trichometer fl derm 2008

THE CROSS SECTION THE CROSS SECTION TRICHOMETERTRICHOMETER

A NEW DEVICE FOR MEASURINGA NEW DEVICE FOR MEASURINGHAIR LOSS - HAIR GROWTH - HAIR DAMAGEHAIR LOSS - HAIR GROWTH - HAIR DAMAGE

Bernard Cohen, MDBernard Cohen, MD VOLUNTARY PROFESSORVOLUNTARY PROFESSOR

UNIVERSITY OF MIAMI SCHOOL OF MEDICINE UNIVERSITY OF MIAMI SCHOOL OF MEDICINE

SEPTEMBER 27, 2008SEPTEMBER 27, 2008Breakers Hotel, Palm Beach, FLBreakers Hotel, Palm Beach, FL

HAIR LOSSHAIR LOSS&&

HAIR GROWTHHAIR GROWTH

Cannot be measured inCannot be measured inan office settingan office setting

NORWOOD SYSTEMNORWOOD SYSTEM

GLOBAL PHOTOGRAPHY

““HOW MUCH HAIRHOW MUCH HAIR””cannot be quantifiedcannot be quantified

8686 9898

4949

IF IT CANIF IT CAN’’T BET BE

MEASUREDMEASUREDIT CANIT CAN’’T BE T BE

MANAGEDMANAGED

What determinesWhat determines

HOW MUCH HAIRHOW MUCH HAIRMASS - QUANTITY - VOLUMEMASS - QUANTITY - VOLUME

DENSITYDENSITY - number of hairs per cm- number of hairs per cm22

DIAMETERDIAMETER - coarse - average - fine - coarse - average - fine

LENGTH LENGTH - short - average - long- short - average - long

Length is not a consideration. Length is not a consideration.

Length is determined by personal styling. Length is determined by personal styling.

Length changes with every haircut.Length changes with every haircut.

AN INCREASE INAN INCREASE IN

DENSITYDENSITY AND/ORAND/OR DIAMETER DIAMETERIS PERCEIVED ASIS PERCEIVED AS

GROWTHGROWTH••••••••••••••••••••••••••••••••••••••••••••

A DECREASE INA DECREASE IN

DENSITYDENSITY AND/ORAND/OR DIAMETER DIAMETERIS PERCEIVED ASIS PERCEIVED AS

LOSSLOSS

DIAMETERDIAMETERMEASUREMENTMEASUREMENT

USING HAND-HELD MICROMETER USING HAND-HELD MICROMETER

ASIANASIAN AFRICANCAUCASIAN

DENSITY COUNTDENSITY COUNT

COUNT THE HAIRS IN ONE CMCOUNT THE HAIRS IN ONE CM22 OF SKIN OF SKIN

ANDROGENETIC ALOPECIA - diameter reduces in size

MIXTURE OFMIXTURE OF

FULL SIZEFULL SIZE&&

INTERMEDIATEINTERMEDIATEHAIRSHAIRS

ANY HAIR LARGER THANANY HAIR LARGER THAN30 MICRONS IS 30 MICRONS IS COUNTED ASCOUNTED AS

ONE HAIRONE HAIR

BALDING WITH MINIATURIZATIONBALDING WITH MINIATURIZATION

HAIR DENSITY COUNTHAIR DENSITY COUNT

rr22 = = CROSS SECTIONAL AREACROSS SECTIONAL AREA••••••••••••••••••••••••••••••••••••••

CHANGING THECHANGING THE HAIR DENSITY HAIR DENSITY 10%10%

CHANGES THE HAIR QUANTITYCHANGES THE HAIR QUANTITY 10%10%

CHANGING THECHANGING THE HAIR DIAMETERHAIR DIAMETER 10%10%CHANGES THE HAIR QUANTITYCHANGES THE HAIR QUANTITY 20%20%

DIAMETERDIAMETER IS MORE INFLUENTIAL THAN IS MORE INFLUENTIAL THAN DENSITYDENSITY

Meaningful Meaningful measurementmeasurementmust includemust include

bothboth

DENSITYDENSITY &&

DIAMETERDIAMETER

• • Demarcate a standard-sized Demarcate a standard-sized AREA of SKINAREA of SKIN• • Isolate and gather the hairs into a bundleIsolate and gather the hairs into a bundle• • Measure the cross sectional Measure the cross sectional AREA of BUNDLEAREA of BUNDLE

