 sessions.
EVALUATION
For more information about participating, please contact us: [email protected]
EVALUATION
Doctor’s evaluation of the results
EXCELLENT
GOOD
SATISFACTORY
NON-SATISFACTORY
Patient’s evaluation of the results
EXCELLENT
GOOD
SATISFACTORY
NON-SATISFACTORY
Physician’s and clinic name
Phone / Fax
E-mail
Signature and date of the filling in
TRANSEPIDERMAL
P E N E T R AT I O N E N H A N C E M E N T
Patented Design
15 | XL HAIR®
CLINICAL STUDY | 15
AESTHETIC DERMAL | Research & Publications
XL HAIR
®
box of 6 vials / 12 vials
containing 3 ml (0,10 Fl.oz.)
Hair energy & anti aging - Symptomatic hair loss - Alopecia
- Different patterns of baldness. No age limit*
HA, non-cross-linked
BIOREVITALIZATION SOLUTION
FGF, GM peptide, Sodium DNA, amino acids,
trace elements, vitamins, terpenes, fatty acids,
flavonoids, antioxidants
MESO TREATMENT
OF SCALP
Area: scalp
Average volume/session: 3ml area
Type of injection: Micro dermal papule or nappage/32G
Frequency: 1 session / week · 1 protocol = 4-12 sessions average, 1
session / 2 weeks: 2 months
Recommended number of sessions: Repeat protocol as necessary
Combination with other aesthetic treatments:
· RRS® injection can be done immediately before microneedling device
· Home care: Daily Care Hair
RRS® XL Hair® must be used under appropriate aseptic
conditions in an authorized clinic on healthy, disinfected skin.
Before the treatment
Before the treatment, the physician should inform the patient:
- about indications and effects
- the possibilities of the side effects (pain, redness, ecchymosis,
stinging sensations and swelling, local inflammation, usually
disappearing in 24 hours)
- check allergy test
Sensitive skins may benefit from application of an anaesthetic
cream prior to the treatment
We recommend to have a consent signed by the patient.
*No studies are available for use during pregnancy and breastfeeding or in case of
treatment on children or minors under 18.
16 | XL HAIR®
After the treatment
Avoid extreme temperatures
Saunas - Hammam
Direct exposure to sun or UV
From next day make-up can be used
Contraindications:
Allergy to any of the ingredients. Patients presenting any skin
alteration, skin disease, infections or sequelae of streptococcal
infections. Patients taking immunosuppressants, undergoing
cortical therapy, with autoimmune disease history, patients
with uncompensated diabetes, acute joint rheumatics,
repetitive angina, and endocarditis.
MORE INFORMATION IN RRS-INJECT.COM/MEDINET
AESTHETIC DERMAL | Clinical Results
Before/After
Before/After
XL HAIR® | 17
AESTHETIC DERMAL | In Vitro Study
XL HAIR - Proliferation of human papilla cells. In vitro study
SUMMARY
An in vitro test has been performed on XL HAIR for efficacy assessment on Human Hair dermal
papilla cells. Cell proliferation following the exposure to the actives in particular conditions has
been evaluated.
Cell proliferation after starving at different end times througt the MTT assay: cell viability assay using
cultured dermal papilla cells from human hair follicles to assess the cell proliferation following
exposure to the test sample.
On the basis of the tests carried out, under the adopted experimentsl conditions, the sample of the test substance.
XL HAIR
Is able to increases cells proliferation with respect to untreated control cell cultures.
The highest effect (+23.3%) is pointed out at 1mg/ml of active substance after a 48 hours exposure-period.
INTRODUCTION
On behalf of AESTHETIC DERMAL an in vito test has been performed for efficacy assessment of the test product XL HAIR,
using Human Hair dermal papilla cells. The study was performed in Abich laboratory, located in Via 42 Martiri, 213/B - 28924
- Verbania - Italy.
The experimentation started on 9th June 2014 and ended on 12th June 2014.
Cells
Human Hair dermal papilla cells
Culture plate
24 wells plate
(cellular)
15000 c/well
Culture Medium
Mesenchymal stem cell medium +2,5% FBS
N
Cell synchronization
6 hours starvation
N
Cell activation
Serum free medium +/- product dilution
Proliferation assay
MTT assay
Result expression
% cell viability = [OD (500mm - 690mm) test
product/OD (500mm - 690mm) negative control]
x 100
Replicates
3
mitochondrial
reductase
N
N
N
NH
N
N
S
Br
MIT
OD = 500 nm
Formazan
% cell viability
23% increase
120
100
0.2 mg/ml
1 mg/ml
XL HAIR
18 | STUDY IN VITRO
N
S
160
140
N
Stimulates papilla cells
REGENERATION
23% proliferation gain
AESTHETIC DERMAL
New aspects of the treatment of
ALOPECIA AREATA
Ligia Brzezińska-Wcisło1, Beata Bergler-Czop1, Dominika Wcisło-Dziadecka2, Anna Lis-Święty1
1
Dermatology Department, Medical University of Silesia, Katowice, Poland Head of Dep.: Prof. Ligia Brzezińska-Wcisło MD, PhD
2
The Institute of Structural Research of Skin, Cosmetology Department of Medical University of Silesia, Katowice, Poland - Head of Dep. : Krzysztof Jasik PhD
Alopecia areata (AA) is a disease involving non-scarring hair loss determined by autoimmune
disorders and inflammation. The disease affects hair on the scalp and/or other parts of the body.
