The number of people with hair loss and thinning hair is increasing in Japan, regardless of age or sex, due to the aging of the population, advancement of women into the workforce, and increase in social stress. Hair loss and thinning have been attributed to genetic predisposition and hormonal imbalance; however, recent research has explored their relationship with environmental and psychological stress. Since 1981, we have been providing treatments focused on growing and nurturing hair in Japan, with the number of patients exceeding 2000 per year. We have conducted research on hair growth and regrowth for 40 years, focusing on factors such as hormonal imbalance, sebum, and stress, based on findings from our specialized manual treatments. In recent years, the number of patients taking finasteride has increased, and we have developed a treatment strategy to maximize its effectiveness. However, some patients either do not respond to the treatment or may not require the use of finasteride. In this study, we report on 1) cases in which efficacy was confirmed with manual treatment alone, 2) cases in which efficacy was confirmed with finasteride and manual treatment, 3) cases that did not respond to manual treatment and finasteride, and 4) cases with confirmed efficacy with continued treatment after discontinuation of finasteride.
KeywordsHair Growth ProductsAGAHair Growth
Yoshino, T. (2005) Estrogen Controls the Expression of BMP-2 Gene through Beta-Type Estrogen Receptor. Fragrance Journal : Research & Development for Cosmetics , Toiletries & Allied Industri es , 33, 31-35. (In Japanese)
Banno, N. and Tsuda, Y. (2005) Promotion of Hair Growth by JIOU with the Combination of Antiandrogenic Effect and Improved Blood Circulation. Fragrance Journal : Research & Development for Cosmetics , Toiletries & Allied Indus tries , 33, 73-78.
Arck, P.C., Slominski, A., Theoharides, T.C., Peters, E.M.J. and Paus, R. (2006) Neuroimmunology of Stress: Skin Takes Center Stage. Journal of Investigative Dermatology , 126, 1697-1704. https://doi.org/10.1038/sj.jid.5700104
Ito, N., Sugawara, K., Bodó, E., Takigawa, M., van Beek, N., Ito, T., et al . (2010) Corticotropin-Releasing Hormone Stimulates the in Situ Generation of Mast Cells from Precursors in the Human Hair Follicle Mesenchyme. Journal of Investigative Dermatology , 130, 995-1004. https://doi.org/10.1038/jid.2009.387
Drake, L.A., Dinehart, S.M., Farmer, E.R., Goltz, R.W., Graham, G.F., Hordinsky, M.K., Lewis, C.W., et al . (1996) Guidelines of Care for Androgenetic Alopecia. Journal of the American Academy of Dermatology , 35, 465-469.
Olsen, E.A., Messenger, A.G., Shapiro, J., Bergfeld, W.F., Hordinsky, M.K., Roberts, J.L., et al . (2005) Evaluation and Treatment of Male and Female Pattern Hair Loss. Journal of the American Academy of Dermatology , 52, 301-311. https://doi.org/10.1016/j.jaad.2004.04.008
Olsen, E.A. (2003) Current and Novel Methods for Assessing Efficacy of Hair Growth Promoters in Pattern Hair Loss. Journal of the American Academy of Dermatology , 48, 253-262. https://doi.org/10.1067/mjd.2003.81
Ogata, T. (1953) Development of Patterned Alopecia. Sogo Rinsho , 2, 101-106. (In Japanese)
Hamilton, J.B. (1942) Male Hormone Stimulation Is Prerequisite and an Incitant in Common Baldness. American Journal of Anatomy , 71, 451-480. https://doi.org/10.1002/aja.1000710306
