A Bald Statement: Current Approaches to Manipulate Miniaturization Focus Only on Promoting Hair Growth

The document from 2018 emphasizes the need for a shift in focus from merely promoting hair growth to targeting the underlying causes of hair follicle miniaturization in Androgenetic Alopecia (AGA). It highlights the importance of the dermal papilla (DP) size in hair fiber thickness and suggests that increasing DP size could potentially reverse hair miniaturization. Current treatments like finasteride and minoxidil are noted to be preventative but not capable of reversing miniaturized hair follicles. The paper also discusses the paradoxical effects of Dihydrotestosterone (DHT) on hair follicles, the role of prostaglandin analogs, and the potential of DP₂ antagonists like setipiprant in clinical trials. It critiques the use of animal models for accurately representing the ability to reverse hair follicle miniaturization and calls for better model systems. The authors propose that research should focus on modulating cellular processes during hair cycle transitions, particularly the influx of cells into the DP from hair follicle dermal stem cells (hfDSCs), and understanding the signaling pathways involved, such as WNT, FGF, BMP, and the Hippo pathway, to develop effective treatments for AGA.