The AA occurs in people of all ages and affects 1–2% of humans. The purpose of this paper is to
present the latest knowledge on the treatment of AA. The decision on the type of treatment depends on the type of hair loss, extent of changes, general health status, the patient’s age, and
his/her motivation. Treatment methods should be chosen individually for each patient.
Alopecia areata (AA) is a disease involving non-scarring hair loss determined by autoimmune disorders and inflammation. The disease affects hair on the scalp and/or other parts of the body. The
AA occurs in people of all ages and affects 1–2% of humans. Clinical forms of AA include [1, 2]:
•
alopecia areata focalis – hair loss occurs in patches on the scalp or on other parts of the body (e.g.
face, abdomen, extremities),
•
alopecia areata totalis – the loss of all hair on the scalp (including eyebrows and eyelashes),
•
alopecia areata universalis – the loss of all or almost all body hair,
•
alopecia maligna – is a generalized long-term loss of hair, resistant to treatment,
•
ophiasis or alopecia areata marginata – snake-shaped hair loss around the circumference of the
head in the temporal, occipital and frontal areas,
•
ophiasis inversus – the inverse pattern of hair loss, which expands from the central to the marginal
area of the head,
•
alopecia areata diffusa or alopecia areata reticularis – diffuse or reticular hair loss where no separate bald patches can be distinguished.
Nails are affected in about 7–60% of
patients. Aberrations include: koilonychia,
trachyonychia, Beau lines, onychorrhexis,
nail pitting, onychomadesis, onycholysis
and haemorrhagic spotting of the lanula.
Poor prognostic factors include bald patches
persisting for more than 1 year, aggravation
or onset of hair loss before puberty, positive
family history of AA, ophiasis pattern of
involvement, associated nail changes, atopy,
and Down syndrome[1].
Typical pathological changes are manifested as
a well-separated bald spot. Skin in bald patches
may be slightly depressed due to reduced
mass of hair follicles, and mild erythema may
develop in some cases. There is no atrophy,
and on the margins, exclamation mark hair
(thick and broken off) is present. Regrowing
hair may demonstrate pigment alteration or a
change in texture (i.e. straight or curly) [2].
Because the aetiology of AA remains
unknown, the treatment is symptomatic
and does not prevent disease relapse. The
efficacy of many treatment methods has been
questioned by many scientific authorities
due to the lack of reliable clinical studies (the
possibility of spontaneous hair regrowth and
very few double-blind placebo-controlled
clinical studies). The decision on systemic
treatment depends on the type of hair
loss, the extent of changes, general health
status, the patient’s age and motivation, and
concomitant diseases. Treatment methods
should be chosen individually for each
patient.
The disease course is difficult to predict because
spontaneous remissions are frequently
observed, while in about 5% of cases the
disease progresses into total alopecia, and in
1% of cases into universal alopecia [3, 4]. After
Articles | 19
AESTHETIC DERMAL | New aspects of the treatment of alopecia areata
pict. 1/2 Alopecia areata. (Pictures don’t
relate to the original article)
pict. 3/4 Histology Alopecia areata
(Images don’t relate to the original article)
20 | Articles
completed treatment patients
must be informed about the high
risk of disease relapse [5].
In emotionally unstable patients,
each exacerbation of hair
loss symptoms may lead to a
depression phase. In patients
with psychoneurotic disorders,
increased hair loss is an underlying
symptom
of
psychopathic
personality. In frequent cases,
patients may have difficulties in
interpersonal relations at the
workplace [4] or in their private life
(withdrawal from active social life).
Alopecia areata is diagnosed
based on trichoscopy, the
hair pull test and trichogram.
Histopathological examination
can be carried out if diagnosis is
uncertain. Trichoscopy is a modern
method and is very useful in the
monitoring of treatment for AA and
the evaluation of its efficacy. This
is a non-invasive, easy to use and
painless test, which enables the
objective assessment of disease
activity. Patients need no hair
shaving or dying, images can be
recorded, and the only requirement
is the considerable experience of
the operator.
The purpose of this paper is to
present the latest knowledge on
the treatment of AA.
Systemic glucocorticosteroids
have been used in the treatment
of AA for many and in different
modalities. Generally, they offer
better outcomes in patients with
multifocal AA than in patients
with other forms of the disease.
Turkish scientists [6], in their paper
on pulse methylprednisolone
therapy for the treatment of
extensive AA, suggested that
therapy might be an option for
severe multifocal AA, but in alopecia
totalis or universalis treatment
results are unsatisfactory. The
study was carried out on 15
adult patients who received
methylprednisolone of 500 mg
intravenously on 3 consecutive
days monthly for 3 months.
According to these researchers,
pulse methylprednisolone therapy
appears to be a safe treatment
option.
Staumont-Salle et al. carried out a
10-year-long assessment of pulse
methylprednisolone therapy for AA [7].
The study included 60 patients
treated between 1995 and 2000
and confirmed the low efficiency,
both short- and long-term, of this
treatment for AA.
Researchers from Saudi Arabia [8]
evaluated the efficacy and safety
of methylprednisolone for severe
therapy-resistant AA, and found
that the use of this drug in severe
forms of AA has relative efficacy
and tolerance, but with a high
relapse rate.
