A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study

Int J Trichology. 2013 Jan;5(1):6-11. doi: 10.4103/0974-7753.114700.
A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study.
Dhurat R, Sukesh M, Avhad G, Dandale A, Pal A, Pund P.

Department of Dermatology, L.T.M. Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.

INTRODUCTION:
Dermal papilla (DP) is the site of expression of various hair growth related genes. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. Microneedling works by stimulation of stem cells and inducing activation of growth factors.
MATERIALS AND METHODS:
Hundred cases of mild to moderate (III vertex or IV) androgenetic alopecia (AGA) were recruited into 2 groups. After randomization one group was offered weekly microneedling treatment with twice daily 5% minoxidil lotion (Microneedling group); other group was given only 5% minoxidil lotion. After baseline global photographs, the scalp were shaved off to ensure equal length of hair shaft in all. Hair count was done in 1 cm(2) targeted fixed area (marked with tattoo) at baseline and at end of therapy (week 12). The 3 primary efficacy parameters assessed were: Change from baseline hair count at 12 weeks, patient assessment of hair growth at 12 weeks, and investigator assessment of hair growth at 12 weeks. A blinded investigators evaluated global photographic response. The response was assessed by 7- point scale.
RESULTS:
(1) Hair counts - The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs 22.2 respectively). (2) Investigator evaluation - Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group. (3) Patient evaluation - In the Microneedling group, 41 (82%) patients reported more than 50% improvement versus only 2 (4.5%) patients in the Minoxidil group. Unsatisfied patients to conventional therapy for AGA got good response with Microneedling treatment.
CONCLUSION:
Dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair growth. Microneedling is a safe and a promising tool in hair stimulation and also is useful to treat hair loss refractory to Minoxidil therapy.

Nice post, CS.  Do you know what the length of the needle was used in the study by chance?

CF wrote:Nice post, CS.  Do you know what the length of the needle was used in the study by chance?

1.5mm I believe

http://www.ijtrichology.com/article.asp?issn=0974-7753;year=2013;volume=5;issue=1;spage=6;epage=11;aulast=Dhurat

There are guys over at HLH that have been experimenting for a few weeks

http://www.hairlosshelp.com/forums/messageview.cfm?catid=10&threadid=106677&enterthread=y

To me, this again points toward DHT being more of an effect, not a cause.

This whole thing of blocking 5ar to reduce the chances of DHT affecting
a sensitive follicle seems ridiculous the more I think about it. although it
does work for some, it seems like an approach that in the future, we
will laugh about.

I have found no explanations as to why (it's just genetics) the follicles
on the top of the head are negatively affected by DHT. Not positively
like the rest of the body. Science can't provide the answer, although I'm sure
they're working on it.

The bloodflow theory seems like part of it. and if bloodflow restriction is
an issue, does this occur after the cascade or does it cause the cascade?

Thanks SlowMoe.

Wow. 1.5 mm. I use 0.5 right now and it stings a little. I am curious if the results were because of the dermarolling, or if the channels dermarolling creates allow the minoxidil to work more efficiently.

Lucky13 wrote:Wow.  1.5 mm.  I use 0.5 right now and it stings a little.  I am curious if the results were because of the dermarolling, or if the channels dermarolling creates allow the minoxidil to work more efficiently.

It's too bad there wasn't a third group that just used a dermaroller.

CF wrote:

Lucky13 wrote:Wow.  1.5 mm.  I use 0.5 right now and it stings a little.  I am curious if the results were because of the dermarolling, or if the channels dermarolling creates allow the minoxidil to work more efficiently.

It's too bad there wasn't a third group that just used a dermaroller.

Agreed. I've always wanted to avoid minoxidil use, but if this is the real deal in getting back some quality hair, then it would be worth it. Definitely curious how well this would work with needling alone.

I have a hard time believing the regrowth is due to increased minoxidil absorptions. I wounder if it has some effect on the actual healing process from the injuries caused be the needles?

I work for a hair restoration doctor in Alpharetta, GA and enjoy reading the doctor to doctor publication called Hair Transplant Forum International we subscribe to.  There are a lot of studies happening related to hair growth and maintenance. Not just hair transplants. Here is the short list of things found to be of benefit to men with MPB:
Vitamin D3, Latisse, Minoxidil, some sun exposure but not sunburn, copper peptides, ACell, and Platelet Rich Plasma.