Severi, G., Sinclair, R., Hopper, J.L., English, D.R., McCredie, M.R.E., Boyle, P., et al . (2003) Androgenetic Alopecia in Men Aged 40-69 Years: Prevalence and Risk Factors. British Journal of Dermatology , 149, 1207-1213. https://doi.org/10.1111/j.1365-2133.2003.05565.x
Itami, S. (2004) Pathomechanism of Androgenetic Alopecia and New Treatment. Nippon Ronen Igakkai Zasshi . Japanese Journal of Geriatrics , 41, 598-600. https://doi.org/10.3143/geriatrics.41.598
Inui, S. and Itami, S. (2012) Androgen Actions on the Human Hair Follicle: Perspectives. Experimental Dermatology , 22, 168-171. https://doi.org/10.1111/exd.12024
Li, R., Brockschmidt, F.F., Kiefer, A.K., Stefansson, H., Nyholt, D.R., Song, K., et al . (2012) Six Novel Susceptibility Loci for Early-Onset Androgenetic Alopecia and Their Unexpected Association with Common Diseases. PLOS Genetics , 8, e1002746. https://doi.org/10.1371/journal.pgen.1002746
Yap, C.X., Sidorenko, J., Wu, Y., Kemper, K.E., Yang, J., Wray, N.R., et al . (2018) Dissection of Genetic Variation and Evidence for Pleiotropy in Male Pattern Baldness. Nature Communications , 9, Article No. 5407. https://doi.org/10.1038/s41467-018-07862-y
Heath, A.C., Nyholt, D.R., Gillespie, N.A. and Martin, N.G. (2003) Genetic Basis of Male Pattern Baldness. Journal of Investigative Dermatology , 121, 1561-1564. https://doi.org/10.1111/j.1523-1747.2003.12615.x
Rexbye, H., Petersen, I., Iachina, M., Mortensen, J., McGue, M., Vaupel, J.W., et al . (2005) Hair Loss among Elderly Men: Etiology and Impact on Perceived Age. The Journals of Gerontology Series A : Biological Sciences and Medical Sciences , 60, 1077-1082. https://doi.org/10.1093/gerona/60.8.1077
Gatherwright, J., Liu, M.T., Amirlak, B., Gliniak, C., Totonchi, A. and Guyuron, B. (2013) The Contribution of Endogenous and Exogenous Factors to Male Alopecia: A Study of Identical Twins. Plastic and Reconstructive Surgery , 131, 794e-801e. https://doi.org/10.1097/prs.0b013e3182865ca9
Manabe, M., Tsuboi, R., Itami, S., Nagata, S., Amaha, Y., Ito, T., Inui, S., et al . (2017) Guidelines for the Diagnosis and Treatment of Male-Pattern and Female-Pattern Hair Loss. The Journal of Dermatology , 127, 2763-2777. (In Japanese)
Drake, L., Hordinsky, M., Fiedler, V., Swinehart, J., Unger, W.P., Cotterill, P.C., et al . (1999) The Effects of Finasteride on Scalp Skin and Serum Androgen Levels in Men with Androgenetic Alopecia. Journal of the American Academy of Dermatology , 41, 550-554. https://doi.org/10.1016/s0190-9622(99)80051-6
Olsen, E.A., Hordinsky, M., Whiting, D., Stough, D., Hobbs, S., Ellis, M.L., et al . (2006) The Importance of Dual 5 α -Reductase Inhibition in the Treatment of Male Pattern Hair Loss: Results of a Randomized Placebo-Controlled Study of Dutasteride versus Finasteride. Journal of the American Academy of Dermatology , 55, 1014-1023. https://doi.org/10.1016/j.jaad.2006.05.007
Otomo, S. (2002) Hair Growth Effect of Minoxidil. Folia Pharmacologica Japonica , 119, 167-174. https://doi.org/10.1254/fpj.119.167
Chanprapaph, K., Sutharaphan, T. and Suchonwanit, P. (2021) Scalp Biophysical Characteristics in Males with Androgenetic Alopecia: A Comparative Study with Healthy Controls. Clinical Interventions in Aging , 16, 781-787. https://doi.org/10.2147/cia.s310178