2 x 2 cm

1 x 2 mm

CROSS SECTIONAL AREACROSS SECTIONAL AREAwill fluctuate ifwill fluctuate if

Diameter increasesDiameter increasesDiameter decreasesDiameter decreases

Diameter decreases… hair vanishesDiameter decreases… hair vanishesExisting hair falls outExisting hair falls outNew hair emergesNew hair emerges

DEMARCATE A STANDARD-SIZEDDEMARCATE A STANDARD-SIZED AREA OF SCALP AREA OF SCALP

2 x 2 cm

This can be a 4cm2

SquareRectangleTriangleHexagon

DESIGN A DEVICE TO DESIGN A DEVICE TO CAPTURE - COMPRESS - COMPACTCAPTURE - COMPRESS - COMPACT

ANDANDMEASUREMEASURE

THE CROSS SECTIONAL AREA THE CROSS SECTIONAL AREA

THE IDEAL DEVICETHE IDEAL DEVICE

1.1. Always compress the bundle with the same exact load…Always compress the bundle with the same exact load… regardless of the hair sample size regardless of the hair sample size

2.2. Compact the bundle completely …donCompact the bundle completely …don’’t damage the hairt damage the hair

3.3. Apply the load with mechanical precision… not by handApply the load with mechanical precision… not by hand

4.4. Include a precise scientific measuring elementInclude a precise scientific measuring element

5.5. Be easy-to-use and widely availableBe easy-to-use and widely available

6.6. Not require that hair be cutNot require that hair be cut

7.7. Not require a physician operatorNot require a physician operator

8.8. Generate results in less than 5 minutesGenerate results in less than 5 minutes

EARLY PROTOTYPEEARLY PROTOTYPE

HAIR CAPTURE ELEMENTHAIR CAPTURE ELEMENT(HOOK AND AVIL)(HOOK AND AVIL)

HAIR IS CAPTURED IN HAIR IS CAPTURED IN RECTANGULAR CHAMBERRECTANGULAR CHAMBER

TURN KNOB TO APPLY LOADTURN KNOB TO APPLY LOAD

BUNDLE ISBUNDLE ISCOMPRESSED & COMPACTEDCOMPRESSED & COMPACTED

CROSS-SECTIONAL AREACROSS-SECTIONAL AREA IS DISPLAYED ON LED SCREENIS DISPLAYED ON LED SCREEN

4 cm4 cm22 of SKIN of SKIN containscontains 2.80 mm 2.80 mm22 of HAIR of HAIR

DivideDivide 2.8O 2.8O byby 4.00 4.00 = .70 = .70 mm mm2 2 HAIR HAIR / cm/ cm2 2 SKIN SKIN

.70 X 100 =.70 X 100 = TRICHOMETRIC INDEXTRICHOMETRIC INDEX = 70= 70

1 x 2.80 mm

2 x 2 cm

mmmm22 HAIR CROSS SECTIONHAIR CROSS SECTIONPERPER

cmcm22 SKIN SURFACESKIN SURFACE

X X 100100

7575 = Fine hair (60 microns) = Fine hair (60 microns)

100100++ = Coarse hair (80 microns)= Coarse hair (80 microns)

For an average density of 230 hairs / cmFor an average density of 230 hairs / cm22 of scalp of scalp

TRICHOMETRIC INDEXTRICHOMETRIC INDEX

HOW WELL DOES HOW WELL DOES

BUNDLE CROSS SECTIONBUNDLE CROSS SECTION

CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN

DIAMETER?DIAMETER?

3-0 80 60 40 20

4-0 20 40 60 80 60 40 20

5-0 20 40 60 80 60 40 20

6-0 20 40 60 80

3.813.81 3.633.63 3.073.07 2.702.70 2.362.36 2.142.14 2.032.03 1.651.65 1.371.37 1.261.26 1.091.09 .82.82 .66.66

STRANDS OF SILK SUTURE MATERIAL

BUNDLE CROSS SECTIONBUNDLE CROSS SECTION PRECISELY CORRELATES WITH PRECISELY CORRELATES WITH

FILAMENT DIAMETERFILAMENT DIAMETER

BUNDLE CROSS SECTION

HOW WELL DOES HOW WELL DOES BUNDLE CROSS SECTIONBUNDLE CROSS SECTION

CORRELATE WITH CHANGES IN CORRELATE WITH CHANGES IN

DENSITY?DENSITY?