In 2011, Alsantali presented a
new treatment plan for AA in
Clinical Cosmetic Investigative
Dermatology. According to this
plan, glucocorticosteroids are a
third-line option in the treatment of
AA. This includes: a once-monthly
pulse of 300 mg methylprednisone
(or a once-monthly pulse of 200
mg), intramuscular triamcinolone
acetonide of 40 mg once monthly
or oral dexamethasone of 0.5 mg/
day [9].
Some researchers from Iran
concluded that the use of
methotrexate (15–25 mg once a
week for 3 months) alone or with
low doses of glucocorticosteroids
or azathioprine alone is an
effective treatment in patients
with severe and chronic AA. This
therapy may be an alternative
option in the treatment of
patients with moderate to severe
forms of AA (due to safety and
efficacy). The study included 20
patients who had a 6-monthlong history of hair loss. Patients
received 2 mg/kg body weight of
azathioprine for 6 months. Hair
regrowth was achieved in 53% of
AESTHETIC DERMAL | New aspects of the treatment of alopecia areata
14
patients and the drug
was well tolerated
[10]
.
Droitcourt et al.
treated
patients
suffering from severe
AA using high-dose
pulse therapy with
methylprednisolone
New products are
(500
mg
unique in compositions.
intravenously per
day for 3 consecutive
Aesthetic Dermal
days monthly over 3
company developed a
new line of injectable
months) plus 15 mg
products based on
of methotrexate once
RRS® technology.
a week for the same
®
treatment period [11].
RRS products are
Of the 14 patients
medical devices made
in conformity with
(20 patients were
Regulation 93/42/CEE.
treated), 10 had total
hair regrowth and
rrs-inject.com
4 had incomplete
aestheticdermal.com
but
satisfactory
Advertising doesn’t relate to
regrowth. Treatment
original article
was well-tolerated.
The analysis of many research papers has
revealed a general controversy about the
administration of glucocorticosteroids. Most
researchers reported that the therapeutic
outcome is short-lasting and the withdrawal
of medication is followed by hair loss.
According to Miteva and Tosti [12], better
therapeutic outcomes have been observed
when treatment begins before the end of
3 months following the onset of the first
symptoms in patients with universal alopecia,
and before the end of 4 to 6 months in patients
with focal AA. Pulse therapy based on the
very short administration of high doses of
glucocorticosteroids is associated with
a lower number of adverse effects. Such
therapy should be considered in adults with
total or universal alopecia resistant to topical
treatment or phototherapy [5].
Bhat et al.[ 13] assessed levels of trace elements
(zinc, copper and magnesium) in patients
with AA. Fifty patients were studied. Samples
were analyzed using atomic absorption
spectrometric methods. Serum zinc levels were
decreased in AA patients compared to healthy
controls. Serum copper and magnesium levels
showed an insignificant rise.
The combination therapy (PUVA with 20 mg
RRS®
prednisone) may modify the immune system
and increase the number of Treg cells,
resulting in hair regrowth in patients with AA
[12]
. Hair regrowth was achieved in 100% of
patients and 22% of patients had a relapse of
hair loss 3 months after the termination of the
treatment. Authors emphasized the efficacy
of this method mainly in patients with AA
resistant to treatment.
Limitations on the use of cyclosporine in the
treatment of AA result from the high relapse
rate after the termination of therapy, the need
for long-term drug administration, and adverse
effects, e.g. nephrotoxicity [5].
Ito et al. [14] concluded that spontaneous
remission occurs in 80% of patients with AA
within 1 year, and not all patients require intense
therapy, and therefore watchful observation is
one of the therapeutic options. However, when
hair loss is progressing, treatment becomes
necessary, and pulse methylprednisolone
should be preferred.
Korean scientists studied the effects of
intradermal botulinum toxin injections on AA
(3 times on each side of the head). One patient
reported aggravation, and the remaining
patients had no local improvement. These
results suggest that botulinum toxin injections
are not useful as a treatment in AA [15].
Some scientists from Iran claim that
antidepressant treatment may result in
improvement in local conditions in patients
with AA who have depressive disorders [16].
Other scientists claim that hypnotherapy
may be effective in achieving a significant
improvement and maintaining good emotional
status and life quality in patients with resistant
AA.
The use of biologics in the treatment of AA
was also tested but no significant efficacy
was shown, and there are some reports on
aggravation during therapy [17].
Luk et al. [18] studied the efficacy and safety of
diphenylcyclopropenone (DPCP) in Chinese
patients with AA resistant to treatment
with steroids and reported a good response
achieved in over 50% of treated subjects.
Campuzano-Maya, of Colombia, described
the case of a 43-year-old patient with an
8-month history of AA of the scalp and beard.
The urea breath test confirmed Helicobacter
pylori infection. The patient went into remission
Articles | 21
AESTHETIC DERMAL | New aspects of the treatment of alopecia areata
from AA after H. pylori eradication [19].
There were also attempts to treat patients
with AA with exposure to narrow-UVB to
the medium total dose of 63.9 J/cm2 or
bexarotene gel, and different regrowth was
achieved [20, 21].
There are also reports describing the effects
of locally administered vitamin D analogues in
the treatment of AA, and a comparative study
on local treatment with 0.05% clobetasol and
1% pimecrolimus, where similar efficacy
was found for both products [22].
