The natural history of androgenetic alopecia

Utilising SNP Association Analysis as a Prospective Approach for Personalising Androgenetic Alopecia Treatment

INTRODUCTION

Androgenetic alopecia (AGA) is a prevalent, multifactorial form of hair loss involving complex aetiological factors, such as altered androgen regulation and energy metabolism. Existing treatments offer limited success, thus highlighting the need for advanced, personalised therapeutic strategies. This study focuses on correlating the genetic mechanisms of AGA with molecular targets involved in the response to current treatment modalities.

METHODS

An anonymised database including 26,607 patients was subjected to analysis. The dataset included information on patients' genotypes in 26 single nucleotide polymorphisms (SNPs), specifically, and diagnosed AGA grades, representing a broad range of ethnic backgrounds.

RESULTS

In our sample, 64.6% of males and 35.4% of females were diagnosed with female pattern hair loss. This distribution aligns well with prior studies, thus validating the representativeness of our dataset. AGA grading was classified using the Hamilton-Norwood and Ludwig scales, although no association was found to the grade of the disease. SNP association analysis revealed eight SNPs, namely rs13283456 (PTGES2), rs523349 (SRD5A2), rs1800012 (COL1A1), rs4343 (ACE), rs10782665 (PTGFR), rs533116 (PTGDR2), rs12724719 (CRABP2) and rs545659 (PTGDR2), to be statistically significant with a p-value below 0.05.

CONCLUSIONS

The study establishes a preliminary association between eight specific SNPs and AGA. These genetic markers offer insights into the variability of therapeutic responses, thus underlining the importance of personalised treatment approaches. Our findings show the potential for more targeted research to understand these SNPs' and further roles in AGA pathophysiology and in modulating treatment response.

Association of androgenetic alopecia and severity of coronavirus disease 2019

OBJECTIVE

To establish the association of androgenetic alopecia (AGA) and the severity of coronavirus disease 2019 (COVID-19).

DESIGN

Observational study.

METHODOLOGY

A total of 300 hospitalized patients of COVID-19 were included. Scoring of AGA was done, and severity of COVID-19 was measured as better and worse hospital outcomes. Correlation between severity of AGA and severity of COVID-19 was noted.

RESULTS

Out of 300 patients, 220 (73.33%) were male and 80 (26.67%) were female. In males, mild-to-moderate Hamilton-Norwood scale (HNS<3) and severe alopecia (HNS3-7) were noted among 43(20%) and 177(80.55%) patients, respectively. In females, 43(54%) had no AGA while 37(46%) had AGA. In 37 females with AGA, mild-to-moderate (Ludwig scale <2) and severe alopecia (Ludwig scale 2-3) were seen in 9(24.32%) and 28(75.68%) patients, respectively. We report a significant increase in frequency (95%) and severity of AGA and worse outcomes in males (p-value 0.000, chi-square: 18.90) compared with females (46%) (p-value 0.273, chi-square: 7.544), with notable adverse COVID-19 disease outcomes in the younger age group of men and also in few women of younger age group suffering from AGA without any comorbidities.

CONCLUSION

Our study shows a significant increase in frequency and severity of AGA and worse outcomes in men compared with women. There was a significant association between AGA severity and hospital disease outcome in men compared with women. Younger age group patients with severe AGA particularly men also faced adverse outcomes while having no known comorbidities, supporting the hypothesis that anti-androgen drugs might be valuable in patients of COVID-19.

Characteristics of telogen effluvium in COVID-19 in western Iran (2020)

BACKGROUND

Although COVID-19 pandemic significantly induces mortality, many of the patients who recovered present other medical problems such as alopecias. Telogen effluvium is a common alopecia that is usually related to previous events such as acute febrile diseases, including COVID-19.

OBJECTIVE

To evaluate the characteristics of telogen effluvium in COVID-19.

METHOD

This cross-sectional study was carried out on 526 patients with documented telogen effluvium that recovered from COVID-19. Demographic data, concurrent alopecia, associated diseases, and COVID-19 severity were recorded. Data were analyzed by appropriate statistical methods.

RESULTS

The mean age of the 526 patients (410 females, 116 males) was 30.97 ± 9.592 years, with 7.65 ± 1.739 weeks of mean time of alopecia onset. Vitamin D deficiency (24.3%), androgenetic alopecia (78.2%), and grade III COVID-19 severity were the most common findings. Alopecia onset was significantly earlier in the younger age group, females, in hypothyroidism, and more severe coronavirus infection. Higher grade coronavirus infection was significantly seen in males, higher ages, earlier onset, and androgenic alopecia.

STUDY LIMITATIONS

Performing a single-center study and considering limited variables.

CONCLUSION

Although Coronavirus 2 infection can be an important factor in telogen effluvium induction, other factors such as associated diseases, drug intake and emotional stress may also be involved. In the cases of early onset of alopecia, concomitant diseases such as hypothyroidism and severe coronavirus infection can occur, thus, the presence of various factors in telogen effluvium induction should be considered.

A Study to Compare the Efficacy of Platelet-rich Plasma and Minoxidil Therapy for the Treatment of Androgenetic Alopecia

Background

Androgenetic alopecia (AGA) is the most common cause of hair loss in men with limited treatment options. Platelet-rich plasma (PRP) therapy is one of the newer treatment options in the management of AGA which has shown promising results.

Aims and Objectives

This study was aimed at comparing the clinical efficacy of PRP therapy with minoxidil therapy.

