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Oiwoh SO, Enitan AO, Adegbosin OT, Akinboro AO, Onayemi EO. Androgenetic Alopecia: A Review. Niger Postgrad Med J 2024; 31:85-92. [PMID: 38826011 DOI: 10.4103/npmj.npmj_47_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
This study reviewed the current knowledge on the epidemiology, pathophysiology, clinical presentations, diagnosis, treatment, quality-of-life assessment and recent trends in androgenetic alopecia (AGA). Relevant articles on AGA from PubMed, Google Scholar, Medline and Scopus from 1950 to 2024 were obtained and scrutinized.. Key search words included each term like 'androgenetic alopecia', 'androgenic alopecia', 'pattern baldness' and 'pattern hair loss' AND each term like 'epidemiology', 'pathophysiology', 'genetics', 'hormones', 'micronutrient', 'stress and inflammation', 'growth factors', 'clinical features', 'staging', 'cardiovascular associations', 'diagnosis' and 'management' were used in the search. AGA is a non-scarring hair loss that is exemplified by a progressive decline of hair follicles, or non-functional or dead hair follicles in the scalp in a defined pattern. It is the most common hair loss, more common in men but can also present in younger age as premature AGA. Hormones, genetics, micronutrient deficiency, microinflammation and stress have been implicated, while psychosocial distress and cutaneous correlate of cardiovascular diseases have become sources of relentless research. AGA is a patterned hair loss that is more prevalent in Men. It results from the interactions between hormonal, genetic and other factors which determine the extent of hair loss and associated disorders (psychosocial and cardiovascular). As results of more research become available, the extent of AGA, its comorbidities as well as the full spectrum of their manifestations will continue to be sources of health education and more holistic examination by dermatologists and patients.
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Affiliation(s)
- Sebastine Oseghae Oiwoh
- Department of Internal Medicine, Dermatology and Venereology Unit, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ademola Olusegun Enitan
- Department of Dermatology and Venereology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria
| | | | - Adeolu Oladayo Akinboro
- Department of Medicine, Dermatology and Venereology Unit, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | - Emmanuel Olaniyi Onayemi
- Department of Dermatology and Venereology, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
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Liu LP, Wariboko MA, Hu X, Wang ZH, Wu Q, Li YM. Factors associated with early-onset androgenetic alopecia: A scoping review. PLoS One 2024; 19:e0299212. [PMID: 38451966 PMCID: PMC10919688 DOI: 10.1371/journal.pone.0299212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Early-onset androgenetic alopecia (AGA) has been associated with various chronic conditions, including metabolic syndrome (MetS). Gaining a deep understanding of early-onset AGA may enable earlier intervention in individuals at high risks. This scoping review aims to explore the risk factors and etiology, associated conditions, and adverse effects on wellbeing in early-onset AGA. METHODS Electronic literature searches were conducted in MEDLINE, EMBASE and CENTRIAL. Eligible studies included case-control, cohort, cross-sectional, and meta-analysis studies. Selected studies needed to clearly define early-onset AGA cases or include only cases starting before the age of 40 and compare them with appropriate controls. The exclusion criteria comprised editorials, commentaries, case series, and non-systematic reviews, among others. Data extraction involved collecting study characteristics, methodologies, main outcomes, and findings. Descriptive tables were used to summarize key information and relevant variables when necessary. RESULTS Among the 65 eligible articles, 67.69% were case-control studies and 78.46% evaluated only male patients. "Early-onset" was defined as cases developing before the age of 30 years in 43.08% of the studies. The Hamilton-Norwood scale was the most frequently used method for evaluating the severity of alopecia in men (69.23%). Reported risk factors for early-onset AGA included a family history of AGA, cigarette smoking, unhealthy dietary habits, and a high body mass index. Early-onset AGA may also be associated with hormonal profiles, 5α-reductase enzyme activity, androgen receptor genes, and some susceptibility loci. Comorbidities investigated included MetS, cardiovascular disease, insulin resistance, dyslipidemia, and Parkinson's disease. Men with early-onset AGA may have reduced treatment efficacy with drug like rosuvastatin, metformin or lisinopril for dyslipidemia, prediabetes, or hypertension. Additionally, young men with AGA tended to suffer from psychological issues such as anxiety and low self-esteem compared to those without hair loss. CONCLUSION Early-onset AGA is a complex condition with various risk factors and etiology, associated comorbidities, and potential implications for treatment response and psychological health.