Researchers from Iran determined the
efficacy of topical triiodothyronine in patients
with patchy AA. Ten patients with AA were
treated with topical triiodothyronine and
placebo applied twice daily. Hair regrowth
was evaluated every 4 weeks. Blood count,
along with thyroid function (T3, T4 and TSH)
and liver function were also tested. After 12
weeks of treatment, there was no statistically
significant difference between the outcome
in the active treatment and placebo groups.
Triiodothyronine was safe but not more
effective than placebo [23].
Literature data on the effects of
sulphasalazine on the treatment of AA can be
compared with the efficacy of cyclosporine
alone. Sulphasalazine is an efficient drug in
cases resistant to other treatment methods,
but offers a much poorer outcome in patients
who had disease onset in childhood [5].
In some patients there is a clear correlation
between AA and the nervous system function,
and bald patches may occur suddenly after
severe emotional trauma, both in children
and adults. According to Manolache et al., the
most frequent stressful events include the
beginning of school or pre-school education,
exams, change of school/group, problems with
teachers, intensive studying, social problems
with peers, death in the family, family financial
problems, emigration of parents for work
reasons, concomitant diseases and surgical
procedures [24].
In addition, Willemsen et al. carried out a study
to investigate whether adult AA is associated
with childhood or total lifetime traumatic
events. The study was carried out using the
“Traumatic Experiences Checklist” [25]. Ninety
patients and 91 people from the control group
were surveyed. The study demonstrated that
the frequency of AA is affected by lifetime
traumatic events. Also, there was an increased
history of childhood trauma in patients with
AA compared with control subjects.
Picture and information bellow don’t related to the original article
«Trichotillomania (TTM) is a behavioral disorder characterized by recurrent and
overwhelming urges to pull out body hair, accompanied by a sense of pleasure and
relief after the hair has been plucked. Although the exact incidence of TTM is not
known, it is estimated to affect as high as 4% of the population. TTM appears to be
common in children and adolescents. Despite the adult cases who generally develop
a chronic course and exhibit an accompanying psychopathology, in children TTM is
usually a self-limited benign condition often considered to be a simple habit disorder.»
Interantional Jurnal of trichology/ Year : 2014 | Volume : 6 | Issue : 2 | Page : 77-79
pict. 1 Trichotillomania, female patient before treatment
22 | Articles
pict. 2 Female patient after treatment with XL Hair once per week
AD Daily Care Hair once per day, 4 weeks (courtesy dr. Ranneva)
AESTHETIC DERMAL | New aspects of the treatment of alopecia areata
Alsantali [9], in his paper published in Clinical
Cosmetic
Investigative
Dermatology,
presented new treatment options for AA.
First-line therapies include intralesional
triamcinolone
acetonide
injections
(2.5–10 mg/ml, maximum volume of 3
ml in a single injection, repeated at 4–6
weekly intervals). The drug can also be
administered using mesotherapy multiinjectors. Other treatment options include
topical corticosteroids (creams, gels,
ointments, lotions, and foams), followed by
minoxidil, anthralin, topical immunotherapy,
prostaglandin analogues, topical retinoids
and capsaicin [9]. Second-line therapies
include oral sulfasalazine of 500 mg twice
daily at the start, then 1 g twice daily for 1
month, and then 1 g three times daily for
3 months, PUVA, PUVA-turban, excimer
laser and fractional photothermolysis
laser. Third-line therapies include systemic
corticosteroids (pulse doses), methotrexate
15–25 mg/weekly for 3 months, cyclosporine
A, azathioprine, biologics and psychological
support. Other therapies mentioned by
Alsantali that have some degree of success
include garlic gel, azelaic acid, topical onion
juice, imiquimod, calcineurin inhibitors,
botulinum toxin and photodynamic therapy.
An important element of the management
of AA is offering psychological support
to stimulate increased self-esteem and
adaptation to this disease. Some patients with
AA require the support of a psychologist or
psychiatrist. With psychological support and
education of the patient about the disease,
long-term improvement can be achieved [1, 3].
It is also worth noting that when AA is limited
to a single patch, the best option in most
patients is leaving it untreated, as 80% of
patients with single patches present for less
than one year go into spontaneous remission [26]
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
Brzezińska-Wcisło L, Lis-Święty A. Hair diseases – what’s new? In: Szepietowski J, Reich A, editors.Dermatology – what’s new? [Polish] Wrocław: Cornetis; 2009. pp. 187–200.
Burgdorf WHC, Plewig G, Wolff HH, Landthaler M. Braun-Falco Dermatology [Polish] Lublin: Czelej; 2010. Hair diseases; pp. 1053–83.
Brzezińska-Wcisło L, Lis A, Kamińska G, Wcisło-Dziadecka D. Physiology and pathology of hair growth and loss on the human scalp [Polish] Postep Derm Alergol. 2003;20:260–6.
Brzezińska-Wcisło L, Wcisło-Dziadecka D, Meszyńska E, et al. New perspectives on the pathogenesis and treatment of hair disorders. Post Nauk Med. 2012;10:800–5.
Łuczak M, Łuczak T, Cieścińska C, Czajkowski R. General treatment of alopecia areata [Polish] Przegl Dermatol. 2013;100:53–8.