STRANDS of SILK 20 40 60 80 100 120 140 160

BUNDLE CROSS SECTION .36 .75 1.17 1.58 1.93 2.36 2.75 3.14

RATIO BUNDLE CROSS SECTION :: STRANDS

.018 .019 .020 .020 .019 .020 .020 .020

BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES TO THEPRECISELY CORRELATES TO THE

NUMBER OF STRANDSNUMBER OF STRANDS

HOW WELL DOESHOW WELL DOES

BUNDLE CROSS SECTION BUNDLE CROSS SECTION

MEASUREMENTMEASUREMENT

CORRELATE WITH CORRELATE WITH

DRY WEIGHT MEASUREMENT?DRY WEIGHT MEASUREMENT?

(THE INDUSTRY GOLD STANDARD)(THE INDUSTRY GOLD STANDARD)

STRANDS ofSILK

150150 148148 146146 144144 142142 140140 138138

GRAMS .2754.2754 .2728.2728 .2705.2705 .2672.2672 .2546.2546 .2590.2590 .2565.2565

BUNDLE CROSSSECTION

2.742.74 2.722.72 2.712.71 2.652.65 2.622.62 2.522.52 2.482.48

RATIO GRAMS :: BUNDLE CROSS

SECTION

.101.101 .100.100 .100.100 .101.101 .101.101 .103.103 .103.103

BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE

WEIGHT OF BUNDLEWEIGHT OF BUNDLE

RATIO STRANDS :: BUNDLE CROSS

SECTION

5555 5454 5454 5454 5454 5656 5656

SAME STUDY USING SAME STUDY USING

HAIRHAIRINSTEAD OF INSTEAD OF

SILK FILAMENTSSILK FILAMENTS

NUMBER OF HAIRS

xx X X MINUSMINUS

22

X X MINUSMINUS

44

X X MINUSMINUS

88

X X MINUSMINUS

1010

X X MINUSMINUS

1212

X X MINUSMINUS

1414

X X MINUSMINUS

1616

X X MINUSMINUS

2020

GRAMS .5536.5536 .5528.5528 .5519.5519 .5511.5511 .5506.5506 .5494.5494 .5480.5480 .5467.5467 .5434.5434

BUNDLE CROSSSECTION mm2

2.082.08 2.042.04 1.981.98 1.951.95 1.941.94 1.921.92 1.891.89 1.871.87 1.821.82

RATIO GRAMS ::

BUNDLE CROSS SECTION

.265.265 .271.271 .278.278 .284.284 .283.283 .286.286 .289.289 .292.292 .298.298

BUNDLE CROSS SECTIONBUNDLE CROSS SECTIONPRECISELY CORRELATES WITH THEPRECISELY CORRELATES WITH THE

WEIGHT OF BUNDLEWEIGHT OF BUNDLE

WHEN HAIR IS USED INSTEAD OF SILK, AMBIENT MOISTURE IS ABSORBEDWHEN HAIR IS USED INSTEAD OF SILK, AMBIENT MOISTURE IS ABSORBED

THE SEVERITY SCALETHE SEVERITY SCALE MINIMALMINIMAL MILDMILD Much more hair than skin More hair than skinMuch more hair than skin More hair than skin

MODERATE SEVERE MODERATE SEVERE More skin than hair Much more skin than hairMore skin than hair Much more skin than hair

1999 - E. Marritt conclusively demonstrated:1999 - E. Marritt conclusively demonstrated:

50% of the hair mass must be lost before50% of the hair mass must be lost beforethe underlying skin becomes visible.the underlying skin becomes visible.

When a man discovers for the first time When a man discovers for the first time that hethat he’’s balding… he has already s balding… he has already

lost 50% of his hair! lost 50% of his hair!