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Affiliation(s)
- Li-Ping Liu
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Institute of Regenerative Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Mary Adumo Wariboko
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Institute of Regenerative Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xiao Hu
- Department of Urology, The First People's Hospital of Zhenjiang, Zhenjiang, Jiangsu, China
| | - Zi-Han Wang
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Institute of Regenerative Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Qian Wu
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Institute of Regenerative Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yu-Mei Li
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Institute of Regenerative Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
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3
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Sathyanarayanan H, Sundaram M. Study of Association of Dyslipidemia in Male Androgenetic Alopecia Patients in a Tertiary Care Hospital. Cureus 2024; 16:e51741. [PMID: 38318584 PMCID: PMC10840442 DOI: 10.7759/cureus.51741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Androgenetic alopecia (AGA) is a hereditary and androgen-dependent progressive thinning of the scalp hair in a defined pattern. Several studies have reported an association between dyslipidemia and AGA. However, scarce data is available on association between severity of AGA and dyslipidemia. Hence, we performed a study to assess the clinical, epidemiological profile in male AGA patients and to compare lipid parameters among AGA cases and non-AGA controls to evaluate dyslipidemia association. MATERIALS AND METHODS This is a prospective case-control study included 108 age-matched AGA cases and non-AGA controls between 19-40 years. AGA was clinically diagnosed, and grading was done according to Norwood-Hamilton Classification. Fasting Lipid parameters for both cases and controls were determined using standard laboratory methods. RESULTS Among the cases and controls, the mean age was 26.20±5.353 years. There was a statistically significant association between AGA and mean total cholesterol (TC) (P<0.001), mean high-density lipoprotein (HDL) (P<0.001), mean low-density lipoprotein (LDL) (P<0.001) and mean cholesterol/HDL ratio (P<0.001), except for mean triglycerides (TG) (P=0.443). Grade 4 was the commonest grading (20.4%). As the severity of AGA increased, the lipid parameters were significantly deranged. It was evident Grade 4 onwards with statistically significant derangement in TC (P<0.001), TG (P=0.005), HDL (P=0.002), LDL (P <0.001) and cholesterol/HDL(P<0.001). CONCLUSIONS AGA was found to be significantly associated with dyslipidemia and more common among severe grades. AGA could be a cutaneous marker of underlying systemic illness. Early screening for dyslipidemia is beneficial in patients with AGA.
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Affiliation(s)
| | - Murugan Sundaram
- Dermatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Palmer MA, Dias IHK, Smart E, Benatzy Y, Haslam IS. Cholesterol homeostasis in hair follicle keratinocytes is disrupted by impaired ABCA5 activity. Biochim Biophys Acta Mol Cell Biol Lipids 2023:159361. [PMID: 37348644 DOI: 10.1016/j.bbalip.2023.159361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
The importance of cholesterol in hair follicle biology is underscored by its links to the pathogenesis of alopecias and hair growth disorders. Reports have associated defects in ABCA5, a membrane transporter, with altered keratinocyte cholesterol distribution in individuals with a form of congenital hypertrichosis, yet the biological basis for this defect in hair growth remains unknown. This study aimed to determine the impact of altered ABCA5 activity on hair follicle keratinocyte behaviour. Primary keratinocytes isolated from the outer root sheath of plucked human hair follicles were utilised as a relevant cell model. Following exogenous cholesterol loading, an increase in ABCA5 co-localisation to intracellular organelles was seen. Knockdown of ABCA5 revealed a dysregulation in cholesterol homeostasis, with LXR agonism leading to partial restoration of the homeostatic response. Filipin staining and live BODIPY cholesterol immunofluorescence microscopy revealed a reduction in endo-lysosomal cholesterol following ABCA5 knockdown. Analysis of oxysterols showed a significant increase in the fold change of 25-hydroxycholesterol and 7-β-hydroxycholesterol following cholesterol loading in ORS keratinocytes, after ABCA5 knockdown. These data suggest a role for ABCA5 in the intracellular compartmentalisation of free cholesterol in primary hair follicle keratinocytes. The loss of normal homeostatic response, following the delivery of excess cholesterol after ABCA5 knockdown, suggests an impact on LXR-mediated transcriptional activity. The loss of ABCA5 in the hair follicle could lead to impaired endo-lysosomal cholesterol transport, impacting pathways known to influence hair growth. This avenue warrants further investigation.
