fig12

Figure 12. Demonstration of improved hair follicle productivity in male pattern hair loss (MPHL) during combined oral and topical drug treatment. Each growing hair on a scalp site of the test subject was dot-mapped on repeat-phototrichogram images according to a sophisticated procedure detailed in the legend of Figure 11B-D. While fluctuating short-lived intermediate and terminal hair growth was present at baseline (compare w-1 and w0), rapid induction of cycling with rapid wash-out of short-lived follicles and new growth occurred within one month of topical minoxidil (On drugs m1). Many disappeared at m3 (On drugs m3), indicating that total length reached by such short-lived fibres would not exceed 1 cm. If one focuses on terminal hair only (green dots), it is probable that, from the five terminal hairs present at w-1, only two [follicular unit dots (FUDs) 5 and 28] remain until m3. The three others (FUDs 50, 62 and 66) exit either spontaneously or as the result of a spontaneous entry into telogen at w0 or premature cycle termination, i.e., a wash-out effect of minoxidil in terminal but short-lived follicles at m1. The “on drugs” period showed rapid hair replacement at m1 with improved growth (disappearing and appearing dots illustrate changes associated with combined “diameter” and “growth rate”). The sustained regrowth of terminal hair with maintenance of growth at m3 in 45 of the 49 hairs present at m1 suggests a more relevant effect of minoxidil. Statistically, the average baseline 178 growing hairs were dispatched based on diameter into 123, 39 and 16 growing thinner, intermediate and terminal hairs, respectively. These total growing hair counts changed to 201 at m1 (+ 14%) and 171 at m3 (- 3%) as an effect of minoxidil applications. The different categories of hair (as percentages of baseline) also shifted + 7%, + 27% and + 35% at m1 and - 63%, + 87% and + 235% at m3 for thinner, intermediate and terminal hair, respectively. The 2 thickest terminal hairs at m3 (diameter ≥ 80 µm) raised from very low density FU hosting most probably some empty follicles at baseline. Multiple fibres sprouting from a single hair follicle characterised this individual’s drug response. The blue and green dots total four or five hairs in FUs 45, 59, 63 and 93. Looking in detail at the same FUs in the 2 baseline images, rapidly on-going hair cycle fluctuations are obvious in the absence of topical treatment. This may range from growth to rest and exogen release in thinner follicles while, at the same time, other follicles from the same FU progress from Anagen 5 (hair in the follicle but still underneath the scalp surface) into initial steps of Anagen 6 with more than one intermediate/terminal hair visible at the surface. Interestingly, a significant proportion of those “baseline” intermediate and terminal hairs vanished already at m1. This documents very short cycling units that come along with an upsurge of thinner tips. The latter arose from intermediate or terminal follicles as they grew already at high speed (precise LHGR not shown), which reflects the earliest steps of re-initiation of productivity from pre-existing but resting/dormant follicles still capable of producing intermediate or terminal hairs. For a very detailed study showing combined LHGR and diameters during initiation of anagen, please read the previous report in^[13]. A preliminary predictive value was suggested as hair/FU that contained 2-3 fibres at baseline were able to contain 4-5 hairs at m3 while FUs bearing fewer than two fibres remained stable or grew less hair (more details on that topic are presented in Supplement File 3; confirmed by ANOVA). Figure 12 demonstrates 3 neglected facts about scalp hair cycling: (1) A biological potential from resting and/or empty terminal hair follicles was present in the scalp at baseline. (2) Those roots and the associated growth potential were not unravelled during a six-month LASER-comb application. And (3) There is no hard evidence for miniaturised follicles to massively transform into intermediate or terminal hair productive units as the result of an efficient drug treatment. The statistical record and speculations on predictive value of combined parameters at baseline are detailed in Supplement File 3.