Introduction: Mechanism of male androgenic alopecia (MAGA) is complex and leads to an excessive hair shedding and decreased hair density. Oral, topical, and injectable autologous treatments demonstrate ability to stimulate hair re-growth, but the response is suboptimal or plateaus off. Synthetic combination of the peptide complex and hyaluronic acid (P-HA) demonstrated hair regrowth in alopecia patients. Electronically-operated pneumatic injections (EPI) generate micro-trauma in the dermis and under wound-healing conditions may enhance regeneration effect of P-HA. Methods: Subjects seeking improvement of their male pattern hair loss (Hamilton-Norwood type 2 - 4) received the P-HA treatments through EPI. The course included 4 treatments every two weeks over the 8-week period. In 6 months, the hair growth was assessed comparative to baseline by global clinical photography and digital phototrichograms. The treatment safety and tolerability were documented through the whole study period. Results: Twelve men (30 - 45 years old) completed the treatment course with high tolerability and without adverse events. Post-treatment assessment of the previously bald areas showed improved coverage on the clinical photographs. The phototrichograms demonstrated statistically significant increase in terminal hair density by 36%, cumulative hair thickness by 37%, and follicular units by 20%; all contributing to a 38% increase in cumulated hair density (all p < 0.05). Conclusion: Electronic pneumatic injection s are well tolerated and can be safely used for the needle-free administration of the peptide-hyaluronic acid combination in MAGA therapy. We achieved significant hair re-densification in the balding scalp. The exact role of the EPI-induced impact in the hair re-growth mechanism remains to be ascertained.
Asfour, L., Cranwell, W. and Sinclair, R. (2000) Male Androgenetic Alopecia. In: Feingold, K.R., Anawalt, B., Boyce, A., et al., Eds., Endotext, MDText.com, Inc., South Dartmouth.
Sonthalia, S., Daulatabad, D. and Tosti, A. (2016) Hair Restoration in Androgenetic Alopecia: Looking Beyond Minoxidil, Finasteride and Hair Transplantation. Journal of Cosmetology & Trichology, 2, Article 1000105. https://doi.org/10.4172/2471-9323.1000105
Yoo, H.G., Kim, J.S., Lee, S.R., Pyo, H.K., Moon, H.I., Lee, J.H., Kwon, O.S., Chung, J.H., Kim, K.H., Eun, H.C. and Cho, K.H. (2006) Perifollicular Fibrosis: Pathogenetic Role in Androgenetic Alopecia. Biological and Pharmaceutical Bulletin, 29, 1246-1250. https://doi.org/10.1248/bpb.29.1246
Rathnayake, D. and Sinclair, R. (2010) Male Androgenetic Alopecia. Expert Opinion on Pharmacotherapy, 11, 1295-1304. https://doi.org/10.1517/14656561003752730
Shimizu, Y., Ntege, E.H., Sunami, H. and Inoue, Y. (2022) Regenerative Medicine Strategies for Hair Growth and Regeneration: A Narrative Review of Literature. Regenerative Therapy, 21, 527-539. https://doi.org/10.1016/j.reth.2022.10.005
Elliott, K., Stephenson, T.J. and Messenger, A.G. (1999) Differences in Hair Follicle Dermal Papilla Volume Are Due to Extracellular Matrix Volume and Cell Number: Implications for the Control of Hair Follicle Size and Androgen Responses. Journal of Investigative Dermatology, 113, 873-877. https://doi.org/10.1046/j.1523-1747.1999.00797.x
Loing, E., Lachance, R., Ollier, V. and Hocquaux, M. (2013) A New Strategy to Modulate Alopecia Using a Combination of Two Specific and Unique Ingredients. Journal of Cosmetic Science, 64, 45-58.
