TRICHOLOGY AND COSMETOLOGY Open Journal Systematic Review * http://dx.doi.org/10.17140/TCOJ-1-101 Is There Scientiic Evidence that Panax Promotes Hair Growth? Corresponding author Éric H.F.F. Frederico Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares Departamento de Biofísica e Biometria Instituto de Biologia Roberto Alcantara Gomes Universidade do Estado do Rio de Janeiro Avenida 28 de Setembro, 87, fundos, 4º andar 20551031, Rio de Janeiro, RJ, Brazil Tel/Fax: 55-21-28688332 E-mail: ericfrederico@msn.com Frederico EHFF1*; Sá-Caputo DC2; Dionello CF3; Cardoso ALBD3; Morel, DS3; Maiworm A4; Guimarães CAS4; Santos R4; Guedes-de-Aguiar EO4; Gonçalves CR3; Carvalho-Lima RP5; Kutter CR5; Machado-Rocha L4; Pereira FG4; Brandão-Sobrinho-Neto S5; JañaRosa A4; Neves RF4; Moreira-Marconi E3; Paineiras-Domingos LL3; Costa-Cavalcanti RG5; Almeida-Farias C4; Souza PL4; Paoli S4; Presta GA4 and Bernardo-Filho M4 1 Programa de Pós-graduação em Biociências, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brazil 2 Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brazil 3 Volume 1 : Issue 1 Article Ref. #: 1000TCOJ1101 Article History Received: February 23rd, 2016 Accepted: March 14th, 2016 Published: March 14th, 2016 Citation Frederico EHFF, Sá-Caputo DC, Dionello CF, et al. Is There Scientiic Evidence that Panax Promotes Hair Growth? Trichol Cosmetol Open J. 2016; 1(1): 1-7. doi: 10.17140/TCOJ1-101 Copyright ©2016 Frederico EHFF. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Trichol Cosmetol Open J Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brazil 4 Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brazil Mestrado Proissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Instituto de Biologia Roberto Alcantara Gomes, Av. Marechal Rondon, Rio de Janeiro, 20950-003, RJ, Brazil 5 ABSTRACT In cosmetology, although the use of natural products can be considered as a fancy, research related to the hair growth has been considered. Some synthetic products, as minoxidil and inasteride have been used to stimulate the hair. However, several important side effects have been reported with these drugs. Natural products are gaining popularity mainly due to, in general, their fewer side effects and better formulation strategies. Hair loss is a dermatologic disorder and urges the necessity of alternative treatments with hair growth promoting potential, as the medicinal plants. Among the medicinal plants used to treat the hair loss and to promote the hair growth, there is the Panax ginseng. The purpose of this study was to review the published researches concerning the use of Panax ginseng in investigations involving the hair growth using the PubMed database. Eight studies have reached the inclusion criteria to be analyzed. Considering the selected papers, there is a predominance of experimental procedures with the compound ginsenoside. The aim of the works was mainly related to investigation on the molecular and cellular mechanisms responsible for hair growth in presence of Panax ginseng or a compound related to this natural product. The number of publications in PubMed with the keyword Panax ginseng involving hair growth is about 0.43 %. The results indicate that Panax ginseng has stood out as a promising natural source with relevant effects in treatment of hair loss, despite the small number of publications selected involving the keywords “Panax ginseng” AND “hair loss”. Putting together the indings, it is concluded that the use of Panax ginseng and its chemical products could be an important strategy to manage the loss hair. KEYWORDS: Panax ginseng; Hair loss; Hair growth; Ginsenoside. INTRODUCTION In cosmetology are considered studies and applications of the beauty treatments. Skin care, cosmetics, hairstyling, manicures/pedicures and electrology are subjects related to the cosmetology. Trichology is that branch of dermatology involved with scientiic investigations of the health of hair and scalp.1 Page 1 TRICHOLOGY AND COSMETOLOGY Open Journal Healthy skin is an excellent barrier maintaining balance between the internal and external environment of the body. In the skin are found several structures with different functions, as the hair.2 Hair loss, in general, is an undesirable disorder in which the hair falls out from skin areas where they are usually present, such as the scalp and the body. This loss interferes with the many useful biologic functions of the hair, including sun protection (mainly to the scalp) and dispersal of sweat gland products. As hair cover to the scalp has psychological importance in our society, patients with hair loss suffer tremendously. In cosmetology, although the use of natural products can