Acikgöz G, Ozmen I, Cayirli M, et al. Pulse methylprednisolone therapy for the treatment of extensive alopecia areata. J Dermatolog Treat. 2014;25:164-6
Staumont-Sallé D, Vonarx M, Lengrand F, et al. Pulse corticosteroid therapy for alopecia areata: log-term outcome after 10. Dermatology. 2012;225:81–7. Bin Saif GA, Al-Khawajah MM, Al-Otaibi HM, et al. Efficacy and safety of oral mega pulse methylprednisolone for severe therapy resistant Alopecia areata. Sudi Med
J. 2012;33:284–91. Alsantali A. Alopecia areata: a new treatment plan. Clin Cosmet Investig Dermatol. 2011;4:107–15.
Farshi S, Mansouri P, Safar F, Khiabanloo SR. Could azathioprine be considered as a therapeutic alternative in the treatment of alopecia areata? A pilot study. Int J
Dermatol. 2010;49:1188–93. Droitcourt C, Milpied B, Ezzedine K, et al. Interest of high-dose pulse corticosteroid therapy combined with methotrexate for severe alopecia areata: a retrospective case
series. Dermatology. 2012;224:369–73.
Miteva M, Tosti A. Treatment options for alopecia: an update looking to the future. Expert Opin Pharmocter. 2012;13:1271–81. Bhat YJ, Manzoor S, Khan AR, Qayooni S. Trace element levels in alopecia areata. Indian J Dermatol Venereol Leprol. 2009;75:29–31. Ito T, Aoshima M, Ito N, et al. Combination therapy with oral PUVA and corticosteroid for recalcitrant alopecia areata. Arch Dermatol Res. 2009;301:373–80.
Cho HR, Lew BL, Lew H, Sim WY. Treatment effects of intradermal botulinum toxin type A injection on alopecia areata. Dermatol Surg. 2010;4:2175–81. Abedini H, Farshi S, Mirabzadeh A, Keshavarz S. Antidepressant effects of citalopram on treatment of alopecia areata in patients with major depressive disorder. J Dermatolog
Treat. 2014;25:153–5.
Otberg N. Systemic treatment for alopecia areata. Dermatol Ther. 2011;24:320–5. Luk NM, Chiu LS, Lee KC, et al. Efficacy and safety of diphenylcyclopropenone among Chinese patients with steroid resistant and extensive alopecia areata. J Eur Acad
Dermatol Venereol. 2013;27:e400–5.
Campuzano-Maya G. Cure of alopecia areata after eradication of Helicobacter pylori: a new association?World J Gastroenterol. 2011;17:3165–70.
Bayramgürler D, Demirsoy EO, Aktürk AS, Kiran R. Narrowband ultraviolet B phototherapy for alopecia areata. Photodermatol Photoimmunol Photomed. 2011;27:325–7.
Raijiv M, Singh N. Bexarotene gel: a new topical therapy for alopecia areata. Int J Trichology.2010;2:66–7.
Ucak H, Kandi B, Cicek D, et al. The comparison of treatment with clobetasol propionate 0,05% and topical pimecrolimus 1% treatment in the treatment of alopecia areata. J
Dermatolog Treat. 2012;23:410–20.
Nasiri S, Haghpanah V, Taheri E, et al. Hair regrowth, with topical triiodothyronine ointment in patients with alopecia areata: a double-blind, randomized pilot clinical trial of
efficacy. Eur Acad Dermatol Venereol.2012;26:654–6.
Manolache L, Petrescu-Seceleanu D, Benea V. Alopecia areata and relationship with stressful events in children. J Eur Acad Dermatol Venereol. 2009;23:107–9. Willemsen R, Vanderlinden J, Roseeuw D, Haentjens P. Increased history of childhood and lifetime traumatic events among adults with alopecia areata. J Eur Acad Dermatol
Venereol. 2009;60:388–93.
MacDonald Hull SP, Wood ML, Hutchinson PE, et al. British Association of Dermatologists. Guidelines for the management of alopecia areata. Br J Dermatol. 2003;149:692–9. Postępy Dermatologii i Alergologii 4, August / 2014
Aesthetic Dermal Thanks to authors for the possibility to reprint the article
Articles | 23
AESTHETIC DERMAL | Focus on hair coloring
XL Hair, Reparestim TD Hair, AD Daily care Hair
Focus on hair coloring
& scalp problems
pict 1. Female patient with hair loss and scalp irritation after hair bleaches
(Courtesy of Dr. Ranneva)
Throughout the ages, society has influenced
hairstyle trends — crew cut, straight vs. curly
hair, hair coloring, etc. — which leaves the scalp
exposed to different chemicals (eg, dyes, highlights,
straightening agents, etc.), hair styling gadgets (eg,
blow dryers, curling or straightening irons, etc.)
and hair-care products (“rinse-off” or “leave-on”
preparations). All of this may lead to scalp irritation.2
pict 2. Female patient after treatments with Reparestim Hair. 4 sessions once a week
by using microneedling device - 0,5 mm , AD Daily Care Hair once per day 4 weeks
(Courtesy of Dr. Ranneva)
HAIR CHEMICALS THAT HAVE BEEN ASSOCIATED
WITH SENSORY IRRITATION OF THE SCALP
Hydrogen peroxide
Ammonium persulfates
p-Phenylenediamine
Thioglycates
Heidi P. Chan, MD, Hongbo Zhai, MD, and Howard I. Maibach, MD
Extensive sun explosure can turn the hair into a brittle, dry mop that breaks and splits easily.