Fields, K., Falla, T.J., Rodan, K. and Bush, L. (2009) Bioactive Peptides: Signaling the Future. Journal of Cosmetic Dermatology, 8, 8-13. https://doi.org/10.1111/j.1473-2165.2009.00416.x
Rinaldi, F., Sorbellini, E., Castiglioni, M. and Bezzola, P. (2010) The Role of Mimicking Growth Factors to Control Anagen Phase: Evaluation in vitro and in vivo. Journal of the American Academy of Dermatology, 62, AB74. https://doi.org/10.1016/j.jaad.2009.11.311
Yang, W., Meng, L., Wang, H., Chen, R., Wang, R., Ma, X., Xu, G., Zhou, J., Wang, S., Lu, Y. and Ma, D. (2006) Inhibition of Proliferative and Invasive Capacities of Breast Cancer Cells by Arginine-Glycine-Aspartic Acid Peptide in vitro. Oncology Reports, 15, 113-117. https://doi.org/10.3892/or.15.1.113
Fan, Y., Li, X.D., He, P.P., Hu, X.X., Zhang, K., Fan, J.Q., Yang, P.P., Zheng, H.Y., Tian, W., Chen, Z.M., Ji, L., Wang, H. and Wang, L. (2020) A Biomimetic Peptide Recognizes and Traps Bacteria in Vivo as Human Defensin-6. Science Advances, 6, Article eaaz4767. https://doi.org/10.1126/sciadv.aaz4767
Gazitaeva, Z.I., Drobintseva, A.O., Chung, Y., Polyakova, V.O. and Kvetnoy, I.M. (2017) Cosmeceutical Product Consisting of Biomimetic Peptides: Antiaging Effects in vivo and in vitro. Clinical, Cosmetic and Investigational Dermatology, 10, 11-16. https://doi.org/10.2147/CCID.S97573
Bassino, E., Zanardi, A., Gasparri, F. and Munaron, L. (2016) Effects of the Biomimetic Peptide Sh-Biopeptide 9 (CG-VEGF) on Cocultures of Human Hair Follicle Dermal Papilla Cells and Microvascular Endothelial Cells. Experimental Dermatology, 25, 237-239. https://doi.org/10.1111/exd.12906
Nam, G.H., Jo, K.J., Park, Y.S., Kawk, H.W., Yoo, J.G., Jang, J.D., Kang, S.M., Kim, S.Y. and Kim, Y.M. (2019) The Peptide AC 2 Isolated from Bacillus-Treated Trapa japonica Fruit Extract Rescues DHT (Dihydrotestosterone)-Treated Human Dermal Papilla Cells and Mediates mTORC1 Signaling for Autophagy and Apoptosis Suppression. Scientific Reports, 9, Article No. 16903. https://doi.org/10.1038/s41598-019-53347-3
Kubanov, A.A., Gallyamova, Y.A., Korableva, O.A. (2018) A Randomized Study of Biomimetic Peptides Efficacy and Impact on the Growth Factors Expression in the Hair Follicles of Patients with Telogen Effluvium. Journal of Applied Pharmaceutical Science, 8, 15-22.
Rinaldi, F., Marzani, B., Pinto, D. and Sorbellini, E. (2019) Randomized Controlled Trial on a PRP-like Cosmetic, Biomimetic Peptides Based, for the Treatment of Alopecia Areata. Journal of Dermatological Treatment, 30, 588-593. https://doi.org/10.1080/09546634.2018.1544405
(2021) DR. CYJ Hair Filler Mechanism. https://www.capactuel.com/storage/app/media/pdfs/DR-CYJ-ENG.pdf
Ito, M., Yang, Z., Andl, T., Cui, C., Kim, N., Millar, S.E. and Cotsarelis, G. (2007) Wnt-Dependent de novo Hair Follicle Regeneration in Adult Mouse Skin after Wounding. Nature, 447, 316-320. https://doi.org/10.1038/nature05766
Zhang, J., He, X.C., Tong, W.G., Johnson, T., Wiedemann, L.M., Mishina, Y., Feng, J.Q. and Li, L. (2006) Bone Morphogenetic Protein Signaling Inhibits Hair Follicle Anagen Induction by Restricting Epithelial Stem/Progenitor Cell Activation and Expansion. Stem Cells, 24, 2826-2839. https://doi.org/10.1634/stemcells.2005-0544
Kwack, M.H., Kim, M.K., Kim, J.C. and Sung, Y.K. (2012) Dickkopf 1 Promotes Regression of Hair Follicles. Journal of Investigative Dermatology, 132, 1554-1560. https://doi.org/10.1038/jid.2012.24