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Affiliation(s)
- Megan A Palmer
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK; Faculty of Medicine, Institute of Biochemistry I, Goethe-University Frankfurt, Frankfurt, Germany
| | | | - Eleanor Smart
- Centre for Dermatology Research, University of Manchester, UK
| | - Yvonne Benatzy
- Faculty of Medicine, Institute of Biochemistry I, Goethe-University Frankfurt, Frankfurt, Germany
| | - Iain S Haslam
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK.
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5
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Roohaninasab M, Yavari SF, Babazadeh M, Hagh RA, Pazoki M, Amrovani M. Evaluating the Role of lncRNAs in the Incidence of Cardiovascular Diseases in Androgenetic Alopecia Patients. Cardiovasc Toxicol 2022; 22:603-619. [PMID: 35507254 DOI: 10.1007/s12012-022-09742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
Hair loss occurs in patients with Androgenetic Alopecia (AGA). The pattern of hair loss is different between men and women. The main cause of hair loss is increased cell apoptosis and decreased regeneration, proliferation and differentiation processes in hair follicles. Long Non-Coding RNAs (lncRNAs) are one of the most important molecules that regulate the processes of apoptosis, regeneration, proliferation and differentiation in hair follicles. Since studies have shown that lncRNAs can be effective in the development of cardiotoxicity and induction of cardiovascular disease (CVD); so effective lncRNAs in the regulation of regeneration, proliferation, differentiation and apoptosis of hair follicles can be involved in the development of CVD in AGA patients with. Therefore, this study investigated the lncRNAs involved in increasing apoptosis and reducing the processes of regeneration, proliferation and differentiation of hair follicles. The aim of the current study was to evaluate the role of lncRNAs as a risk factor in the incidence of CVD in AGA patients; it will help to design treatment strategies by targeting signaling pathways without any cardiotoxicity complications.
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Affiliation(s)
- Masoumeh Roohaninasab
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences, Sattarkhan St, Tehran, 1445613131, Iran
| | - Shadnaz Fakhteh Yavari
- Department of Tissue Engineering and Applied Cell Science, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.,Parvaz Research Ideas Supporter Institute, Tehran, Iran
| | - Motahareh Babazadeh
- Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mahboubeh Pazoki
- Department of Cardiology, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Mehran Amrovani
- High Institute for Education and Research in Transfusion Medicine, Tehran, Iran.
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6
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Qiu Y, Zhou X, Fu S, Luo S, Li Y. Systematic Review and Meta-analysis of the Association Between Metabolic Syndrome and Androgenetic Alopecia. Acta Derm Venereol 2021; 102:adv00645. [PMID: 34935992 PMCID: PMC9558341 DOI: 10.2340/actadv.v101.1012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The association of androgenetic alopecia with metabolic syndrome has been investigated in several studies, with conflicting results. We conducted a meta-analysis to quantitatively evaluate the risk grade of metabolic syndrome and the metabolic profile in patients with androgenetic alopecia compared with controls. In total, 19 articles (2,531 participants) satisfied the inclusion criteria. The pooled odds ratio for the prevalence rate of metabolic syndrome between the group with androgenetic alopecia and controls was 3.46 (95% CI 2.38–5.05; p < 0.001). Female sex, early onset, and African ethnicity were associated with an increased risk of metabolic syndrome. Furthermore, patients with androgenetic alopecia had significantly poorer metabolic profiles, such as body mass index, waist circumference, fasting glucose, blood lipids, and blood pressure. It is important for physicians to screen metabolism-related indicators in patients with androgenetic alopecia. More rigorously designed studies and larger sample sizes are required in future studies.
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Affiliation(s)
| | | | | | | | - Yaping Li
- Second Xiangya Hospital, Central South University, #139 Renmin Middle Rd, Changsha, Hunan 410011, P.R. China.
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7
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Fatima F, Das A, Kumar P, Datta D. Skin and Metabolic Syndrome: An Evidence Based Comprehensive Review. Indian J Dermatol 2021; 66:302-307. [PMID: 34446955 PMCID: PMC8375528 DOI: 10.4103/ijd.ijd_728_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Metabolic syndrome is currently considered to be a global epidemic, causing a significant increase in the cost of health care, apart from deteriorating the quality of life. Skin serves as a mirror of underlying metabolic sinister. Various dermatological conditions like psoriasis, acanthosis nigricans, lichen planus, acne vulgaris, acrochordons, atopic dermatitis, etc. have been reported to be associated with metabolic syndrome. We hereby present an evidence-based review of the various dermatological conditions and their association with the development of metabolic syndrome.