Materials and Methods

In the study, patients were randomized into two groups - Group A (given PRP therapy) and Group B (given minoxidil therapy). Both groups were followed up over a period of 6 months, and final analysis was done with the help of global photography, hair pull test, standardized hair growth questionnaire, patient satisfaction score; in addition, a comparison of platelet counts in PRP was done, to know that if a clinical correlation exists between platelet concentration and clinical improvement. A total of 40 patients clinically diagnosed with AGA were enrolled in the study with 20 patients in each group. Four patients from Group A (PRP) and six patients from Group B (minoxidil) could not complete the treatment for 6 months and were eventually excluded.

Results

At the end of 6 months, 30 patients were evaluated to compare the efficacy of intradermal PRP and topical minoxidil therapy. On global photography, Group A (PRP) was found to have a comparatively better outcome than Group B (minoxidil). In hair pull test, hair growth questionnaire, and patient satisfaction score, Group A was found to be better than Group B. Mean platelet count at baseline was 3.07 ± 0.5 lac/mm, 3 while platelet count in final PRP prepared was 12.4 ± 1.7 lac/mm, and patients with a higher platelet count in PRP had a much better clinical improvement compared to patients with a low platelet count in PRP. Side effects with PRP therapy were minimal with better results which may improve the compliance of the patient.

Conclusion

PRP therapy can be a valuable alternative to topical minoxidil therapy in the treatment of AGA.

Conditions simulating androgenetic alopecia

Androgenetic alopecia is a common form of hair loss, characterized by a progressive hair follicular miniaturization, caused by androgen hormones on a genetically susceptible hair follicle, in androgenic-dependent areas. Characteristic phenotype of androgenetic alopecia is also observed in many other hair disorders. These disorders are androgenetic-like diseases that cause many differential diagnosis or therapeutic error problems. The objective of this review was to systematically analyse the greatest number of conditions that mimic the AGA pattern and explain their disease pathogenesis.

Role of polymorphism of the androgen receptor gene andnon-random x chromosome inactivation in the pathogenesisof androgenic alopecia

The article presents data on molecular and genetic studies of mechanisms of development of androgenic alopecia as well as correlation between polymorphism of the androgen receptor gene by the CAG repeat length in exon 1 and androgen-dependent diseases including alopecia.

Androgenetic alopecia in the paediatric population: a retrospective review of 57 patients

BACKGROUND

Hair loss is an unwelcome event at any age, but it can be particularly distressing for adolescents and their families. While androgenetic alopecia (AGA) is the most common form of hair loss in adults, little is known about its prevalence, clinical features and response to treatments in the paediatric population.

OBJECTIVES

To better characterize the causes of alopecia in a paediatric population.

METHODS

We performed a retrospective chart review to identify all patients with hair loss seen in an academic paediatric dermatology practice at New York University over a 12-year period to better characterize the causes of alopecia in this population. We review the clinical and histological features, natural progression and associated laboratory abnormalities of AGA in 57 paediatric patients.

RESULTS

AGA was identified as the most frequent cause of hair loss in adolescents and the second most common diagnosis overall. The male to female ratio was 2 : 1 and the average age at initial presentation with AGA was 14.8 years. Adolescent girls had diffuse thinning or thinning at the crown, and boys frequently presented with female pattern hair loss. When biopsies were performed, perifollicular inflammation was a common finding. A family history of AGA was reported in 83% of patients. Laboratory evaluation for androgens revealed polycystic ovarian syndrome in three girls and late-onset congenital adrenal hyperplasia in one boy.

CONCLUSIONS

AGA is the most common form of hair loss in adolescents, and can be the presenting sign of an underlying endocrine disorder. An accurate and timely diagnosis is essential for appropriate medical and psychosocial intervention when warranted.

Androgenetic alopecia and insulin resistance in young men

BACKGROUND

Epidemiological studies have associated androgenetic alopecia (AGA) with severe young-age coronary artery disease and hypertension, and linked it to insulin resistance. We carried out a case-control study in age- and weight-matched young males to study the link between AGA and insulin resistance using the homeostasis model assessment of insulin resistance (HOMA-IR) index or metabolic syndrome clinical manifestations.

METHODS

Eighty young males, 18-35 years old, with AGA > or = stage III in the Hamilton-Norwood classification, and 80 weight- and age-matched controls were included. Alopecia, glucose, serum insulin, HOMA-IR index, lipid profile and androgen levels, as well as metabolic syndrome criteria, were evaluated.

RESULTS

The HOMA-IR index was significantly higher in cases than controls. Nonobese cases had a higher mean diastolic blood pressure and a more frequent family history of AGA than nonobese controls. A borderline difference in the HOMA-IR index was found in obese AGA cases vs. obese controls [P = 0.055, 95% confidence interval (CI) 2.36-4.20 vs. 1.75-2.73]. Free testosterone values were significantly higher in controls than cases, regardless of body mass index (BMI). A statistically significant additive effect for obesity plus alopecia was found, with significant trends for insulin, the HOMA-IR index, lipids and free testosterone when BMI and alopecia status were used to classify the participants.

CONCLUSIONS

Our results support the recommendation for assessing insulin resistance and cardiovascular-related features and disorders in all young males with stage III or higher AGA, according to the Hamilton-Norwood classification.

Nutrition and nutritional supplementation: Impact on skin health and beauty

Skin acts as a natural barrier between internal and external environments thus plays an important role in vital biological functions such as protection against mechanical/chemical damages, micro-organisms, ultraviolet damage. Nutrition has a critical impact on strengthening skin's capabilities to fight against these multiple aggressions.Nutritional deficiencies are often associated with skin health disorders, while diets can either positively or negatively influence skin condition. More recently, the concept of nutritional supplementation has emerged as a new strategy in the daily practice of dermatology as well as a complementary approach to topical cosmetics in the field of beauty. Focusing on human clinical data, this paper proposes to illustrate the link between skin health and nutrition and to exemplify the beneficial actions of nutritional supplementation in skin health and beauty.