br Acknowledgements br Introduction The
Introduction The study methods consisted of the review of articles included in the Pubmed and Medline databases and in the clinicaltrials.gov clinical trials register between 2013 and 2016, and of the preliminary results of therapies presented at international trichology conferences. The authors of this review also describe their personal experience with the different therapies.
Alopecia Areata The therapeutic novelties in the treatment of AA fall into 2 groups: a) new data and forms of application of traditional treatments, and b) new therapies.
Scarring Alopecia The etiology and pathogenesis of frontal fibrosing alopecia (FFA) are currently considered to involve a double autoimmune and hormonal mechanism.59, 60, 61 This justifies the use both of anti-inflammatory drugs (corticosteroids) to reduce the autoimmune inflammation and of antiandrogens (finasteride and dutasteride). In recent years, several studies have been published that show the potential usefulness of these drugs in FFA,59, 60, 61, 62, 63, 64 including a multicenter Spanish study of 355 patients. The mechanism by which the antiandrogens act in the FFA is not fully understood, but it would appear that inhibition of the action of male avibactam on the root of the follicle helps to stabilize the disease.59, 61 Some authors have even reported regrowth after the administration of antiandrogens. However, others remain skeptical regarding the use of these drugs in FFA. Although their mechanism of action remains unclear, there is evidence that a hormonal factor is responsible forFFA. Another important therapeutic novelty in FFA and lichen planopilaris (LPP) is the use of the oral antidiabetic agent pioglitazone, which blocks the peroxisome proliferator-activated receptor-γ (PPARγ). Recent studies have suggested that altered function of PPAR-γ may play a role in the initiation of inflammation in LPP and FFA. Four studies have been published in which pioglitazone has been used to treat LPP and FFA.67, 68, 69, 70 Results have been variable, with an efficacy of between 20% and 70% and adverse effects in up to 50%. Marquez and Camacho performed a study in 68 women with FFA, with favorable results in 64% after the use of pioglitazone. The authors believe that pioglitazone could be effective in some cases, but intolerance is not uncommon, mainly in the form of lower limb edema and weight gain, leading to drug withdrawal in a significant number of cases. In the case of folliculitis decalvans (FD), a Spanish multicenter study including 82 patients concluded that the most effective treatment (improvement in 15/15 patients treated) with the longest period of remission after treatment (7.2 months) was the combination of rifampicin plus clindamycin administered for 10 weeks (Fig. 3). Another therapeutic novelty reported in the literature is the possible usefulness of photodynamic therapy (PDT) with benefit in 9 out of 10 patients with FD. However, other authors have reported a negative experience with PDT in 3 out of 3 patients.
Hair transplant To complete this review, 2 novel methods stand out in the field of hair transplant. First, the arrival of the new automated robotic systems that reduce operating times and, in some cases, improve the rates of follicular transection in the follicular unit extraction technique. However, we consider that results depend more on surgical dexterity than on the device used. The other novelty is a new technique of follicular extraction, known as partial longitudinal extraction. This consists of only partially extracting the follicular units, so that the part of the follicle that remains in the donor region can survive and regenerate an intact follicular unit, thus avoiding the progressive depopulation that occurs in the donor region. The concept is interesting, but still needs to be developed. A summary of the most relevant therapeutic novelties in trichology is presented in Table 1.