Summary

Off-label use of approved medication for hair regrowth without hair transplantation.

Keywords

Hair, Hair transplant, Wound, Surgery

Verteporfin is FDA-approved for neovascular macular degeneration. Recent Stanford research [1] has revealed a novel use for verteporfin promoting scarless skin regeneration by inhibition of Yes-associated protein (YAP), preventing the activation of En1-positive fibroblasts causing scars [2-4].

Two male subjects aged 35 and 48 with androgenetic alopecia and history of remote (>3 years) FUE hair transplant sought de novo hair growth without additional hair transplant. One participant had undergone remote (>3 years) scalp micro pigmentation. Patients were blocked with tumescent solution (2% Lidocaine with epinephrine and bicarbonate with 0.25% Marcaine). An 11 blade was used without guide to create dermal incisions per standard procedure for follicular placement for Follicular Unit Extraction (FUE) placement and 25 mg of compounded verteporfin was injected subcutaneously diffusely beneath the dermal wounds. Patients received topical neomycin, polymyxin B and dexamethasone for twice daily use for one week and were instructed to avoid direct sunlight for seven days. Patients healed well and returned at one and three months for subjective and objective assessments (Ultimate Hair Densitometer, Eschenbach, Germany) including density in treated areas. Regrowth was most noticeable in traditional donor sites with greatest density pre-operatively (mean increase of 63%), less in areas of thinning (mean of 38%), and no growth (0%) was noted in areas of baldness or complete recession.

Regrowth of donor sites in hair transplantation has been reported [5,6] but no reports exist to demonstrate that hair regrowth may be possible with de novo incisions combined with subcutaneous injections of verteporfin (Figure 1 and Figure 2). This may represent a novel method of regrowth in thinning areas due to androgenetic alopecia and a way to bolster donor areas for future transplant procedures [7,8].

References

1. https://techfinder.stanford.edu/technology/use-verteporfin-prevention-skin-scarring
2. https://www.science.org/doi/10.1126/scitranslmed.adt6387
3. Mascharak S, Talbott HE, Januszyk M, Griffin M, Chen K, et al. (2022) Multi-omic analysis reveals divergent molecular events in scarring and regenerative wound healing. Cell Stem Cell 29: 315-327.
4. Morgan A, Valencia C, Januszyk M, Lorenz HP, Wan D, et al. (2024) Inhibiting Yes-associated protein prevents scarring and promotes regeneration in a large animal model of wound repair. The 23 ^rd annual Emile Holman Lecture in Surgery Booklet.
5. Parry D, Allison K (2022) Is the future scarless? - Fibroblasts as targets for scarless wound healing: A narrative review. Scars Burn Heal 8: 20595131221095348.
6. Clark RAF (2021) To scar or not to scar. N Eng J Med 385: 469-471.
7. Chen K, Kwon SH, Henn D, Kuehlmann BA, Tevlin R, et al. (2021) Disrupting biological sensors of force promotes tissue regeneration in large organisms. Nat Commun 12: 5256.
8. Cavanzo NP, Riesmeijer SA, Holt-Kedde IL, Werker PMN, Piersma B, et al. Verteporfin ameliorates fibrotic aspects of Dupuytren’s disease nodular fibroblasts irrespective the activation state of the cells. Scientific Reports 12: 13940.

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