We had a patient recently who had a stand-alone ACell/PRP treatment. We used the HairCheck system to determine improvement in his hair mass index. The hair mass numbers doubled in some critical areas of his crown. ACell/PRP doesn't work well for everyone. This particular patient had been using Avodart for around 8 years before having the ACell/PRP treatment. Avodart may have enhanced his result.

Stay away from minox! One day you will get tired of using it and it may spell disaster for your hair!

There are two big threads at HLT and Bald thruth talk with people experimenting with dermarollers. http://www.hairlosstalk.com/interact/showthread.php/69374-New-Dermaroller-Study-Thoughts-comments  
http://www.baldtruthtalk.com/showthread.php?t=13420
Here's a study with a simple graph http://scitechdaily.com/study-points-to-a-way-to-treat-wounds-and-grow-hair/

I kinda want to try the dermaroller but a little worried for damage.

The write-up describing that image says how mice have the γδ T cell whereas humans do not have enough of them for the wounding process to work, as the γδ T cell is necessary for the production of FGF9.  But if you go through the HLT thread ramboprincess posts some about how the minoxidil increases PGE2 and the PGE2 leads to the production of FGF9.  (I believe he got that from a Cotsarelis study.)

In terms of natural topicals that increase PGE2 I have been looking.  There's not a lot. (Some people have used castor oil because of some study that fed it to pregnant rats and it increased it in the liver, or something like that.)

However, sunlight increases PGE2.  Maybe that would be enough? (I have no idea.) In case one were to try that I think it bears mentioning that astaxanthin when applied to human keratinocytes prior to UVB exposure prevented PGE2 production. Here is the thread for that information.

Giving that dermaroller study a try might be worth while but instead of minox, maybe msm spray, ahk peptides, emu oil, etc. There's plenty to try. I think 4039 uses a derma roller, others brush, but the concept is the same.

"minoxidil increases pge2"

Since minoxidil is a vasodilator, I'm sure it increases a lot of things; it introduces more nutrients.

Perhaps manual blood flow increasing methods would provide the same stimulus as minoxidil....?

So, what dermaroller should we be using?

I would buy this one if I was on a budget (which I am):

http://www.hairlosstalk.com/interact/showthread.php/69374-New-Dermaroller-Study-Thoughts-comments/page13

They use a 1.5 MM once a week I believe. Dermarollers should be cheap. It might be worth a try especially for those who already brush. We can try a similar community study but with natural products instead to see if we can get results.

Hi,
I'm on 0.75mm derma roller for almost 2 months.
The first month i roll two times a week, but i had a lot of shedding from the next day.
The second month, i switch to once a week, shedding has stop and my hair looks better, more thicker i think. No regrowth.
I also brush for over a year. No regrowth too.
I am Nw 3v
Anyway, i already have bought a 1.5mm roller, but i will not use it for the moment.
From my research it is very important the growth factors after wounding.
I applying only black castor oil after third day but i am thinking the addition of topical calcipotriol. (active VD3)
I know you guys are expert to those stuff, so please could you advise about topical calcipotriol? (dovonex calcipotriol scalp solution)
Is it safe?

i can't post link as a new member, but search google for topical calcipotriol for alopecia areata.

Live forever wrote:To me, this again points toward DHT being more of an effect, not a cause.

This whole thing of blocking 5ar to reduce the chances of DHT affecting
a sensitive follicle seems ridiculous the more I think about it. although it
does work for some, it seems like an approach that in the future, we
will laugh about.

I have found no explanations as to why (it's just genetics) the follicles
on the top of the head are negatively affected by DHT. Not positively
like the rest of the body. Science can't provide the answer, although I'm sure
they're working on it.

The bloodflow theory seems like part of it. and if bloodflow restriction is
an issue, does this occur after the cascade or does it cause the cascade?

Things discontinue working properly when it either has too much of something negative (toxicity) or not enough of something positive(deficiency). The blood flow ideas have to do with the delivery of those factors. Dht isnt generally negative to hair, I believe it has more to do with calcification and location of, which can reduce the blood flow clearance... Everything works in convolutions.