Sakamoto, T., Nakamura, M. and Nakano, M. (1994) A Genetic Study on Female Hormones and Hair Thinning. Fragrance Journal : Research & Developme nt for Cosmetics , Toiletries & Allied Industries , 22, 65-72. (In Japanese)
Fukuda, M. (2001) Dermatology in Cosmetic Science. Journal of the Japan Society of Colour Material , 74, 308-316. https://doi.org/10.4011/shikizai1937.74.308
Downing, D.T., Strauss, J.S. and Pochi, P.E. (1969) Variability in the Chemical Composition of Human Skin Surface Lipids. Journal of Investigative Dermatology , 53, 322-327. https://doi.org/10.1038/jid.1969.157
Jacobsen, E., Billings, J.K., Frantz, R.A., Kinney, C.K., Stewart, M.E. and Downing, D.T. (1985) Age-Related Changes in Sebaceous Wax Ester Secretion Rates in Men and Women. Journal of Investigative Dermatology , 85, 483-485. https://doi.org/10.1111/1523-1747.ep12277224
Strauss, J.S. and Pochi, P.E. (1968) The Changes in Human Sebaceous Gland Activity with Age. In: Baccaredda-Boy, A., Moretti, G. and Frey, J.R., Eds., International Symposium , Rapallo , July 1967, Proceedings : “ Biopathology of Pattern Alopecia ”, Karger, 166-170.
Pochi, P.E. and Strauss, J.S. (1969) Sebaceous Gland Response in Man to the Administration of Testosterone, Δ4-Androstenedione, and Dehydroisoandrosterone. Journal of Investigative Dermatology , 52, 32-36. https://doi.org/10.1038/jid.1969.4
Giltay, E.J. and Gooren, L.J.G. (2000) Effects of Sex Steroid Deprivation/Administration on Hair Growth and Skin Sebum Production in Transsexual Males and Females. The Journal of Clinical Endocrinology & Metabolism , 85, 2913-2921. https://doi.org/10.1210/jcem.85.8.6710
Gershbein, L.L. and Baburao, K. (1984) Multiple Discriminant Analysis of Fatty Acids from Male Scalp Hair Lipids. Fette , Seifen , Anstrichmittel , 86, 121-128. https://doi.org/10.1002/lipi.19840860310
Okajima, K. (2009) Hair-Growing Effect of a Saliva Component Sialic Acid: The Molecular Mechanism and Possible Therapeutic Application for Alopecia. Fragrance Journal : Research & Development for Cosmetics , Toiletries & Allied Industries , 37, 43-47. (In Japanese)
Okajima, K. and Harada, N. (2008) Promotion of Insulin-Like Growth Factor-I Production by Sensory Neuron Stimulation; Molecular Mechanism(s) and Therapeutic Implications. Current Medicinal Chemistry , 15, 3095-3112. https://doi.org/10.2174/092986708786848604
Shanshanwal, S.S. and Dhurat, R. (2017) Superiority of Dutasteride over Finasteride in Hair Regrowth and Reversal of Miniaturization in Men with Androgenetic Alopecia: A Randomized Controlled Open-Label, Evaluator-Blinded Study. Indian Journal of Dermatology , Venereology , and Leprology , 83, 47-54. https://doi.org/10.4103/0378-6323.188652
Leliefeld, H.H.J., Debruyne, F.M.J. and Reisman, Y. (2023) The Post-Finasteride Syndrome: Possible Etiological Mechanisms and Symptoms. International Journal of Impotence Research . https://doi.org/10.1038/s41443-023-00759-5
Lueangarun, S., Visutjindaporn, P. and Parcharoen, Y. (2021) Systematic Review and Meta-Analysis of Randomized Controlled Trials of United States Food and Drug Administration-Approved, Home-Use, Low-Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology. The Journal of Clinical and Aesthetic Dermatology , 14, E64-E75.
