Precision in hair loss

With his clinics located in Mumbai, Gurugram, Hyderabad and Bhubaneswar, Dr Pradeep Sethi and Dr Arika Bansal share key insights on the evolving hair loss treatment landscape in conversation with Shriyal Sethumadhavan. He highlights advanced diagnostic tools, regenerative therapies, and personalised approaches for improved clinical outcomes.

From your experience, what are the key complexities or challenges encountered by an aesthetic dermatologist/ trichologist in diagnosing various types of hair loss, especially distinguishing between different conditions or causes?

Diagnosing hair loss is both an art and a science. The primary challenge lies in accurately identifying the root cause amidst overlapping clinical presentations. Factors such as genetic predisposition, hormonal imbalances, nutritional deficiencies, autoimmune conditions, or even stress-related shedding can mimic one another. Distinguishing between androgenetic alopecia, Telogen effluvium, and alopecia areata often requires a detailed history, thorough clinical examination, and sometimes advanced diagnostic tools like trichoscopy or scalp biopsies. Misdiagnosis not only delays effective treatment but can also exacerbate the patient’s psychological distress, making an accurate, empathetic approach paramount.

Another challenge is that many types of hair loss have overlapping symptoms, which makes it hard to differentiate between them.

• Alopecia areata and scarring alopecia: Both conditions can cause patchy hair loss, but the causes and how they progress are different.

• Telogen effluvium and androgenetic alopecia: These both cause widespread thinning, but the reasons behind them are different.

• Traction alopecia: Caused by tight hairstyles, this type of hair loss can look similar to other forms of alopecia. That is why the patient’s history such as their hairstyle habits is so important for an accurate diagnosis.

Tell us about the diagnostic tools and techniques that can be used to identify the type of hair loss.

To accurately diagnose hair loss, dermatologists often need to use specialised tests and tools.

• Scalp biopsy: If scarring alopecia or another inflammatory condition is suspected, a scalp biopsy can help confirm the diagnosis by looking at tissue under a microscope.

• Blood tests: These can help check for nutritional deficiencies, thyroid problems, or hormone imbalances that may be contributing to hair loss.

Overall, diagnosing hair loss requires a careful approach. Dermatologists need to consider a wide range of factors, including the patient’s medical history, a detailed examination, lab tests, and sometimes even the psychological impact of hair loss, to determine the right treatment and help the patient feel better.

How have PRP and regenerative therapies evolved in recent years in addressing hair loss concerns?

PRP (Platelet-Rich Plasma) therapy has undergone significant advancements in recent years, moving beyond conventional methods to incorporate innovations such as dual-spin techniques for achieving higher platelet concentrations and the use of bioactive enhancers to enhance efficacy. It has become a cornerstone in addressing hair loss, particularly when integrated with other therapeutic modalities.

Regenerative medicine, including stem cell-based treatments and exosome therapy, has also gained attention for its potential to reverse hair miniaturisation but as of now we do not have enough literature to prove it scientifically. However, the efficacy of these therapies varies among patients. While some experience noticeable improvements in hair growth, others may not achieve the same results.

From our experience, it is important to note that these treatments are still considered off-label for conditions like male pattern baldness, meaning they have not been officially approved by the USFDA for this specific use. Because of this, the full effectiveness and long-term outcomes are still being studied. PRP delivers the best outcomes when combined with other treatments such as finasteride, oral minoxidil, and a proteinrich diet. This comprehensive approach not only optimises hair regrowth but also provides a minimally invasive, safe, and effective solution, with visible improvements typically observed within a few months.

“PRP delivers the best outcomes when combined with other treatments such as finasteride, oral minoxidil, and a protein-rich diet. ”

“Emerging treatments like stem cell therapy hold the potential to revolutionise hair loss management. ”

What are the latest treatments and technologies that you are using in your clinic?

At Eugenix Hair Sciences, we employ state-of-the-art solutions tailored to individual needs. Our latest offerings our DHT (Direct Hair Transplant) technique, developed in-house, ensures a higher survival rate of grafts and a natural aesthetic. Furthermore, we incorporate regenerative therapies, PRPs, GFC, laser caps and combination treatments to address varying degrees and causes of hair loss effectively.

In April 2013, our doctors published a paper titled “Direct Hair Transplantation: A Modified Follicular Unit Extraction Technique” in a journal. The key advantage of DHT is its ability to significantly reduce the time that hair grafts spend outside the body, which helps improve the grafts’ survival rates and promotes better growth.

Can you elaborate a little more on DHT?

DHT involves two main steps:

• Pre-made sites: The recipient sites are carefully prepared to match the ideal angle, direction, depth, and density for the transplanted hair follicles.

• Simultaneous scoring, extraction, and implantation: In this step, the grafts are scored using a motorised punch, then extracted and immediately loaded into SAVA implanters (blunt needle implanters). These loaded implanters are then used to place the grafts into the pre-made sites, all in one seamless process.

Looking ahead, how do you foresee the integration of these advancements in clinical practice for treating various forms of hair loss? Are there specific developments on the horizon that might revolutionise these treatment modalities?

The future of hair restoration lies in personalisation and precision. Genomics-based diagnostics and AI might play pivotal roles in customising treatments based on an individual’s genetic makeup and disease progression. Emerging treatments like stem cell therapy hold the potential to revolutionise hair loss management. I foresee a shift towards preventive care, with an emphasis on early intervention to preserve existing hair. Such advancements will not only enhance clinical outcomes but also significantly improve the patient experience.