Reflectance confocal microscopy in the treatment monitoring of androgenetic alopecia topical combination therapy

Reflectance Confocal Microscopy for Treatment Monitoring of Androgenetic Alopecia

Authors

  • Alexandra Rubin Rao Dermatology, Atlantic Highlands, (New Jersey), USA./ Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Center for Dermatology, Somerset, (New Jersey), USA.
  • Marielle Jamgochian Rao Dermatology, Atlantic Highlands, (New Jersey), USA./ Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Center for Dermatology, Somerset, (New Jersey), USA.
  • Shazli Razi Rao Dermatology, Atlantic Highlands, (New Jersey), USA./ Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Center for Dermatology, Somerset, (New Jersey), USA.
  • Thu Truong Rao Dermatology, Atlantic Highlands, (New Jersey), USA./ Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Center for Dermatology, Somerset, (New Jersey), USA.
  • Kabir Al-Tariq Rao Dermatology, Atlantic Highlands, (New Jersey), USA./ Georgetown University School of Medicine, Washington, D.C., USA.
  • Babar Rao Rao Dermatology, Atlantic Highlands, (New Jersey), USA./ Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Center for Dermatology, Somerset, (New Jersey), USA.

Keywords:

reflectance confocal microscopy, androgenetic alopecia, noninvasive diagnosis, treatment monitoring

Abstract

Androgenetic alopecia (AGA) is the most common type of non-scarring alopecia. While global photography is the most commonly employed to track therapeutic efficacy, reflectance confocal microscopy (RCM) is a non-invasive imaging tool that may offer novel insights in tracking treatment progression for AGA. Ten patients with androgenetic alopecia initiating topical combination therapy elected to undergo treatment monitoring of this formulation using global photography and/or reflectance confocal microscopy. All patients had evidence of follicular miniaturization at baseline, and rimmed dermal papillae at both baseline and the end of the study. One patient had follicular miniaturization at baseline but not at the end of the study; however, this patient did not exhibit any changes in their Hamilton Norwood Score. Two patients exhibited inflammatory cells in the epidermis of the frontal scalp and mid-scalp at baseline on RCM that were no longer visible on RCM after 12 weeks of treatment. Of these two patients, one patient had a Hamilton Norwood score that did not improve after treatment, even though inflammatory cells were no longer present post-treatment. RCM offers a novel, non-invasive option for monitoring sub-clinical treatment progress in patients with AGA that can uncover novel insights in patients’ presentation and response to treatment earlier than with global photography.

References

Stefanato CM, Histopathology of alopecia: a clinicopathological approach to diagnosis. Histopathology. 2010;56(1):24-38.

Piraccini BM, Alessandrini A. Androgenetic alopecia. G Ital Dermatol Venereol. 2014;149(1):15-24.

Lolli F, Pallotti F, Rossi A, et al. Androgenetic alopecia: a review. Endocrine. 2017;57(1):9-17.

Olsen EA, Weiner MS, Amara IA, DeLong ER. Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil. J Am Acad Dermatol. 1990;22(4):643–646. doi:10.1016/0190-9622(90)70089-z

Suchonwanit P, Srisuwanwattana P, Chalermroj N, Khunkhet S. A randomized, double-blind controlled study of the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in the treatment of male androgenetic alopecia. J Eur Acad Dermatol Venereol. 2018;32(12):2257-2263.

Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, & Trancik RJ. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002;47(3):377-385.

Zhou Y, Chen C, Qu Q, Zhang C, Wang J, Fan Z, et al. (2020). The effectiveness of combination therapies for androgenetic alopecia: A systematic review and meta-analysis. Dermatologic therapy, 33(4), e13741.

Chen L, Zhang J, Wang L, Wang H, Chen B. The Efficacy and Safety of Finasteride Combined with Topical Minoxidil for Androgenetic Alopecia: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2020;44(3):962-970.

Ardigò M, Agozzino M, Franceschini C, et al. Reflectance confocal microscopy for scarring and non-scarring alopecia real-time assessment. Arch Dermatol Res. 2016;308(5):309-318.

Agozzino M., Ardigò M. (2015) Scalp Confocal Microscopy. In: Humbert P., Maibach H., Fanian F., Agache P. (eds) Measuring the Skin. Springer, Cham.

Cinotti E, Gergelé L, Perrot JL, et al. Quantification of capillary blood cell flow using reflectance confocal microscopy. Skin Res Technol.

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Published

2023-10-12

How to Cite

1.
Rubin A, Jamgochian M, Razi S, Truong T, Al-Tariq K, Rao B. Reflectance confocal microscopy in the treatment monitoring of androgenetic alopecia topical combination therapy: Reflectance Confocal Microscopy for Treatment Monitoring of Androgenetic Alopecia. J Pak Assoc Dermatol [Internet]. 2023Oct.12 [cited 2024Oct.5];33(4):1293-7. Available from: https://jpad.com.pk/index.php/jpad/article/view/2335

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Original Articles