Pillai, J. and Mysore, V. (2021) Role of Low-Level Light Therapy (LLLT) in Androgenetic Alopecia. Journal of Cutaneous and Aesthetic Surgery , 14, 385-391. https://doi.org/10.4103/jcas.jcas_218_20
Egger, A., Resnik, S.R., Aickara, D., Maranda, E., Kaiser, M., Wikramanayake, T.C., et al . (2020) Examining the Safety and Efficacy of Low-Level Laser Therapy for Male and Female Pattern Hair Loss: A Review of the Literature. Skin Appendage Disorders , 6, 259-267. https://doi.org/10.1159/000509001
Afifi, L., Maranda, E.L., Zarei, M., Delcanto, G.M., Falto‐Aizpurua, L., Kluijfhout, W.P., et al . (2016) Low‐Level Laser Therapy as a Treatment for Androgenetic Alopecia. Lasers in Surgery and Medicine , 49, 27-39. https://doi.org/10.1002/lsm.22512
Revene, A. (2023) Hair Transplant: Procedures, Complications and Tips.
Arif, T., Dorjay, K., Adil, M. and Sami, M. (2017) Dutasteride in Androgenetic Alopecia: An Update. Current Clinical Pharmacology , 12, 31-35. https://doi.org/10.2174/1574884712666170310111125
Zhou, Z., Song, S., Gao, Z., Wu, J., Ma, J. and Cui, Y. (2019) The Efficacy and Safety of Dutasteride Compared with Finasteride in Treating Men with Androgenetic Alopecia: A Systematic Review and Meta-Analysis. Clinical Interventions in Aging , 14, 399-406. https://doi.org/10.2147/cia.s192435
Gupta, A.K., Talukder, M. and Williams, G. (2022) Comparison of Oral Minoxidil, Finasteride, and Dutasteride for Treating Androgenetic Alopecia. Journal of Dermatological Treatment , 33, 2946-2962. https://doi.org/10.1080/09546634.2022.2109567
Emer, J. and Lauren Levy, L.L. (2013) Female Pattern Alopecia: Current Perspectives. International Journal of Women ’ s Health , 5, 541-556. https://doi.org/10.2147/ijwh.s49337
Johnson, D.B. and Sonthalia, S. (2021) Defibrillation. StatPearls Publishing.
Shaw, J.C. (1996) Antiandrogen Therapy in Dermatology. International Journal of Dermatology , 35, 770-778. https://doi.org/10.1111/j.1365-4362.1996.tb02970.x
Zgonc Škulj, A., Poljšak, N., Kočevar Glavač, N. and Kreft, S. (2019) Herbal Preparations for the Treatment of Hair Loss. Archives of Dermatological Research , 312, 395-406. https://doi.org/10.1007/s00403-019-02003-x
Farris, P.K., Rogers, N., McMichael, A. and Kogan, S. (2017) A Novel Multi-Targeting Approach to Treating Hair Loss, Using Standardized Nutraceuticals. Journal of Drugs in Dermatology , 16, s141-s148.
Stevens, J. and Khetarpal, S. (2019) Platelet-Rich Plasma for Androgenetic Alopecia: A Review of the Literature and Proposed Treatment Protocol. International Journal of Women ’ s Dermatology , 5, 46-51. https://doi.org/10.1016/j.ijwd.2018.08.004
Gupta, A.K., Cole, J., Deutsch, D.P., Everts, P.A., Niedbalski, R.P., Panchaprateep, R., et al . (2019) Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia. Dermatologic Surgery , 45, 1262-1273. https://doi.org/10.1097/dss.0000000000001894
Gentile, P., Garcovich, S., Bielli, A., Scioli, M.G., Orlandi, A. and Cervelli, V. (2015) The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial. Stem Cells Translational Medicine , 4, 1317-1323. https://doi.org/10.5966/sctm.2015-0107
Evans, A.G., Mwangi, J.M., Pope, R.W., Ivanic, M.G., Botros, M.A., Glassman, G.E., et al . (2020) Platelet-Rich Plasma as a Therapy for Androgenic Alopecia: A Systematic Review and Meta-Analysis. Journal of Dermatological Treatment , 33, 498-511. https://doi.org/10.1080/09546634.2020.1770171