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Affiliation(s)
- Farhat Fatima
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Piyush Kumar
- Department of Dermatology, Katihar Medical College and Hospital, Katihar, Bihar, India
| | - Debatri Datta
- Consultant Dermatologist, Oliva Skin and Hair Clinic, Kolkata, West Bengal, India
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8
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Kash N, Leavitt M, Leavitt A, Hawkins SD, Roopani RB. Clinical Patterns of Hair Loss in Men: Is Dihydrotestosterone the Only Culprit? Dermatol Clin 2021; 39:361-370. [PMID: 34053589 DOI: 10.1016/j.det.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A number of pathways and factors including oxidative stress, inflammation, prostaglandins, vasculogenesis, Wnt/β-catenin, and transforming growth factor-β have been shown to be important in male androgenetic alopecia. There is limited but increasing evidence of the potential usefulness of antioxidants, anti-inflammatory agents, prostaglandins, and growth factors for treating of androgenetic alopecia. Lifestyle factors and comorbidities including cardiovascular risk factors have been shown to be associated with male androgenetic alopecia. Further study of these pathways, factors, and comorbidities is needed to better understand the pathophysiology, find potentially useful therapeutic targets, and ensure a comprehensive approach to the management of androgenetic alopecia in men.
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Affiliation(s)
- Natalie Kash
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Program, 260 Lookout Place, Suite 103, Maitland, FL 32751, USA
| | - Matt Leavitt
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Program, 260 Lookout Place, Suite 103, Maitland, FL 32751, USA; Advanced Dermatology and Cosmetic Surgery, Maitland, FL, USA; University of Central Florida, College of Medicine, Orlando, FL, USA; Bosley Medical Group, Maitland, FL, USA.
| | - Adam Leavitt
- Department of Dermatology, The University of Michigan, Ann Arbor, MI, USA
| | - Spencer D Hawkins
- Department of Dermatology, The University of Michigan, Ann Arbor, MI, USA
| | - Rahil B Roopani
- Hair Restoration Surgery Program, Leavitt Medical Associates, 260 Lookout Place, Suite 103, Maitland, FL 32751, USA
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9
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Adibi N, Robati RM. Skin and metabolic syndrome: A review of the possible associations. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:16. [PMID: 34084195 PMCID: PMC8106409 DOI: 10.4103/jrms.jrms_585_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022]
Abstract
Metabolic syndrome (MeTS) is a well-known health-related problem with several end-organ damages and the resulted side effects such as rising in the blood glucose and lipid and blood pressure. Although MeTS might show several skin symptoms such as acanthosis nigricans, skin tags, acne, and androgenic alopecia, it could also be implicated in the pathophysiology of numerous dermatologic disorders. Furthermore, some dermatologic drugs might be implicated in the incidence or exacerbation of MeTS. Consequently, MeTS and skin problem could interfere closely with each other and each one could predispose the patient to the other one and vice versa. Remembering these close relationships help us to have better therapeutic choices regarding each inflammatory skin conditions. Moreover, some of the skin symptoms should be followed cautiously to define the underlying MeTS.
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Affiliation(s)
- Neda Adibi
- Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Arefi R, Pishgahi M, Joharimoghaddam A, Momeni MA, Khoshfetrat M. Association of Baldness with Coronary Artery Disease and Its Severity. Galen Med J 2020; 9:e1474. [PMID: 34466550 PMCID: PMC8344039 DOI: 10.31661/gmj.v9i0.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/23/2019] [Accepted: 08/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The pivotal role of baldness as a potential risk factor for cardiovascular disorders remains a debate, and the small body of literature has generated inconsistent findings. We aimed to assess the association between baldness and the risk for coronary artery disease (CAD) and its severity in a sample of Iranian men. MATERIALS AND METHODS This cross-sectional study was performed on 105 consecutive patients suspected to CAD and scheduled for elective coronary angiography. The severity of CAD was determined according to the number of involved coronary vessels. For assessing the severity of baldness, the Hamilton-Norwood scale for grading of androgenetic alopecia in males was used. RESULTS The overall frequency of CAD in the groups with and without baldness was 88.9% and 72.5%, respectively, indicating a significant difference (P=0.033). Similarly, patients with the family history of baldness suffered more from CAD as compared to those without history (93.3% vs.76.0%). However, no significant association was found between the baldness and non-baldness groups with regard to the severity of CAD (P=0.291). According to the multivariable logistic regression model, the presence of baldness could predict the increased likelihood of CAD (or=3.037, P=0.046). CONCLUSION Along with traditional risk factors for CAD, the presence of baldness and positive family history of this phenotype could be considered as the primary determinant for the increasing likelihood of CAD.