Choosing AD Daily Care Hair wich provides full vitamin nutrition became good recommendation for the patients.
24 | CLINICAL CASE
AD Daily Care Hair
NEW ENERGY FOR YOU HAIR
xl-hair.com
AESTHETIC DERMAL | Research & Publications
XL Hair
®
A new medical approach for alopecia areata
Gabriel Siquier1 and Evgeniya Ranneva2
1-aesthetic medicine practicioner (Netherlands)
2-phd, dermatologist (Spain)
Abstract: Alopecia areata is a non-scarring hair loss disease that affects 1-2% of human population. For
such a prevalent disease it is surprising that it’s etiology is not fully understood and treatment still poses a
challenge with little therapeutic options that commonly have many side effects. XL Hair® formula contains
growth factors, macro and micro-nutrients and matrix remodeling actives that prolong the anagen phase
of hair growth. It has already been proved effective on other types of non-cicatricial hairloss like alopecia
androgenetica. In this case study, an AA patient is treated with once a week intradermal injections of XL
Hair® formula achieving astonishing results within the first 6 weeks of treatment (hair regrowth achieved
after 3 weeks). The side effects reported were swelling and ecchymosis that lasted for 24-48h after the
procedure. This encouraging result strengthens the evidence that XL Hair® is a promising new therapy for all
types of non-cicatricial hairloss.
Introduction
Alopecia Areata (AA) is a non-scarring
hair loss disease with prevalence of
0.1-0.2% (calculated lifetime risk of
2%) depending on ethnic and world
region1. It affects both sexes with
some studies showing slightly higher
prevalence on men (1.4:1 ratio)2. Most
patients (66%) are younger than 30
years old3 and earlier onset of the
disease is associated with poorer
prognostics 2. It is characterized
as hair loss and thinning in a wellcircumscribed skin region most times
located on scalp and beard and it can
evolve to total scalp hair loss (alopecia
areata totalis) or even total body hair
loss (alopecia areata universalis)4.
The diagnostic may be achieved
by trichoscopy, hair pull test or
trichogram. Trichogram is being
replaced by trichoscopy, which is a
more modern, less painful and not
invasive method that depends only
on the experience of the operator5.
Even though the etiology of AA is still
unknown, most specialists believe
that it is an autoimmune disease
caused by the breakdown of the
immune privilege of the hair follicle
and invasion of T lymphocytes which
results in shortening of the anagen
phase of hair growth and acute
hair loss6. Like most autoimmune
diseases, AA has a strong genetic
component and familial cases have
poorer prognosis, faster progression,
more frequent relapses and greater
resistance to therapy7,8.
Treatment of AA is far more
challenging than it’s diagnostics
with few, and many times ineffective,
drugs available. There is no
known curative therapy to date
and currently treatment options
relies on corticosteroids that are
taken either by injections on the
affected site, oral pills (in pulse
doses) or topical formulations
pict 1. Female patient with Alopecia areata
before treatment
pict 2. Female patient with Alopecia areata
after treatment
CLINICAL STUDY | 25
AESTHETIC DERMAL | Research & Publications
(creams, gels, ointments, etc)9,
immunosuppressive drugs like
ciclosporin or anti-inflammatory
drugs like sulfasalazine10. However,
all those treatments have limited
success rate with often unsatisfactory
results. Hair regrowth can be
seen in 60-67% of the cases using
intradermal corticosteroids and in
30% of the cases treated orally with
the same class of drugs. Relapses
occur frequently once treatment is
discontinued and can affect up of 25%
of the successfully treated patients8.
It is, therefore, crucial to explore
different treatment options for such
a high prevalence disease with so
little treatment options. This article
presents a case study of a patient
treated with XL Hair® formulation
which is composed of growth factors,
antioxidants, aminoacids, DNA,
trace elements, vitamins, matrix
reorganization compounds and micro
nutrients. The final target of the
actives is to repair and to stimulate
hair growth, increase the thickness
of hair by improving skin nutrition
and skin defenses against internal &
external stress and damage factors.
Treatment:
The treatment was accomplished
by once a week intradermal
injections of the XL hair® formula
in the affected area (pict. 4/5). The
injections contained hyaluronic acid
0,001 mg/ml associated in XL Hair®
with active bio revitalization solution
that helps to improve the transport
function of the actives from BS.
The complex actives of BS are:
growth factors GF (Rh-Polipeptide1,Copper peptide),deoxyribonucleic
acid, amino acids (Alanine, Folic Acid,
Leucine, Valine,Tyrosine ,Glycine,
Histidine,
Isoleucine,
Lysine,
Methionine, Phenylalanine, Proline,
Serine, Threonine and etc),trace
elements (Ca, Fe, K, Mg, Mn, Na, P,
Se and etc),vitamins (Vit A,PP, B,H
26 | XL HAIR®
and etc),terpenes (Quercetin),fatty
acids (Oleic Acid ,Linoleic Acid),
flavonoids (Rutin, Kaempferol),
antioxidants (Quercetin, Citric Acid,
Ginkgolides A- B- C- M), NAD, NADP.