be considered as a fancy, research related to the hair growth has been considered.3 The causes of hair loss are controversial and there is no agreement about the main factors that cause the loss of hair, which is a universal complaint. It affects the both genders and depends on the race since the humankind existed.3,4 Among the factors that can contribute to the hair loss include (i) genetic predisposition, (ii) hormonal factors, (iii) disease states and (iv) the use of chemotherapeutic agents.5 Various medical treatments aimed at arresting the progression of the hair loss have become available (i) surgical treatments are constantly being reined and (ii) medications, such as minoxidil and inasteride, that are the only two drugs approved by the Food Drug Administration (FDA), USA for hair growth in men. The treatment of hair loss depends on the knowledge of its etiology and of the progression of this undesirable condition. Angiogenesis (through endogenous substances), androgen antagonism, vasodilatation through potassium channel opening 5-α reductase inhibition and modulation of hair cycle are some of the non-surgical therapeutic strategies for the hair growth promotion.6,7 Minoxidil is the only drug available for women with androgenetic alopecia. Besides having hair growth promotion effect, therapy with the synthetic drug has become questionable due to their occasional lack of eficacy, safety and their potential side effects.3 Integrative and complementary practices involve several procedures in healthcare. These practices are related to the disease prevention and health promotion.8,9 Some of them are related to the Traditional Chinese Medicine, as phytotherapy and acupuncture.8 In the phytotherapy are used medicinal plants in different forms. The utilization of natural products, as the medicinal plants in the art of healing is an ancient form of treatment of different diseases.9 In cosmetology, research related to the use of herbal medicines for hair growth has been considered.5 Moreover, Patel et al3 have pointed out that various medicinal plants have been used for care of the hair and hair growth potential activity. Considering the hair loss (alopecia), Patel et al3 reported that there Trichol Cosmetol Open J http://dx.doi.org/10.17140/TCOJ-1-101 are various causes for this loss and the phenomenon related to this, it is still poorly known. Natural products are gaining popularity mainly due to, in general, their fewer side effects. Herbal medicines have been widely used for alopecia treatment since ancient times as reported in Ayurveda, Chinese and Unani systems of medicine. Kumar et al10 reported that the hair grows from follicles of the dermis and it is found exclusively in mammals. Zhang et al11 described that the hair is a complex ilamentous biomaterial that has a structure with many layers including, from outside in, the cuticle, the cortex and the medulla, all bound by the cell membrane. In mammals, hair plays a vital role in thermal insulation and for social and sexual communication, both visually and as a means for dispersing scents secreted by skin glands. Humans are relatively hairless compared to other mammals and human hair has no known signiicance for survival of species. However, it remains an important cosmetic asset.12 Among the medicinal plants used to treat the hair loss and to promote the hair growth, there is the Panax ginseng. Ginseng radix is the steamed and dried root of Panax ginseng.13-15 Panax ginseng is traditionally used as an important medicinal herb worldwide for more than 5,000 years.16 It is a semishade perennial plant originally from the Eastern Asia regions. It belongs to the family Araliaceae, and is known to possess various pharmacological effects, such as anti-inlammatory, antioxidation, antitumor, antidiabetic and antihepatotoxicity.17,18 In addition, Matsuda et al19 have reported that Panax ginseng is able (i) to improve the constitutional tendencies to poor body condition, (ii) to promote appetite, (iii) to increase vitality and (iv) to reduce over sensitivity to cold. It contains several chemical components, as ginsenosides, essential oil, sesquiterpenes, polyacetylenes, polysaccharides, peptidoglycans, steroid, choline, vitamin- B, C, E, fatty acid, carbohydrates, and amino acids. Moreover, it is reported that a 70% methanolic extract from red ginseng seems to have superior activity to that of the white ginseng in a hair growth-promoting assay using mouse vibrissal follicles in organ culture. The activity is credited to the saponin component of ginseng. Studies revealed that ginseng acts as a 5-α reductase inhibitor.6,7 Ginsenosides Ro enhances in vivo hair re-growth based on their