Wu, Z., Zhu, Y., Liu, H., Liu, G. and Li, F. (2020) Wnt10b Promotes Hair Follicles Growth and Dermal Papilla Cells Proliferation via Wnt/β-Catenin Signaling Pathway in Rex Rabbits. Bioscience Reports, 40, Article BSR20191248. https://doi.org/10.1042/BSR20191248
Espinoza, L., Vinshtok, Y., McCreesh, J., Tyson, J. and McSorley, M. (2020) Kinetic Energy-Assisted Delivery of Hyaluronic Acid for Skin Remodeling in Low and Middle Face. Journal of Cosmetic Dermatology, 19, 2277-2281. https://doi.org/10.1111/jocd.13339
Garcia, P.N., Vinshtok, Y., Andrino, R.L. and Cohen, N. (2019) Efficient Treatment of Upper-Lip Rhytidosis by Pneumatic Administration of Hyaluronic Acid. Journal of Cosmetic and Laser Therapy, 21, 346-348. https://doi.org/10.1080/14764172.2019.1660792
Cassuto, D. and Vinshtok, Y. (2020) Treatment of Scar Contracture with Intralesional Jet-Assisted Injection of Hyaluronic Acid. Journal of Dermatology Research and Therapy, 6, Article 094. https://doi.org/10.23937/2469-5750/1510094
Levenberg, A., Halachmi, S., Arad-Cohen, A., Ad-El, D., Cassuto, D., Lapidoth, M. (2010) Clinical Results of Skin Remodeling Using a Novel Pneumatic Technology. International Journal of Dermatology, 49, 1432-1439. https://doi.org/10.1111/j.1365-4632.2010.04627.x
Kwon, T.R., Seok, J., Jang, J.H., et al. (2016) Needle-Free Jet Injection of Hyaluronic Acid Improves Skin Remodeling in a Mouse Model. European Journal of Pharmaceutics and Biopharmaceutics, 105, 69-74. https://doi.org/10.1016/j.ejpb.2016.05.014
Erlendsson, A.M., Haedersdal, M. and Rossi, A.M. (2020) Needle-Free Injection Assisted Drug Delivery—Histological Characterization of Cutaneous Deposition. Lasers in Surgery and Medicine, 52, 33-37. https://doi.org/10.1002/lsm.23191
Christensen, R.L., Omland, S.H., Persson, D.P., Husted, S., Haedersdal, M. and Olesen, U.H. (2021) Topical Delivery of Nivolumab, a Therapeutic Antibody, by Fractional Laser and Pneumatic Injection. Lasers in Surgery and Medicine, 53, 154-161. https://doi.org/10.1002/lsm.23322
MacGillis, D. and Vinshtok, Y. (2021) High-Velocity Pneumatic Injection of Non-Crosslinked Hyaluronic Acid for Skin Regeneration and Scar Remodeling: A Retrospective Analysis of 115 Patients. Journal of Cosmetic Dermatology, 20, 1098-1103. https://doi.org/10.1111/jocd.14002
Marques, C.C., Denise Steiner, D., Miquelin, G.M., Colferai, M.M.T. and Gatti, E.F. (2016) Comparative and Randomized Study of Rich-Platelet Plasma in Male Androgenetic Alopecia. Surgical & Cosmetic Dermatology, 8, 336-340. https://doi.org/10.5935/scd1984-8773.20168406
Bassino, E., Gasparri, F. and Munaron, L. (2020) Protective Role of Nutritional Plants Containing Flavonoids in Hair Follicle Disruption: A Review. International Journal of Molecular Sciences, 21, Article 523. https://doi.org/10.3390/ijms21020523
Motofei, I.G., Rowland, D.L., Tampa, M., Sarbu, M.I., Mitran, M.I., Mitran, C.I., Stoian, A.P., Diaconu, C.C., Paunica, S. and Georgescu, S.R. (2020) Finasteride and Androgenic Alopecia; From Therapeutic Options to Medical Implications. Journal of Dermatological Treatment, 31, 415-421. https://doi.org/10.1080/09546634.2019.1595507
Goren, A. and Naccarato, T. (2018) Minoxidil in the Treatment of Androgenetic Alopecia. Dermatologic Therapy, 31, e12686. https://doi.org/10.1111/dth.12686
Kim, J.H., Na, J., Bak, D.H., et al. (2019) Development of Finasteride Polymer Microspheres for Systemic Application in Androgenic Alopecia. International Journal of Molecular Medicine, 43, 2409-2419. https://doi.org/10.3892/ijmm.2019.4149
