1. Introduction
abnormal hair loss, alopecia areata, FM, androgenetic alopecia, hair loss, Hair loss, alopecia
PATHOLOGY, ALOPECIA AREATA, ANDROGENETIC ALOPECIA, DIFFUSE ALOPECIA, DISORDERS, HAIR LOSS, SECONDARY, HAIR LOSS, ALOPECIA, PATHOGENESIS
Plant-derived secondary metabolites (polyphenols/terpenes/alkaloids) and microbial exometabolites/membrane components of fermented tropical fruits are known as highly bioavailable biomolecules causing skin and hair improvement effects (wound healing, anti-inflammatory, antioxidant, antidiabetic, antiacne, skin/hair microbiota balancing, hair growth-promoting, and hair loss-inhibiting). Caffein is considered as a hair growth promoter. A randomized placebo- and caffein-controlled clinical trial on the efficacy of fermented papaya (FP) plus fermented mangosteen (FM) towards human hair quality and loss was conducted. Shampoo and lotion hair care products containing FP, FM, and caffein as active agents were developed and applied to 154 subjects of both sexes with clinically confirmed androgenic or diffuse alopecia for 3 months. Their clinical efficacy was assessed subjectively by questionnaires filled in by dermatologists/trichologists, and by the objective trichomicroscopical calculations. Hair and scalp skin quality was determined by microbiota pattern and ATP, SH-groups, protein, and malonyl dialdehyde quantification. Comparative clinical data showed that the experimental hair care cosmetics significantly inhibited hair loss, increased hair density/thickness, and improved hair follicle structure versus placebo and caffein controls. The cosmetics with FP and FM substantially normalized the microbiota pattern and increased ATP content in hair follicle, while inhibiting lipid peroxidation in the scalp skin, and SH-group formation in the hair shaft.Hair loss (alopecia) is a widespread health problem affecting many people and thus causing an immense medical and psychological burden that deteriorates the patient’s quality of life. Very often, alopecia reflects existing disorders in humans—hormonal status, reactions to psychological and environmental stresses, and to pharmacological treatments. Sometimes, the etiology of abnormal hair loss remains unknown. The status of scalp skin and quality of hair has been regarded as an important risk factor for the pathogenesis of alopecia [Regarding androgenetic alopecia, which affects both men and women, the treatments are numerous and diverse, including hair transplantation, paramedical physical devices, cosmetics, and pharmacology. Current pharmacological therapies of androgenetic alopecia based on FDA-approved drugs are few, with topical minoxidil (2,4-di-amino-6-piperidinopyrimidine-3-oxide) [Immunosuppressive drugs represent leading therapeutic options for the treatment of alopecia areata [Nowadays, arachidonic acid and its major metabolites prostaglandins, mainly prostaglandin F2α, have been attentively studied as prospective remedies against alopecia (reviewed in [Owing to these unmet clinical needs, the extensive search for clinically efficient and safe (adverse effects-free) pharmacological/physical means for the therapy and prevention of alopecia has been constantly growing. In addition, the development of hair care cosmetics to normalize scalp skin status and ameliorate hair shaft and root quality has become a great priority.Recent advances in understanding hair biology and pathology have encouraged the research and development of novel and safer natural hair growth agents. As a common current trend, natural plant-derived or plant substances-based remedies have flooded the immense and fast-growing market of hair care and anti-hair loss paramedical and cosmetic products. The number of publications describing the discovery, development, and research on the mechanisms of the anti-hair loss and pro-hair growth effects of natural herbal/marine phytoextracts, or of their isolated substances has been growing exponentially. The dedicated comprehensive reviews of analytical, preclinical, and clinical data are many [A series of publications was focused on the preclinical studies of tricogenicity, an intense hair-inductive activity, of an Annurca (The application of high-throughput proteomic and genomic approaches to 20 vital medicinal plants from the Korean Pharmacopeia has shown that they could exert therapeutic effects on alopecia mainly by regulating phase II metabolic enzymes, such as acetylcholinesterase, phospholipase A2, ecto-5-nucleotidase, nicotinamide N-methyltransferase, and quinolinate phosphoribosyltransferase [Epigallocatechin gallate in combination with rapamycin, delivered transdermally in the form of dissolvable microneedle, promoted fast hair regeneration in mice [Caffeine, a hydrophilic alkaloid with high bioactivity and capacity to penetrate the lipid skin barrier, has recently attracted increased attention as an active cosmetic agent possessing antioxidant, anticellulite, antiphotoaging, and hair growth-stimulating properties [An emerging trend to the prevention and treatment of hair loss is represented by the development and application of cosmeceutical and nutraceutical compositions with probiotic and prebiotic capacities. The rationale for such an approach relies on the hypothesis that defects in the communication axes, for example, the brain–gut–skin chain, could be involved in alopecia [Microbial (bacterial-, yeast-, fungi-, and mold-driven) fermentation has been traditionally used for the preservation of foods and the improvement of food flavor [The present clinical and laboratory study has been designed and performed in order to check the effects, if any, of two cosmetic preparations (hair lotion and shampoo) containing standard preparations of fermented papaya (FP) and fermented mangosteen (FM) towards hair loss and hair quality in persons with diagnosed androgenetic alopecia and diffuse hair loss. For this purpose, a randomized double-blind placebo- and caffein-controlled clinical trial was carried out. The clinical data were assessed by questionnaires developed for the professional dermatologists–trichologists, supported by quantitative trichomicroscopy and biochemical analyses of ATP content in the hair follicles, SH-group content and protein release from the hair shaft, malonyl dialdehyde (MDA) content in the scalp skin lipids, and microbiota spectrum on the scalp skin.