Fibroblast growth factors (FGFs) and
their receptors control a wide range
of biological functions, regulating
cellular
proliferation,
survival,
migration and differentiation. The
treatment also delivers copper
peptide to the base of follicles, which
helps strengthen hair by stimulating
hair follicles to produce a strong
hair shaft, help blood circulation
in the scalp, and revitalize hair
follicles. Another group known
as nutritional supplementation
including vitamins, minerals, and/
or antioxidants may help in hair
growth and health. Vitamins are
considered “micronutrients” and
occur in only very small amounts
within cells, but are critically
important as coenzymes. Amino
acids have several functions: the
energy storage function (as it can be
used on Krebs cycle), the endocrine
integration function (hormones), the
informative function (membrane
receptors, intracellular signals).
Trace elements have an influence on
the binding, transport and release of
oxygen, donate or accept electrons
in reaction of reduction or oxidation,
compensate cells nutrition and play
the structural role to important
biological molecules.
The
biggest
group
of
bioreviatlization solution of XL Hair®
is antioxidants. The mechanisms
by which these antioxidants act at
the molecular and cellular level
include roles in gene expression and
regulation, apoptosis, and signal
transduction.
Antioxidants
are
involved in fundamental metabolic
and homeostatic processes and help
repairing damaged biomolecules
and defense antioxidant enzymes,
which are mostly intracellular11.
pict 3. Male patient with Alopecia areata
before treatment
pict 4. Injections scheme
pict 5. Xl Hair injections.
pict 6. Male patient with Alopecia
areata after treatment
XL Hair® neutralizes the
functional imbalance and
recovers hair follicle function
resulting in hair regrowth
AESTHETIC DERMAL | Research & Publications
Results:
The patients (pict. 1/3) had a complaint of a small
baldness spot that appeared 6 to 12 months
before treatment near the occipital area, this
lesion was confirmed as AA by trichoscopy. Initial
results were accomplished after only three weeks
of treatment with visible hair regrowth and after
six weeks the bald patch was no longer visible (pict.
2/6). Similar results were achieved in other noncicatricial alopecia patients as presented on the
previous case series with successful regrowth in
73% of the female group and 63% on the male one
and overall satisfaction rate of 60%11. The only side
effects reported were swelling and ecchymosis on
the treated area that vanished 24-48h after the
procedure. Since it is a single case study, relapse
ratio cannot be defined and should be analyzed in
further research.
References
Conclusions:
Alopecia areata is a non-cicatricial hairloss
disease. In those types of baldness, the hair
follicle is not damaged and what causes the
disease is an imbalance in function that may
have several etiologies. XL Hair® formula is so
effective because it has growth factors, macro
and micro-nutrients that extends the anagen
phase of hair growth cycle and hyaluronic acid
that promotes matrix reorganization. Therefore, it
neutralizes the functional imbalance and recovers
hair follicle function resulting in hair regrowth.
Furthermore, XL Hair® have showed considerable
less side effects than conventional therapy which
encourage it’s use for longer periods preventing
relapse. In conclusion, this case study shows
that AA can be successfully treated by XL Hair®
formula with minimal side effects and therefore
puts it in advantage in comparison to standard
therapy options.
1.
Safavi, K.H., Muller, S.A., Suman, V.J., et al, 1995. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin. Proc. 70, 628–633.
2.
Xiao FL, Yang S, Liu JB, et al. The epi- demiology of childhood alopecia areata in China: a study of 226 patients. Pediatr Dermatol 2006;23:13-8.
3.
Kyriakis KP, Paltatzidou K, Kosma E, Sofouri E, Tadros A, Rachioti E. Alopecia areata prevalence by gender and age. J Eur Acad Dermatol Venereol 2009;23:572-3.
4.
Amin S et al (2013). Alopecia areata: A review. Journal of the Saudi Society of Dermatology & Dermatologic Surgery (2013) 17, 37–45.
5.
Brzezinska-Wcisto et al. (2014). New aspects of the treatment of alopecia areata. Postep Derm Alergol 2014; XXXI, 4: 262–265.
6.
McElwee et al (2013). What causes alopecia areata? Exp Dermatol. 2013 September ; 22(9): 609–626.
7.
Goh C, Finkel M, Christos PJ, Sinha AA (2006). Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family
history. J Eur Acad Dermatol Venereol 2006;20:1055-60.
8.
Gilhar A (2012). Alopecia areata. New England Journal of Medicine, 366: 1515-1525.
9.
Harries MJ, Sun J, Paus R, King LE Jr (2010). Management of alopecia areata. BMJ 2010; 341:c3671.
10. Garg S, Messenger AG. Alopecia areata: evidence based treatments. Semin Cutan Med Surg 2009;28:15-8.
11. Ranneva E, Siquier G (2014). Clinical study to evaluate the efficacy of a combined treatment with XL Hair in different baldness patterns. Aesthetic Dermal 1-8.
CE CLASS III INJECTABLE
THE RIGHT
S O L U T I O N*
INNOVATIVE FORMULAS
FROM EXCLUSIVE TECHNOLOGY
10 1 4
www.rrs -inje ct .co m
P A R A B E N , P R E S E R V A T IV E & C O L O U R IN G F R E E
CLINICAL STUDY | 27
AESTHETIC DERMAL | REPARESTIM® TD LINE
Reparestim® Hair TD - AD Daily care
New approach in hair loss treatment
Optimally prepare the skin before hair transplantation
8 vials x 5 ml
Improves transport function of
signal molecules
Stimulates cellular proliferation,
migration and cells diferentiation
Improves cellular metabolism
28 | XL HAIR®
Fibroblast Growth Factor
Rh- Polypeptide-1
Copper peptide
Vitamins: Ascorbic acid
(Vit. C), Retinol (Vit. A), Biotin
(Vit. B8), Riboflavin (Vit. B2),
Pyridoxine (Vit B6), Folic acid
(Vit B9), Tocopherol (Vit E),
Cyanocobalamin (Vit B12).