Giordano, S., Romeo, M., di Summa, P., Salval, A. and Lankinen, P. (2018) A Meta-Analysis on Evidence of Platelet-Rich Plasma for Androgenetic Alopecia. International Journal of Trichology , 10, 1-10. https://doi.org/10.4103/ijt.ijt_74_16
Panda, B., Sharma, Y., Gupta, S. and Mohanty, S. (2021) Mesenchymal Stem Cell-Derived Exosomes as an Emerging Paradigm for Regenerative Therapy and Nano-Medicine: A Comprehensive Review. Life , 11, Article No. 784. https://doi.org/10.3390/life11080784
Chahla, J., Cinque, M.E., Piuzzi, N.S., Mannava, S., Geeslin, A.G., Murray, I.R., et al . (2017) A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. Journal of Bone and Joint Surgery , 99, 1769-1779. https://doi.org/10.2106/jbjs.16.01374
Kost, Y., Muskat, A., Mhaimeed, N., Nazarian, R.S. and Kobets, K. (2022) Exosome Therapy in Hair Regeneration: A Literature Review of the Evidence, Challenges, and Future Opportunities. Journal of Cosmetic Dermatology , 21, 3226-3231. https://doi.org/10.1111/jocd.15008
Krane, N.A., Christofides, E.A. and Halaas, Y. (2021) Advances in Hair Restoration. Current Otorhinolaryngology Reports , 9, 436-441. https://doi.org/10.1007/s40136-021-00368-0
Gupta, A.K., Renaud, H.J. and Halaas, Y. (2020) Exosomes: A New Effective Non-Surgical Therapy for Androgenetic Alopecia? SKINmed , 18, 96-100.
Huh, C.-H. and Kwon, S.H. (2019) Exosome for Hair Regeneration: From Bench to Bedside. Journal of the American Academy of Dermatology , 81, AB62.
Yuan, A., Bian, Q. and Gao, J. (2020) Current Advances in Stem Cell-Based Therapies for Hair Regeneration. European Journal of Pharmacology , 881, Article ID: 173197. https://doi.org/10.1016/j.ejphar.2020.173197
Food and Drug Administration (2019) Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals.
Ocampo‐Garza, S.S., Fabbrocini, G., Ocampo‐Candiani, J., Cinelli, E. and Villani, A. (2020) Micro Needling: A Novel Therapeutic Approach for Androgenetic Alopecia, a Review of Literature. Dermatologic Therapy , 33, e14267. https://doi.org/10.1111/dth.14267
Dhurat, R., Sukesh, M., Avhad, G., Dandale, A., Pal, A. and Pund, P. (2013) A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study. International Journal of Trichology , 5, 6-11. https://doi.org/10.4103/0974-7753.114700
Faghihi, G., Nabavinejad, S., Mokhtari, F., Fatemi Naeini, F. and Iraji, F. (2020) Microneedling in Androgenetic Alopecia; Comparing Two Different Depths of Microneedles. Journal of Cosmetic Dermatology , 20, 1241-1247. https://doi.org/10.1111/jocd.13714
Neerja, P. (2020) A Study on the Efficacy of Microneedling with Minoxidil Solution versus Microneedling with Hair Multivitamin Solution for the Treatment of Androgenetic Alopecia. International Journal of Dermatology and Clinical Research , 6, 10-12. https://doi.org/10.17352/2455-8605.000037
Daruwalla, S.B., Dhurat, R.S. and Hamid, S.A.T. (2022) All That a Dermatotrichologist Needs to Know about Hair Camouflage: A Comprehensive Review. International Journal of Trichology , 14, 77-83. https://doi.org/10.4103/ijt.ijt_6_21
Saed, S., Ibrahim, O. and Bergfeld, W.F. (2017) Hair Camouflage: A Comprehensive Review. International Journal of Women ’ s Dermatology , 3, S75-S80. https://doi.org/10.1016/j.ijwd.2017.02.016