Objective 

Present the latest bibliographical information on the pathophysiology and management of alopecia

Methodology 

Review of scientific literature

Results 

Senescent alopecia: myth or reality?

Analysis of the gene expression profiles of scalp biopsies from patients with androgenetic alopecia or senescent alopecia showed differences, suggesting two distinct hair pathologies and the involvement of non-androgenic pathophysiological mechanisms 

New therapeutic target: the Wnt/β-catenin pathway

The Wnt (wingless-related integration site) signaling pathway is essential for maintaining dermal papilla activity and cell growth. Recent data suggest that androgen-induced imbalance in the Wnt pathway agonist/antagonist expression is responsible for disturbances in hair follicle stem cell differentiation, and that this phenomenon contributes to the development of androgenetic alopecia

Prostaglandins and hair growth

Prostaglandins E2 and F2α are known to stimulate hair growth. More recently, it has emerged that prostaglandins, particularly D2, also inhibit hair growth. Prostaglandin D2 appears to act by increasing testosterone formation via an interaction between the prostaglandin D2/reactive oxygen species (ROS) pathway. These factors suggest the value of using antioxidants as a complement to other treatments for androgenetic alopecia

Low-level laser

This technique appears to be a promising non-invasive treatment for androgenetic alopecia, inducing an increase in hair density comparable to that of finasteride or minoxidil. To ensure reproducibility, optimum technical parameters need to be established, including wavelength, irradiation and exposure time

Platelet-rich plasma (PRP)

To date, no study has been sufficiently powerful to assess the benefit/risk ratio of this technique. The lack of a standardized method for preparing platelet-derived products makes it difficult to correlate clinical results between different studies

Stem cells

Cultured follicular stem cells (follicular regeneration) could be more widely used in the future. In contrast to animal trials, human studies have produced mainly disappointing results, and further research is needed

Latest advances in hair transplantation

New automated technologies should increase the speed of follicular unit extraction, and partial longitudinal follicular unit transplantation represents a new therapeutic option. This technique makes it possible to partially preserve the follicular units remaining in the dermis of the donor area so that they can regenerate and reproduce a complete follicular unit

Janus kinase (JAK) inhibitors in alopecia areata

These molecules specifically target the enzymes that keep hair follicles dormant in alopecia areata. Two major problems are associated with the JAK inhibitors currently being tested: cost and the likelihood of relapse after discontinuation of treatment

Conclusion

Several promising techniques and treatments are being developed as monotherapy and adjuvant therapy for the management of alopecia. Further large-scale, long-term studies are needed to establish standardized protocols and validate these new therapeutic options