Singh, S., Neema, S. and Vasudevan, B. (2017) A Pilot Study to Evaluate Effectiveness of Botulinum Toxin in Treatment of Androgenetic Alopecia in Males. Journal of Cutaneous and Aesthetic Surgery, 10, 163-167. https://doi.org/10.4103/JCAS.JCAS_77_17
Gentile, P. and Garcovich, S. (2020) Autologous Activated Platelet-Rich Plasma (AA-PRP) and Non-Activated (A-PRP) in Hair Growth: A Retrospective, Blinded, Randomized Evaluation in Androgenetic Alopecia. Expert Opinion on Biological Therapy, 20, 327-337. https://doi.org/10.1080/14712598.2020.1724951
Gentile, P. (2019) Autologous Cellular Method Using Micrografts of Human Adipose Tissue Derived Follicle Stem Cells in Androgenic Alopecia. International Journal of Molecular Sciences, 20, Article 3446. https://doi.org/10.3390/ijms20143446
Gentile, P., Scioli, M.G., Cervelli, V., Orlandi, A. and Garcovich, S. (2020) Autologous Micrografts from Scalp Tissue: Trichoscopic and Long-Term Clinical Evaluation in Male and Female Androgenetic Alopecia. BioMed Research International, 2020, Article ID: 7397162. https://doi.org/10.1155/2020/7397162
Ramdasi, S. and Tiwari, S.K. (2016) Growth Factors and Cytokines Secreted in Conditioned Media by Mesenchymal Stem Cells—Promising Possible Therapeutic Approach for Hair Regeneration. Journal of Stem Cells, 11, 201-211.
Shin, H., Won, C.H., Chung, W.K., et al. (2017) Up-to-Date Clinical Trials of Hair Regeneration Using Conditioned Media of Adipose-Derived Stem Cells in Male and Female Pattern Hair Loss. Current Stem Cell Research & Therapy, 12, 524-530. https://doi.org/10.2174/1574888X12666170504120244
Gkini, M.A., Kouskoukis, A.E., Tripsianis, G., Rigopoulos, D. and Kouskoukis, K. (2014) Study of Platelet-Rich Plasma Injections in the Treatment of Androgenetic Alopecia through an One-Year Period. Journal of Cutaneous and Aesthetic Surgery, 7, 213-219. https://doi.org/10.4103/0974-2077.150743
Anderi, R., Makdissy, N., Azar, A., Rizk, F. and Hamade, A. (2018) Cellular Therapy with Human Autologous Adipose-Derived Adult Cells of Stromal Vascular Fraction for Alopecia Areata. Stem Cell Research & Therapy, 9, Article No. 141. https://doi.org/10.1186/s13287-018-0889-y
Vinshtok, Y. and Cassuto, D. (2020) Biochemical and Physical Actions of Hyaluronic Acid Delivered by Intradermal Jet Injection Route. Journal of Cosmetic Dermatology, 19, 2505-2512. https://doi.org/10.1111/jocd.13674
Kwon, H.H., Choi, S.C., Park, K.H. and Jung, J.Y. (2018) A Novel Combination Regimen with Intense Focused Ultrasound and Pressure-and Dose-Controlled Transcutaneous Pneumatic Injection of Hypertonic Glucose Solution for Lifting and Tightening of the Aging Face. Journal of Cosmetic Dermatology, 17, 373-379. https://doi.org/10.1111/jocd.12419
Bik, L., Van Doorn, M.B.A., Biskup, E., Ortner, V.K., Haedersdal, M. and Olesen, U.H. (2021) Electronic Pneumatic Injection-Assisted Dermal Drug Delivery Visualized by Ex Vivo Confocal Microscopy. Lasers in Surgery and Medicine, 53, 141-147. https://doi.org/10.1002/lsm.23279
Turlier, V., Delalleau, A., Casas, C., et al. (2013) Association between Collagen Production and Mechanical Stretching in Dermal Extracellular Matrix: In Vivo Effect of Crosslinked Hyaluronic Acid Filler. A Randomised, Placebo-Controlled Study. Journal of Dermatological Science, 69, 187-194. https://doi.org/10.1016/j.jdermsci.2012.12.006
Litwiniuk, M., Krejner, A., Speyrer, M.S., Gauto, A.R. and Grzela, T. (2016) Hyaluronic Acid in Inflammation and Tissue Regeneration. Wounds: A Compendium of Clinical Research and Practice, 28, 78-88.