inhibitory activity against 5-α reductase in the androgenetic alopecia model.20 As authors have demonstrated the possibility of medicinal plants act in the process involving the hair loss and/ or hair growth,21,22 the purpose of this study was to review the published researches concerning the use of Panax ginseng in investigations involving the hair growth. Considering the indings described in the literature, it is hypothesized an improvement in the hair growth due to the Panax ginseng. Page 2 TRICHOLOGY AND COSMETOLOGY http://dx.doi.org/10.17140/TCOJ-1-101 Open Journal METHODS Search Strategy and Selection of the Studies This systematic review of scientiic studies followed the guidelines of the Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA statement).23 One database was systematically searched for experimental trials in vivo and in vitro. The papers were searched in the PubMed, (http://www. ncbi.nlm.nih.gov/pubmed) on February 14th, 2016. The search was performed using the keyword (i) “Ginseng radix”, (ii) “hair loss”, (iii) “hair growth”, (iv) “Ginseng radix” AND “hair growth”, (v) “”Ginseng radix” AND “hair loss”, (vi) “Medicinal plants” AND “hair growth”, (vii) “Medicinal plants” AND “hair loss”, (viii) “Panax ginseng”, (ix) “Panax ginseng” AND “hair growth” and (x) “Panax ginseng” AND “hair loss”. Inclusion and exclusion criteria A systematic selection of the articles was carried out by three independent examiners based on the following inclusion criteria: (i) Biological activity: hair growth activity of Panax ginseng; (ii) Plant material: extract from Panax ginseng; (iii) Study design: experimental trials in vitro and/or in vivo (with Panax ginseng); (iv) Language: articles written in English. In addition, ethnobotanical and ethnopharmacological surveys, case reports, expert opinion or consensus statements were excluded, as those have used Panax ginseng mixed with other product. PubMed involving the keywords that were searched. It is possible to verify a strong interest in studies involving “hair loss” and “hair growth”, with more than three thousands papers. It is also observed that about 0.43% and 0.19% of the articles with the keyword “Panax ginseng” are related to “hair growth” and “hair loss”, respectively. Keyword “Ginseng radix” Number of publication 266 “Ginseng radix” AND “hair growth” 1 “Ginseng radix” AND “hair loss” 0 “hair growth” 3,162 “hair loss” 3,627 “Medicinal plants” AND “hair growth” 8 “Medicinal plants” AND “hair loss” 7 “Panax ginseng” 2,083 “Panax ginseng” AND “hair growth” 9 “Panax ginseng” AND “hair loss” 4 Table 1: Number of publications (database PubMed) involving Panax ginseng and hair growth/hair loss. According to a previously set strategy, literature searches involving the keywords “Ginseng radix” AND “hair growth”, “Ginseng radix” AND “hair loss”, “Panax ginseng” AND “hair growth”, “Panax ginseng” AND “hair loss”, “medicinal plants” AND “hair growth” and “medicinal plants” AND “hair loss” resulted in 29 articles. Eight publications met the inclusion criteria and were included in the inal review after thorough analysis (Figure 1). RESULTS Table 1 shows the number of publications found in the It is possible to see in Table 2 the aim, the experimental model used and the plant material or the chemical compound Figure 1: Flow diagram of the search strategy comprising the identiication of potentially relevant material, and preliminary screening and inal selection of the studies included in this review (based on PRISMA statements). Trichol Cosmetol Open J Page 3 TRICHOLOGY AND COSMETOLOGY Open Journal related to the Panax ginseng ginsenoside.13,20,21 of the selected papers. There is a predominance of experimental procedures with the compound Only one study14 does not specify what part of the plant/chemical compound that was used. The aim of these selected works was mainly related to investigation on the molecular and cellular mechanisms responsible for hair growth in presence of a chemical component of the Panax ginseng. It is possible to see in Table 3 the results and conclusion of the selected studies. Despite the different protocols and procedures, the results indicated a hair growth due the treatment with Panax ginseng. According the majority of the studies13-15,24 the Panax ginseng seemed to be effective in the treatment of hair growth. http://dx.doi.org/10.17140/TCOJ-1-101 DISCUSSION In cosmetology, several subjects are related to the study and application of the beauty treatments have been considered; such as skin care, cosmetics, hairstyling, manicures and pedicures, and electrology. Concerning to the cosmetology, trichology is involved with scientiic investigations of the health of