THE SEVERITY SCALETHE SEVERITY SCALE MINIMALMINIMAL MILDMILD Much more hair than skin More hair than skinMuch more hair than skin More hair than skin

MODERATE SEVERE MODERATE SEVERE More skin than hair Much more skin than hairMore skin than hair Much more skin than hair

SEVERITY SCORESEVERITY SCORE TRICHOMETRIC INDEXTRICHOMETRIC INDEX

Patient #1Patient #1 minimalminimal 4747



Patient #4Patient #4 mildmild 3636



Patient #7Patient #7 moderatemoderate 2525



Patient #10Patient #10 severesevere 2222



Severity Score and Trichometric Index

HOW CAN THE TECHNOLOGY HOW CAN THE TECHNOLOGY

BE APPLIED TOBE APPLIED TO

MEDICINEMEDICINE AND AND

HAIR PHYSIOLOGYHAIR PHYSIOLOGY

TODAYTODAYNo treatmentNo treatment

49497575 6161

18 MONTHS LATER

TODAYTODAYSTART PROPECIA

49497575 8686

18 MONTHS LATER

PRE OPPRE OPHAIR TRANSPLANTATION

49493333 6363

POST OP

4 MONTHS AFTER4 MONTHS AFTERCHILDBIRTHCHILDBIRTH

49497575 9595

10 MONTHS AFTERCHILDBIRTH

FEMALE with HAIR LOSSFEMALE with HAIR LOSS(occiput & mid scalp are about equal)(occiput & mid scalp are about equal)

CONCLUSION = Hair Loss is DIFFUSE not PATTERNCONCLUSION = Hair Loss is DIFFUSE not PATTERN

7474

7777

MALE with EARLY BALDINGMALE with EARLY BALDINGVertex = 50% LOSS = VISIBLEVertex = 50% LOSS = VISIBLE

Mid scalp = 12% LOSS = NOT VISIBLEMid scalp = 12% LOSS = NOT VISIBLE(86/98 X 100 = 88%)(86/98 X 100 = 88%)

8686 9898

4949

CAN THE DEVICECAN THE DEVICEBE USED TOBE USED TO

MEASUREMEASURE

HAIR DAMAGE?HAIR DAMAGE?

If hair is chemically treated each month. If hair is chemically treated each month.

DISTAL DISTAL shaft willshaft willreceive more treatments receive more treatments thanthan PROXIMAL PROXIMAL shaft.shaft.

Breakage will occur in Breakage will occur in DISTALDISTAL shaft. shaft.

THEREFORETHEREFORE

Measure a hair bundleMeasure a hair bundle’’s X-section s X-section along its length along its length

to detect the absence of to detect the absence of DISTALDISTAL hair shafts. hair shafts.

BUNDLE OF DAMAGED HAIRBUNDLE OF DAMAGED HAIR

X-sect = 1.73 sq mmX-sect = 1.73 sq mm




Skin surface

2 cm

5 cm

7 cm

10 cm

If the X-section is 1.73 mmIf the X-section is 1.73 mm2 2 at 10 cm at 10 cm

and 4.54 mmand 4.54 mm2 2 at the skin surface…at the skin surface…

1.73 divided by 4.54 = .381.73 divided by 4.54 = .38

WE CAN CONCLUDEWE CAN CONCLUDE

THERE IS 38% HAIR BREAKAGETHERE IS 38% HAIR BREAKAGE

@ 10 CM FROM THE SCALP@ 10 CM FROM THE SCALP

HAIR DAMAGEHAIR DAMAGE measurements can be performed on the measurements can be performed on the 2 x2 cm bundle that was captured for the standard2 x2 cm bundle that was captured for the standard TRICHOMETRIC INDEX TRICHOMETRIC INDEX measurement.measurement.

HAIR DAMAGEHAIR DAMAGE measurements can be performed on measurements can be performed on anyany random bundle of hair, provided it fits into the random bundle of hair, provided it fits into the capture chamber of the device.capture chamber of the device.

The size of the bundle has no relevance. No scalp The size of the bundle has no relevance. No scalp measurement is required.measurement is required.

Performance of aPerformance of a HAIR DAMAGE HAIR DAMAGE measurement measurement takes about 2 minutes. takes about 2 minutes.

Hair may be wet or dry.Hair may be wet or dry.

No training or experience is required.No training or experience is required.

SUMMARYSUMMARY

• Measure hair damage and breakageMeasure hair damage and breakage• Track & measure shedding (effluvium) Track & measure shedding (effluvium) • Track & measure thinning (balding) Track & measure thinning (balding) • Manage hair loss treatmentManage hair loss treatment• Measure the efficacy of a device or drugMeasure the efficacy of a device or drug• Measure HT resultsMeasure HT results• Determine if a drug causes hair lossDetermine if a drug causes hair loss• Detect balding many years in advanceDetect balding many years in advance

ENDEND

trichometer fl derm 2008

Health & Medicine