Hair Restoration

                                 Dermaroller Therapy                         

Introduction

Androgenetic alopecia affects up to 30% of men below 30 years of age and approximately 50% of men above 50 years of age. The incidence of androgenetic alopecia seems to be increasing in women also. There is a significant psycho-social impact associated with hair loss and thinning of hair. There is a growing demand amongst the patients to seek treatment to prevent the existing hair loss and to regain new hair with good thickness, volume and density. About 40% of patients with androgenetic alopecia go bald inspite of conventional therapy with minoxidil and finasteride. Dermaroller is also known as Microneedling. It is a recent advancement to the treatment modality for androgenetic alopecia and hair loss due to other causes. The procedure is well tolerated and well accepted by the patients and is a cost-effective therapy for treatment of androgenetic alopecia and hair loss in both men and women.

Dermaroller-The Instrument

The standard dermaroller consists of a drum-shaped roller which is studded with 192 fine microneedles which are arranged in eight rows. The length of the needles varies from 0.20- 3.0 mm and has a diameter of 0.1 mm. The microneedles are usually synthesized by reactive ion etching techniques on silicon or medical-grade stainless steel. Dermaroller is presterilized by gamma irradiation.

Mechanism of action

During treatment with dermaroller, the needles penetrate through the stratum corneum and create micro-channels (holes) without damaging the epidermis. Rolling with a dermaroller (192 needles, 200 µm length and 70 µm diameter) for 15 times over an area creates approximately 250 holes/ cm2. Dermaroller works by:

1. Release of various platelet-derived growth factor and epidermal growth factors by activation of platelets and skin wound regeneration mechanism. This helps to stimulate the formation of new hair follicles and increase the nutrition to the existing hair follicles.
2. Dermaroller causes activation of stem cells in the hair bulge area which stimulates new hair growth.
3. Post dermaroller there is overexpression of hair growth-related genes, vascular endothelial growth factor, B catenin, Wnt3a, and Wnt10.
4. It causes formation of new capillaries (neo-angiogenesis) which helps to stimulate growth of new hair follicles. Increase in blood supply to the hair follicles also increases the supply of nutrients to the follicle, which in turn helps to nourish them.
5. Topical application of products after dermaroller can increase their absorption by atleast 40 fold as compared to their application on intact scalp. Hence it is used for enhancing the percutaneous penetration and absorption of various hair growth products such as minoxidil, hair serums, platelet rich plasma etc.

Indications of dermaroller for hair loss and thinning

1. Treatment of androgenetic alopecia in both men and women.
2. Treatment of alopecia areata in children and adults
3. Treatment of other causes of hair loss such as telogen effluvium.
4. Delivery of hair growth products to enhance their percutaneous absorption. Topical application of products after dermaroller can increase their absorption by atleast 40 fold as compared to their application on intact skin.
5. Post Hair transplantation surgery in order to stimulate and maintain the growth of transplanted hair follicles.

Pre-Procedure Instructions for patients

On the day of treatment with dermaroller patients should:

1. Wash their hair with shampoo
2. Women should apply conditioner after shampoo to prevent the hair from tangling
3. Do not use any oil or any other hair product after bath
4. For men it is best to get a haircut prior to the procedure as short hair will interfere minimally with the treatment. There is no need to get bald, just little shorter hair should be good.
5. There is no need to be fasting or to be empty stomach for this procedure. Please have a good meal before you come for the procedure.

Procedure

Treatment with dermaroller is a simple office-based procedure. Scalp is cleansed using betadine and spirit. Topical Minoxidil solution is applied on the scalp. Dermaroller is rolled in the area in horizontal, vertical, and oblique directions until mild erythema and few pin point bleeding points are noted. The entire procedure lasts for 15 to 20 minutes. Immediately after this, topical minoxidil and hair growth serums are applied and massaged into the scalp inorder to enhance their penetration. Use of Platelet rich plasma can also be combined with dermaroller. The area is covered with an occlusive sheet for next 1 hour to enhance penetration of topical minoxidil and hair growth serums. The whole procedure from the time patient enters the hospital and leaves takes around 40 minutes. The patient can leave hospital and can remove the occlusive sheet by themselves after 1 hour.

Post procedure

Treatment with dermaroller is usually well tolerated by the patients. As the microholes close immediately, postoperative infections do not occur.

1. Cool ice packs may be applied to decrease post procedure discomfort which may be experienced by some patients.
2. Patient can remove the occlusive sheet after 1 hour. The area may be cleansed with water and soap if the patient wishes, or can be left as it is.
3. Though the treatment is usually well tolerated, patients can experience slight tenderness and pain in the scalp which can be treated with analgesics for 1-2 days.
4. Scalp should be washed with shampoo on the next morning of the procedure.
5. Slight erythema and oedema may be experienced by few patients which will subside in few hours to 1 day and can be decreased with the application of ice packs.
6. Very rarely, few patients may experience enlargement of lymph nodes draining the scalp. In this case a course of antibiotics and analgesics may be required.

Schedule of treatment

It is advised to get 12-14 sessions of treatment with dermaroller at an interval of 2-4 weeks. For good results treatment plan for at least 6 months is advised.

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