hair and scalp.1 The skin is a barrier in the body to maintain the balance between the internal and external environment of the body, and the hair is found in it.2 Hair loss, in general, is an undesirable disorder and strategies to avoid the hair loss and to promote the hair growth are desirable. Among these strategies, the use of medicinal products would be considered.19-21 Reference Aim Experimental procedure Plant material/chemical component (13) To investigate the molecular and cellular mechanisms responsible for HG promoting effect of GRe in vitro and in vivo. Investigation of the HG in animals. Isolation and culture of C57BL/6 mouse vibrissa HFs. Cell culture and western blot analysis. High quality mRNA extract and NGS. MA datasets and systemic analysis. GRe (26) To investigate the synergistic effect of each Eclipta alba (L.) Hassk, Asiasarum sieboldii (Miq.) F. Asiasari radix, and Panax ginseng for HG potential on nude mice, as these mutant mice genetically lack hair. Chromatographic analysis. Toxicity studies. Treatment protocol of extracts on nude mice. Measurement of hair density and length. Evaluation of hair existing area. Histologic assessment of HG. BrdU immunohistochemistry. Dried roots (Panax ginseng) (15) To identify the molecules through which Rg3 stimulates HG. The thymidine incorporation for measuring cell proliferation was determined. Culture of human dermal papillae cells. Thymidine incorporation assay. RNA isolation. MA. Real-time PCR. Immunohistochemistry. Image acquisition and protein quantiication. Ginsenoside Rg3 (14) To investigate the hair growth eficacy and safety of KRG in AA comparing corticosteroid ILI alone patient group with ILI with KRG taking patient group using Folliscope 2.5 for 12 weeks. Phototrichogram. Expert panel assessment of global photographs. Korean red ginseng (24) To determine how ginsenosides prevent HL and investigate the effects of ginsenosides on cell genesis in different phases of adult HFs, using BrdU as a marker for dividing cells. BrdU labeling. Immunohistochemical staining. Ginsenosides Rb1 and Rd (25) To evaluate the effects of FPG on proliferation and apoptosis of human hair DPCs. Cells and growth condition. Cell viability assay. Immunoblot analysis. HG activity in vivo Ginsenoside Re (5.99%) was revealed as the major component of the extract. (19) This report deals with the HG promoting effect of Ginseng Radix on vibrissal HFs (excised from the upper lip region of mice) in order to explore resources involved in the acceleration and promotion of HG. Organ culture of mouse vibrissal HFs. Measurement of length of vibrissal HFs. Red Ginseng or white ginseng and ginsenosides To investigate the effect of the water fraction of Panax ginseng on apoptosis and the formation of medullary cell in the HFs of irradiated mice Adult N:GP(s) mice with HFs synchronously in the middle of the HG cycle received doses of gamma-radiation. HFs were analyzed either 12 hours after irradiation with 2 Gy in the experiment on the apoptosis, or 3 days after 3 Gy in the experiment on the forming medulla. The number of medullary cells per unit length (100 microns) was measured by H and E staining. Apoptosis was detected by a non ISEL technique and H and E stain applied to histologic sections. Water fraction of Panax ginseng (27) BrdU – 5-bromo-2’ deoxyuridine, NGS – next-generation sequencing, ILI – intra-lesional injection, KRG – Korean red ginseng, HFs – hair follicles, HG – hair growth, HL – hair loss, Gy – gray, H – hematoxylin, E – eosin, ISEL – isotopic in situ DNA end-labeling, GRe – ginsenoside Re, MA – Microarray, N:GP(s) Table 2: Information about the aim, experimental procedure and plant material or chemical component related to the Panax ginseng used on the selected studies. Trichol Cosmetol Open J Page 4 TRICHOLOGY AND COSMETOLOGY Open Journal http://dx.doi.org/10.17140/TCOJ-1-101 Reference Results Conclusion (13) Topical treatment of GRe increased the hair shaft length and hair existent time, comparable to the minoxidil. GRe stimulated hair shaft elongation in the ex vivo cultures of vibrissa HFs isolated from C57BL/6 mouse. Systemic transcriptome analysis by next generation sequencing demonstrated that TGF-β-pathway related genes were selectively down-regulated by treatment of GRe in vivo, and the same treatment suppressed TGF-β induced phosphorylation of ERK in HeLa cells. GRe is the effective constituent in the ginseng on hair promotion via selective inhibition of the HG phase transition related signaling pathways, TGF-β signaling cascades. (26) The hair density and length of Eclipta alba treated mice were increased. HG area was visible in Eclipta alba treated mice. Mice treated with