Improvement of Post-Treatment Eyebrow Alopecia Using Stem Cell Growth Serum
Kathleen Hui Xin Ong ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Samuel Wei Qiang Ong; Anglo-Chinese School (independent), Singapore
Shu Jin Lee; Department of Surgery, National University Health System, Singapore
INTRODUCTION
Eyebrow lacerations are a very common injury and cicatricial alopecia (CA) is a common sequela. Often referred to as "scarring alopecia", CA differs from non-scarring subtypes of alopecia as hair loss in affected individuals is irreversible due to damage to epithelial stem cells in the bulb region of the hair follicle at the level where the arrector pili muscle inserts. To date, post-traumatic eyebrow CA is irreversible and psychologically distressing for affected individuals. While hair transplants are the gold standard for treating eyebrow alopecia, it is a painful and invasive procedure, especially for pediatric patients. We seek to improve the long-term surgical outcomes of eyebrow lacerations by treating the associated eyebrow alopecia with the topical application of Calecim stem cell serum.
METHODOLOGY
We present 4 cases of chronic and acute eyebrow trauma respectively. Cases 1 and 2 are 5-year-old and 4-year-old males respectively with no significant past medical history. Both patients suffered lacerations to the eyebrow (Fig 1 and Fig 2) which had healed uneventfully but developed mature scars over the accident site, with the presence of CA (Fig 1 middle and Fig 2 middle). Both patients began Calecim treatment 3 and 4 years post-accident respectively, with monthly visits. The scars were cleaned topically with alcohol and shallow scratchings were made with a sterile 30-Gauge needle, whereby Calecim serum was applied to the site immediately. Both patients were instructed to apply Calecim serum 5 times a day over 48 hours before reducing it to twice a day subsequently, alongside silicone gel and sunblock.
Conversely, cases 3 and 4 are acute presentations of significant eyebrow trauma. Case 3 suffered a flap degloving of the eyebrow (Figure 3 left) and Case 4 experienced significant crush trauma (Figure 4 left). Calecim serum was applied topically after suture removal at 1 week and twice a day thereafter.
RESULTS
For cases 1 and 2, there was evidence of fair to moderate villous-like hair regrowth after 6 months (Fig 1 right and Fig 2 right).
FIG 1, CASE 1. (LEFT) LEFT EYEBROW LACERATION. (MIDDLE) MATURE SCAR WITH CHRONIC ALOPECIA 4 YEARS POST TRAUMA AT COMMENCEMENT OF CALECIM USE. (RIGHT) MODERATE HAIR REGROWTH AFTER MONTHLY TREATMENTS FOR 6 MONTHS
FIG 2, CASE 2. (LEFT) RIGHT EYEBROW LACERATION. (MIDDLE) MATURE SCAR WITH CHRONIC ALOPECIA 3 YEARS POST TRAUMA AT COMMENCEMENT OF CALECIM USE. (RIGHT) MILD HAIR REGROWTH AFTER 6 TREATMENTS.
For cases 3 and 4, the 4 month results show good hair retention over the site of trauma (Figure 3 right, Figure 4 right).
FIG 3. CASE 3 (LEFT) SEVERE LEFT EYEBROW DEGLOVING ACCIDENT. (RIGHT) 4 MONTHS POSTOPERATIVE WITH TWICE DAILY APPLICATION OF CALECIM SERUM.
FIG 4. CASE 4 (LEFT) RIGHT EYEBROW LACERATION. (RIGHT) 4 MONTHS AFTER TWICE DAILY APPLICATION OF CALECIM SERUM.
Hence, the overall results show that Calecim serum is an effective adjunct, acting as a non-invasive topical serum which aids hair retention in acute trauma and helps in fair to moderate hair regrowth in chronic scarred eyebrows.
DISCUSSION
Previously, there was no available treatment to stimulate hair follicle neogenesis in CA. A study assessed the outcomes of hair transplantation (HT) in patients with CA and it was found that HT in scarring alopecia has low graft survival rates (50%), especially in secondary CA compared to nonscarring alopecia (>90%). Furthermore, HT is an invasive surgical procedure that is associated with complications such as hypertrophic scars, graft rejection, infection, and corkscrew hair Moreover, limited blood supply of graft recipient sites increases the risk of post-op infection, ischemia, and necrosis that may cause further vascular insult.
Patients in this study were treated with stem cell serum from Calecim, which is a cell-free protein extract derived from umbilical cord lining containing mesenchymal stem cells (MSCs). Stem cell-derived conditioned media is rich in bioactive molecules such as cytokines and growth factors, which are proposed to suppress proinflammatory cytokines and reverse disrupted hair follicle activity in conventional alopecia. Cell-free conditioned media is proposed to be more desirable than stem cell-based transplantation as it avoids donor-recipient matching, is easier to prepare, is cheaper, and has less risk of tumor development.
CONCLUSION
In conclusion, the findings in this case report suggest that post-traumatic CA is a preventable condition that can be treated in a convenient, noninvasive manner with topical application of stem cell growth serum.
- In acute cases of eyebrow lacerations, early application of stem cell serum allows for hair retention and prevents the onset of CA in the long-term to improve both wound healing and cosmetic outcomes.
- Conversely, in the setting of chronic secondary CA, shallow scratching of the skin surface allows for perforation of the dermis to encourage wound healing, increased vascularity and penetration of growth factors from the stem cell serum.
ACKNOWLEDGEMENT
The off-label product used, Calecim, is a cosmeceutical and the procedure using the product was done with the patients’ full consent.
