Focal atrichia: A diagnostic clue in female pattern hair loss

Trichoscopy Features of Indonesian Males with Androgenetic Alopecia in Association with Disease Severity

Introduction

Androgenetic alopecia (AGA) is a progressive loss of terminal hairs in a specific pattern distribution related to androgen. The dermoscopy of hair and scalp, known as trichoscopy, is a noninvasive method for diagnosing alopecia and other hair and scalp disorders.

Objective

This study aims to report the correlation between the severity of males with AGA based on Hamilton-Norwood's scale with the clinical characteristics found in trichoscopy.

Materials and Methods

This study included 40 patients aged 25-58 years who visited the dermatology outpatient clinic in a tertiary health facility in Indonesia. Clinical diagnosis was determined through history taking, physical examination, and trichoscopy. Based on Hamilton-Norwood's criteria, patients were divided into two groups: early and late stage. Parameters examined in trichoscopy include yellow dots, white dots, peripilar sign, vellus hair, hair diameter diversity, single-hair follicles, and empty follicles. The Chi-square test and Fisher's exact test were used to analyze the statistical significance between the groups.

Results

All participants presented with hair diameter diversity, vellus hair, and empty follicles (100%). None of the study participants had yellow dots. White dots and single-hair follicles were seen in 32 (80%) and 30 cases (75%), respectively. In the late-stage group, these features were more prevalent. Peripilar sign was found in 25 participants (62.50%), and it was more common in the early-stage group. No significant association was found between disease severity and trichoscopy features.

Conclusion

The most common trichoscopy findings in particular order were hair diameter diversity, vellus hair, and empty follicles, followed by white dots, single-hair follicles, and peripilar signs. No significant association between alopecia severity and trichoscopy parameters was observed. Studies with a larger number of participants, including a control group, should be conducted to yield more significant results.

Female Androgenetic Alopecia: An Update on Diagnosis and Management

Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.