Asiasari radix and Panax ginseng had hair loss. Histomorphometric observation of nude mice skin samples revealed an increase in number of HFs. The presence of follicular keratinocytes was conirmed by BrdU labeling, S-phase cells in HFs. Eclipta alba extract and/or phytochemicals strongly displayed incomparability of hair growth promotion activity than others. Thus, the standardized Eclipta alba extract can be used as an effective, alternative, and complementary treatment against HL. (15) Reverse transcription polymerase chain reaction showed dose-dependent increases in VEGF mRNA levels on treatment with Rg3. Immunohistochemical analysis showed that expression of VEGF was upregulated by Rg3 in human DP cells and in mouse HFs. CD8 and CD34 were also up-regulated by Rg3 in the mouse HFs. It may be concluded that Rg3 might increase HG through stimulation of HF stem cells and it has the potential to be used in HG products. (14) At the 12th week after initiation, the result of expert panel assessment of global photographs showed improvement. The hair density and hair thickness, measured by Folliscope 2.5, also showed a tendency of some improvement. The eficacy of KRG in the treatment of AA and recommend KRG as a useful complimentary food for gaining eficacy of treatment for AA was observed. (24) Treatment with ginsenosides Rb1 and Rd increased cell proliferation in both anagen and telogen of HFs. Investigation of p63 demonstrated that up-regulation of p63 expression in the matrix and outer root sheath might be one of the mechanisms by which ginsenosides Rb1 and Rd promote cell proliferation in HFs. Ginsenoside promotes hair growth through p63 induction in follicular keratinocytes and indicates that ginsenosides Rb1 and Rd might be developed as a therapeutic agent for the prevention of HL. (25) FPG extract signiicantly increased the proliferation of DPCs in dose and time dependent manners. FPG extract also enhanced Bcl-2 expression and decreased Bax expression compared with control. Signiicant elongations of anagenphase during hair cycle after application of FPG were evaluated by photographical and histological observations FPG extract improves the cell proliferation of human DPCs through anti apoptotic activation. Topical administration of FPG extract might have hair regeneration activity for the treatment of HL. (19) Panax ginseng, ginsenoside-Rb1 (G-Rb1) exhibited activity, but ginsenoside-Rg1 (G-Rg1) and -Ro (G-Ro) were ineffective. Additionally, 20(S)-ginsenoside-Rg3 (20(S)-G-Rg3) formed by the processing of red ginseng from the crude root of Panax ginseng Panax ginseng also showed HG promoting activity. These results indicate that Ginseng Radix possesses hair growth promoting activity, and its bioactive components are partially attributable to the ginseng saponin components. (27) Ginseng administration before irradiation resulted in a suppression of apoptosis, as shown by a reduced number of cells stained with ISEL for fragmented DNA, both i.p. (0.3 mg/head) and p.o. (2 mg/ml of drinking water) treatment. Ginseng treatment increased the number of medullary cell per unit length as compared with the vehicle treated mice. The water fraction of ginseng can exert a potent effect on the recovery of the HFs by its combined effects on proliferation and apoptosis of the cells in the HF. BrdU – 5-bromo-2’ deoxyuridine, NGS – Next-generation sequencing, ILI – Intra-lesional injection, KRG – Korean red ginseng, HFs – Hair follicles, HG – Hair growth, HL – hair loss, Gy – gray, H – hematoxylin, E – eosin, ISEL – Isotopic in situ DNA end-labeling, GRe – ginsenoside Re, VEGF – Vascular endothelial growth factor, ISEL – Isotopic in situ DNA end-labeling, TGF-β – transforming growth factor beta, ERK – Extracellular-signal-regulated kinases, FPG – Fructus Panax ginseng, DPC – Dermal papilla cells. Table 3: Results and conclusion of indings reported on the selected studies. The utilization of natural products, as the medicinal plants is an ancient form of treatment of different diseases.28 This consideration justiies more studies about the mechanism of action and the eficacy of these natural products to be validated scientiically.29 Various medicinal plants have been used for care of the hair and they promote hair growth.3 It is also observed that about 0.43% and 0.19% of the articles with the keyword “Panax ginseng” are related to “hair growth” and “hair loss”, respectively (Table 1). Eight studies have reached the inclusion criteria to be analyzed (Figure 1). In almost all of these investigations, the conclusions indicated that Panax ginseng or some chemical compound seemed to be effective in the treatment of hair growth.13,19,24,27 Begum et al26 