Female pattern hair loss: the relation to metabolic syndrome in premenopausal women

A cross-sectional, observational study of the clinico-epidemiological profile of female pattern hair loss in Western India and its association with metabolic syndrome

Background

The increasing prevalence of female pattern hair loss (FPHL) is an alarming concern. There are many studies on FPHL in the world literature but there is a dearth of Indian data on the same.

Aims and objectives

The present study aims to ascertain the demographic variables and clinical features of FPHL in Western India and its association with metabolic syndrome (MetS) to add over and above the existing data.

Materials and Methods

Ninety females who were diagnosed with FPHL were included after approval of the institutional ethics committee. Demographic details, detailed history, and clinical features were noted, following which a few blood investigations for diagnosis of MetS were advised and evaluated.

Results

Our study population's age ranged from 17 to 65 years, with the mean age of 34.7 ± 1.3 years. According to the Basic and Specific (BASP) classification, The basic pattern prevalence as found in our study was 46.7% for M type, 35.6% for L type, and 17.7% for C type. The FPHL severity score revealed that 82 (91.1%) had advanced disease at presentation. Prevalence of MetS was found to be 34.4% and had a significant correlation with age of onset in years (p=0.041) and severity score (p=0.013) implying that it leads to an early onset and greater severity of FPHL.

Conclusion

FPHL is increasingly common among Indian women, who frequently present with a bitemporal recession of the hairline. Calculation of the female pattern hair loss severity index (FPHL-SI) can help in the categorization of patients and assessment of prognosis. MetS should be actively looked for in patients of FPHL and managed accordingly.

Gynecologic and andrologic dermatology and the metabolic syndrome

The relationship of sex hormones to obesity and inflammation has been extensively studied. Research on endogenous and exogenous sex steroids, including studies on animal models of metabolic syndrome (MetS), has indicated that sex hormones are involved in metabolic pathways relevant to MetS. Lower testosterone levels in men and higher levels in women increase risks of MetS and type 2 diabetes mellitus (T2DM). Lower levels of sex hormone-binding globulin increase risks of MetS and T2DM in both sexes. Skin diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance. Insulin resistance increases the risk for metabolic and potentially cardiovascular complications, and patients with such skin diseases should be followed for a prolonged time to determine whether they develop these complications. Early intervention may help delay or prevent the onset of T2DM and decrease cardiovascular risks.

Association of metabolic syndrome with female pattern hair loss in women: A case-control study

BACKGROUND

Several studies have addressed the association of metabolic syndrome (MetS) with androgenetic alopecia (AGA) in men with few reports focusing on this association in females. The aim of this work was to investigate the association of MetS among Egyptian women with different stages of female pattern hair loss (FPHL) and to compare the results with age- and sex-matched controls.

METHODS

This study included 90 female participants, 45 cases with different stages of FPHL classified according to the Ludwig scale and 45 healthy control participants that were age- and sex-matched with the cases. Assessment of MetS components was done according to the Adult Treatment Panel III criteria.

RESULTS

Compared to the control group, a statistically significant association was found between FPHL and the presence of MetS with a tendency to increase with the severity of FPHL being greater in stage III > stage II > stage I. Among metabolic syndrome components, waist circumference (WC) (OR 5.6, 95% CI 2.2 -13.9, P = 0.0002) and hypertension (HTN) (OR 3.5, 95% CI 1.3-8.9, P = 0.008) were revealed as the most important factors associated with FPHL. WC also tended to increase with the severity of FPHL.

CONCLUSIONS

We demonstrated a significant association between MetS and FPHL. Women with FPHL, particularly if associated with an increased WC or hypertension, should be screened for MetS criteria for early identification and management.