Fallacara, A., Baldini, E., Manfredini, S. and Vertuani, S. (2018) Hyaluronic Acid in the Third Millennium. Polymers, 10, 701. https://doi.org/10.3390/polym10070701
Patzelt, A. and Lademann, J. (2013) Drug Delivery to Hair Follicles. Expert Opinion on Drug Delivery, 10, 787-797. https://doi.org/10.1517/17425247.2013.776038
Santos, A.C., Pereira-Silva, M., Guerra, C., Costa, D., Peixoto, D., Pereira, I., Pita, I., Ribeiro, A.J. and Veiga, F. (2020) Topical Minoxidil-Loaded Nanotechnology Strategies for Alopecia. Cosmetics, 7, Article 21. https://doi.org/10.3390/cosmetics7020021
Seok, J., Oh, C.T., Kwon, H.J., Kwon, T.R., Choi, E.J., Choi, S.Y., Mun, S.K., Han, S.H., Kim, B.J. and Kim, M.N. (2016) Investigating Skin Penetration Depth and Shape Following Needle-Free Injection at Different Pressures: A Cadaveric Study. Lasers in Surgery and Medicine, 48, 624-628. https://doi.org/10.1002/lsm.22517
Taddio, A., Ipp, M., Thivakaran, S., et al. (2012) Survey of the Prevalence of Immunization Non-Compliance Due to Needle Fears in Children and Adults. Vaccine, 30, 4807-4812. https://doi.org/10.1016/j.vaccine.2012.05.011
Spoudeas, H.A., Bajaj, P. and Sommerford, N. (2014) Maintaining Persistence and Adherence with Subcutaneous Growth-Hormone Therapy in Children: Comparing Jet-Delivery and Needle-Based Devices. Patient Preference and Adherence, 8, 1255-1263. https://doi.org/10.2147/PPA.S70019
Rohrer, T.R., Ceplis-Kastner, S., Jorch, N., Müller, H.L., Pfäffle, R., Reinehr, T., Richter-Unruh, A., Weißenbacher, C., Holterhus, P.M., Ferring Arzneimittel GmbH, S.C.-K. (2018) Needle-Free and Needle-Based Growth Hormone Therapy in Children: A Pooled Analysis of Three Long-Term Observational Studies. Hormone Research in Paediatrics, 90, 393-406. https://doi.org/10.1159/000496614
Abell, E. and Munro, D.D. (1973) Intralesional Treatment of Alopecia Areata with Triamcinolone Acetonide by Jet Injector. British Journal of Dermatology, 88, 55-59. https://doi.org/10.1111/j.1365-2133.1973.tb06672.x
Mallick, Y.A., Kapadia, N.F., Mansoor, M. and Talat, H. (2018) Efficacy of Intralesional Triamcinolone Acetonide in Alopecia Areata by Dermojet at Abbasi Shaheed Hospital, Karachi, Pakistan. Rawal Medical Journal, 43, 227-230
Kaliyadan, F., Alkhateeb, A. and Swaroop, K. (2018) Localized Atrophy with Surrounding Hair Growth in a Case of Alopecia Areata Treated with Intralesional Steroids, Using a Needle-Less Injector. Indian Journal of Dermatology, Venereology and Leprology, 84, 581-582. https://doi.org/10.4103/ijdvl.IJDVL_297_17