Nucleotides: Adenine,
Cytosine, Guanine, Thymine.
Organic Silicium
Hyaluronic acid
100 ml (50ml spray + 50 ml refill)
Improves local blood circulation
Nutritional suplementation
Energy storage function
Amino acids: Alanine, Arginine,
Aspartic acid, Glutamic acid,
Glycine, Histidine,
Hydroxyproline, Isoleucine,
Leucine, Lysine, Methionine,
Phenylalanine, Proline, Serine,
Threonine, Tyrosine, Valine.
Trace elements: Cu, Fe, Zn, Se,
Ca, Mg.
Vitamins: Ascorbic acid
(Vit. C), Retinol (Vit. A), Biotin
(Vit. B8), Riboflavin (Vit. B2),
Pyridoxine (Vit B6), Folic acid
(Vit B9), Tocopherol (Vit E),
Cyanocobalamin (Vit B12).
Hyaluronic acid
Flavonoids: Quercetin,
Kaempferol, Rutin.
Fatty acids: Linoleic acid,
Linolenic acid.
AESTHETIC DERMAL | HOW IT WORKS
REPARESTIM ® HAIR & AD DAILY CARE HAIR
A
DROP
OF
HAIR
www.aestheticdermal.com
Anti oxidant
Helps to repair damaged
biomolecules
Improves anti oxidant defence
Vitamins: Ascorbic acid (Vit. C),
Retinol (Vit. A), Tocopherol (Vit
E),
Cyanocobalamin (Vit B12).
Terpenoids: Quercetin,
Quercetin.
Hydrobalance
Skin matrix hydration
Hyaluronic acid
Scan here
OPTIMALLY SELECTED CONCENTRATION OF MAIN ACTIVES
MAXIMUM NUTRIENTS
STIMULATION OF HAIR GROWTH FACTORS
DEFENCE AGAINST FREE RADICALS
HOW IT WORKS | 29
AESTHETIC DERMAL | Questions & Answers
Frequent
Q&A
Questions & Answers
What is XL Hair®?
How is used XL Hair®?
XL Hair® is an injectable medical device, CE
certified class III, made of a non cross linked
hyaluronic acid, mainly used as a intradermal
carrier and associated to a Bio-stimulating
solution
XL Hair® is usually injected in the scalp
dermis, at the level of hair rooths. It also
can be used transdermally, together with
microneedling.
What volume is necessary for one
treatment?
3 ml are usually sufficient by session
Is any scalp preparation necessary
before treatment?.
Scalp should be clean, a disinfectant
shampoo can be recommended. Hair should
be dry and disinfected before injection.
What is the bio-stimulating
solution of XL Hair®?
Is injection painful?
No anaesthetic is necessary before injection;
the solution is not painful when injected.
XL Hair® biostimulating solution is made of 47
active elements restoring an ideal perifollicular What are the contraindications?
matrix structure for a renewed hair growth.
Allergy to one of the components; local active
What are the best indications of XL infections or irritations; No study have been
done for pregnant or breastfeeding women.
®
Hair ?
XL Hair® has showed results in case of male Is any combination treatment
or female hairloss aswell as in case of alopecia necessary?
areata.
XL Hair® injections should be associated to
the daily application of AD Daily Care Hair
Are there evidences of activity?
spray.
Cultivation of human hair dermal papillae
cells, mainly specialized fibroblasts, showed How quickly are expected the first
an increase of proliferation by 25%, after 48 results?
hours, demonstrating in vitro the exceptional
First results appear quickly: visible signs of
activity of XL Hair® solution.
regrowth can be seen after 3 to 6 sessions.
30 | XL HAIR®
AESTHETIC DERMAL | Research & Publications
What is Reparestim® hair and how
to use it?
Reparestim® Hair TD is a sterile solution,
without conservative, specially made
for a transdermal application, using a
microneedling device. Its formula is similar
to XL Hair® formula.
When to use microneedling vs
injections?
Microneedling is generally used for treating
large surfaces and injections for treating
smaller surfaces or alopecia areata.
What is AD Daily Care Hair?
AD Daily Care Hair is a solution that has
been specially formulated for helping to
keep or increase the results of the medical
treatment with XL Hair® or Reparestim® Hair
TD. The patient applies it on a daily basis or
every other day.
Could AD Daily Care Hair be used
as a sole treatment?
AD Daily Care Hair can definitively be used
as a sole treatment in any case of hair loss,
with good results.
Enter in:
A maintenance program, combining injections
of XL Hair®, sessions of microneedling for
enhancing the transdermal penetration
of XL Hair® and regular application of AD
Daily Care Hair solution allow a long term
maintenance of results.
MEDINET
How to maintain the results?
On rrs-inject.com to
find more information
about injections
techniques and protocols,
videos, articles and
clinical studies
CLINICAL STUDY | 31
xl-hair.com / rrs-inject.com / aestheticdermal.com
HAIR RESTORATION
Hairs are different
Problems are different
Solution is unique!
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XL Hair®