had shown some results about hair growth indicating possible effects of the various medicinal plant extracts, and among them, the Panax ginseng. Trichol Cosmetol Open J Due to, in general, their fewer side effects and better formulation strategies, the natural products are gaining popularity. Panax ginseng have stood out as a promising natural source with relevant effects in treatment of hair loss,13,15 despite the small number of publications in the PubMed database involving the keyword Panax ginseng AND “hair loss”, as shown in Table 1. The chemical components of the plant used were similar in most of studies using the dried roots (Table 2), namely ginsenoside who is the major bio-active ingredients included in Panax ginseng. The aim of these selected works was mainly investigate the molecular and cellular mechanisms responsible for hair growth. As it was shown in Table 2, different experimental procedures were used. The main indings of the selected papers reveal the importance of the Panax ginseng in improving hair growth. TherePage 5 TRICHOLOGY AND COSMETOLOGY Open Journal http://dx.doi.org/10.17140/TCOJ-1-101 fore it might be developed as a therapeutic agent for the prevention of alopecia. The studies on the hair follicle, demonstrate that it undergoes successive cyclic periods of growth, involving an (i) active growing phase (anagen) during which the previous hair is shed, (ii) a small transitionary regressive phase (catagen) and (iii) a dormant resting phase (telogen),10 which allows the follicle to produce different types of hair in response to hormonal changes. Each strand of hair on the human body is at its own stage of development. Once the cycle is complete, it restarts and a new strand of hair begins to form. Accessed on February 22, 2016. The indings with Panax ginseng are important due to the fact that minoxidil and inasteride used for treatment of androgenic alopecia may have side effects.30 The associated adverse events with the use of these synthetic compounds include erythema, scaling, pruritus, gynaecomastia, dermatitis, itching or skin rash. In consequence, due to these undesirable side effects, alternative products have been investigated to treat the alopecia, as the natural products.31 4. Patna P, Varghese D, Balekar N, et al. Formulation and evaluation of herbal hair oil for alopecia management. Planta indica. 2006; 2: 27-30. The current study has several limitations that must be considered in the interpretation of the indings in this review. It is suggested to take care in generalizing these results due to the analyzed publications have methodological variations concerning to the experimental procedure utilized, and design of the protocols. In addition, although we have tried to retrieve the articles following the selected keywords, it was not retrieved all the papers identiied for inclusion, including articles that were not published in English and articles published in journals that were not indexed in the PubMed database. The indings reported in this study are also relevant considering that the management of alopecia is a target of a steadily growing multi-billion dollar market worldwide. Great opportunities are associated with pharmaceutical hair loss management, but still there is no radical improvement in the availability of speciic therapies. In this case, the results with Panax ginseng could be important to have alternative chemical products to manage the loss hair. CONCLUSION Putting together the indings described in this study and considering the results in the publications, it is possible to conclude and to suggest that the use of Panax ginseng could be suitable to try to improve the hair growth. However, it is important to consider the limited number of publications available in the PubMed involving searches evaluating the hair growth effect of Panax ginseng. CONFLICTS OF INTERESTS: None. REFERENCES 1. Trichology and Cosmetology - Open Journal. Web site. http:// openventio.org/OpenJournal/TrichologyandCosmetology.html Trichol Cosmetol Open J 2. Szyszkowska B, Lepecka-Klusek C, Kozowicz K, Jazienicka I, Krasowska D. The inluence of selected ingredients of dietary supplements on skin condition. Postepy Dermatol Alergol. 2014; 31: 174-181. doi: 10.5114/pdia.2014.40919 3. Patel S, Sharma V, S Chauhan N, Thakur M, Dixit VK. Evaluation of hair growth promoting activity of Phyllanthus niruri. Avicenna J Phytomed. 2015; 5: 512-519. 5. Roy RK, Thakur M, Dixit VK. Development and evaluation of Polyherbal formulation for hair growth promoting activity. J Cosm Dermatol. 2007; 6: 108-112. doi: 10.1111/j.14732165.2007.00305.x 6. Liu WK, Xu SX, Che CT. 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