by Kevin Rands | May 13, 2016 11:33 pm
Measuring Hair Loss one Follicle at a Time – July 15, Marburg Germany
Until recently, it has been nearly impossible to accurately measure the changes in a persons hair loss over time. Whether you want to know if things are getting worse, or slightly better, the methods available today to give you an answer to these inquiries are shoddy at best. Even the clinical studies we all put so much faith in have very imperfect measurement tools. For these scenarios especially, accuracy is of the utmost importance.
Say you’ve been on Propecia for 6 months, and all you see is more hair in the shower every day. You’ve convinced yourself that it’s not working, and you’ve spent endless hours being annoyed, depressed, and feeling hopeless. Asking a dermatologist whether the treatment is working for you or not would be an act in futility, first and foremost because chances are, all he can do is look at your head and comment. What he has to say probably won’t be very helpful because you know he’s just guessing, and those of you who are just starting to lose your hair may even risk being told you’re not losing it in the first place, which could make you go postal right there in the waiting room.
In order to reduce violence in Dermatologists offices all over the world, a new tool has been created which takes the guesswork out of … well .. guessing. Your doctor, whom you may feel is clueless on most topics (especially hair loss) will soon be able to speak with authority on the issue thanks to a new invention known as “TrichoScan”.
Some Background
Thinning hair is a common “ailment” for many of us, and a good percentage of us are not completely bald just yet. With men, there is typically a well known pattern for hair loss which can help a qualified person establish that you are indeed losing your hair. The horseshoe shape pattern, the bald spot in the back, etc. In the initial stages of Androgenetic Alopecia however, you are usually the only person who knows that changes are taking place. This typically is why many of you have complained to us that your Dermatologist has said: “You’re not losing your hair”.
But you know you are…
As mentioned above, many times it is nearly impossible to determine whether a treatment truly is working for you. We’ve introduced the results of the Revivogen Consumer trials[1] this month in our July Newsletter, but the very basis for these results is assumption.
Even if these participants were being closely monitored by physicians, the comparison between baseline and current status for the hairs that exist would be vague. Why? Quite simply, the tools haven’t existed to perform a perfect analysis.
Well what about the Propecia studies[2], the Minoxidil studies, and all those hair counts, percentages and seemingly exact data included with them? Numerous methods are available to asses the *rate* of hair growth. The techniques fall in to three categories: Invasive (biopsies), semi-invasive (Trichogram, unit area Trichogram), and non-invasive (global hair counts, phototrichogram).
Some of these were used in the Propecia trials[3]. While they may be somewhat accurate, researchers repeatedly find them time consuming, costly, and sometimes very difficult to perform.
In light of the cost, difficulty, and inaccuracy of current methods, researchers in Marburg Germany saw a need for a more “user friendly”, patient friendly (no more cutting your head open!), inexpensive, and accurate tool. The results of their efforts produced the TrichoScan.
TrichoScan uses something called Epiluminescence Microscopy (ELM), a fancy term for “digital image”, along with automatic digital image analysis for measuring human hair. Simply put, it takes a digital image of a section of your head, and not only instantly counts the number of hairs there, but also determines their length, width, and their current state (Growth, Regression, etc.)…
In order to understand how TrichoScan works, its important to understand how hair works. The largest portion of the hair follicle is really a fiber factory, consisting of repeating cycles of the building and destruction of keratinocytes. This building and destroying is manifest in cyclic growth and regression phases.
Many of you who experience shedding on a treatment are actually experiencing the cycling of the hair phase from anagen (growth) into catagen (regression) and sometimes telogen (resting). This defined rhythm is controlled by numerous physiological and pathological factors. No hair stays in growth phase forever, however the Anagen phase typically lasts several years, Catagen lasting a few weeks, and Telogen several months.
Therefore, logically, you’ve got a mass of hairs in Anagen (growth) phase, and only some individual hairs in Catagen (regression) at any given time. On a typical human scalp, approximately 18% of the follicles are in the Telogen (resting) phase at any one time, while 40 – 50% are in telogen on your body. Those with conditions such as Telogen Effluvium[4] and Androgenetic Alopecia (Male Pattern Baldness)[5] have a much higher number of telogen hairs on their head.
Knowing the exact ratio of anagen to telogen follicles on a person’s scalp is an effective way to determine whether a person is losing their hair, and exactly how far it has progressed. Likewise, being able to accurately detect a decrease in telogen follicles when using a hair loss treatment can reveal how successful that treatment truly is. Conventional trichogram’s can perform this function.
Today’s most common method for determining the anagen / telogen ratio on any given scalp is called the Trichogram. It usually involves several painful epilations, and several factors including the abstention from hair washing for several days prior to the procedure, make it a difficult and inconvenient test. The location and rate of the epilation may vary, which can pretty much nullify the accuracy of the results. Consequently, the conventional Trichogram is beneficial only for basic evaluation of hair loss, not for exact therapeutic monitoring.
TrichoScan can be viewed as a modification of the classic Trichogram. The software that comes with the procedure quickly and easily counts the number of hairs and the anagen/telogen ratio within one operation. A typical TrichoScan procedure will occur as follows:
Step 1: Shaving an area of scalp that is approximately 1.8cm squared. Hair is not shaved to the scalp, but only enough to leave short hair shafts visible.
Step 2: 3 days is allowed to pass. Die is then applied to the shaved area using a wooden spatula. Die is left in place for 10 to 12 minutes.
Step 3: A video Image is taken at a magnification of 20 times.
Step 4: Using the logic that anagen hairs grow 0.3mm per day, and telogen hairs do not grow, the TrichoScan software analyzes the image and determines the anagen/telogen ratio.
Before and after photos of a person on any given treatment regimen allow a detailed conclusion to be made regarding the success or failure of that hair loss treatment. The advantages of the TrichoScan lie in its simple, fast, and photographic processing, as well as the painlessness of the procedure and the reproducibility of the results.
The dermatology clinic that has a significant proportion of clients with hair loss problems (mostly telogen effluvium and AGA) can use the approach as a simple, non-invasive method of measuring hair loss (and hair growth in response to treatment). As long as the clinic has a suitable method for taking close up photos and scanning them into a computer, then they can use the software. It’s simple, cheap, effective, and doesn’t require much expertise to apply. Much simpler and cheaper than using traditional Trichogram, and more accurate and informative than global photographs. The future of TrichoScan
The creators of TrichoScan in Marburg Germany are looking to market the tool to dermatology clinics. You can help by printing this article and bringing it to your dermatologist.
The second aim (and main aim) is to get the pharmaceutical companies interested in using the technique for screening in treatment trials. Some companies are very interested, but they have a practical problem in that few companies are planning new trials right now.
It may take a while to get this end of the project off the ground.
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