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Affiliation(s)
- Reza Arefi
- Research Committee of AJA University of Medical Science, Tehran, Iran
| | - Mehdi Pishgahi
- Cardiovascular Research Center, Shohadaye Tajrish, Shahid Beheshti Medical Science University, Tehran, Iran
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Di Guardo F, Ciotta L, Monteleone M, Palumbo M. Male Equivalent Polycystic Ovarian Syndrome: Hormonal, Metabolic, and Clinical Aspects. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2020; 14:79-83. [PMID: 32681618 PMCID: PMC7382675 DOI: 10.22074/ijfs.2020.6092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/31/2019] [Indexed: 12/04/2022]
Abstract
Recent studies identified the presence of a male polycystic ovarian syndrome (PCOS), which mainly affects men
whose female relatives are afflicted with PCOS, caused by genes responsible for the susceptibility of this syndrome in women.
Similar hormonal, metabolic, and clinical alterations occurring in PCOS women have also been reported in their male
relatives, suggesting a association between the male and female forms of the syndrome. Although the remarkable
clinical manifestation of the male equivalent PCOS is diagnosed by the early-onset androgenetic alopecia, characterized by hair recession, pronounced hypertrichosis, insulin resistance, biochemical and hormonal abnormalities, the
hormonal/metabolic profile is still controversial. Men affected by early-onset androgenetic alopecia (AGA) are at risk
of developing hyperinsulinemia, insulin-resistance, dyslipidaemia, and cardiovascular diseases. However, there is no
consensus on the association of male equivalent PCOS with hypertension and obesity. Moreover, reduced levels of
sex hormone-binding globulin have been detected in these male patients, accompanied by increased free androgens.
Conversely, literature reported lower concentrations of testosterone in male equivalent PCOS when compared with the
normal range, indicating a crucial role for the conversion of cortical androgens. Finally, further studies are warranted
to investigate a possible link among AGA, metabolic/hormonal alterations, and acne. Our study assessed the hormo-
nal, metabolic and clinical aspects of male equivalent PCOS syndrome reported in the literature to evaluate similar
and divergent elements involved in the female version of the syndrome.
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Affiliation(s)
- Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.Electronic Address:
| | - Lilliana Ciotta
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Morena Monteleone
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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12
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Coogan PF, Bethea TN, Cozier YC, Bertrand KA, Palmer JR, Rosenberg L, Lenzy Y. Association of type 2 diabetes with central-scalp hair loss in a large cohort study of African American women. Int J Womens Dermatol 2019; 5:261-266. [PMID: 31700983 PMCID: PMC6831789 DOI: 10.1016/j.ijwd.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hair loss on the central scalp commonly occurs among African American (AA) women and can pose substantial psychosocial burdens. The causes of hair loss remain obscure, although type 2 diabetes has been hypothesized to increase the risk of hair loss. The objective of the present study was to prospectively estimate the association between type 2 diabetes and severe central hair loss in AA women. METHODS The Black Women's Health Study has collected data on medical and lifestyle factors, including diagnosis of type 2 diabetes, biennially since 1995 from AA women across the United States. The present analysis was based on responses from 5389 women to an online hair loss questionnaire in 2015. Respondents indicated severity of central hair loss on a validated six-item photographic scale; the highest levels, levels 3 to 5, were designated as severe. We used Cox proportional hazards models to estimate multivariable hazard ratios and 95% confidence intervals (CIs) for type 2 diabetes in relation to severe central hair loss. RESULTS During the follow-up period, 850 cases of severe hair loss occurred. The multivariable hazard ratio for severe hair loss associated with diabetes was 1.68 (95% CI, 1.38-2.06) overall, and 2.05 (95% CI, 1.48-2.85) for diabetes duration of ≥ 10 years. CONCLUSION Type 2 diabetes was associated with an increased risk of severe central scalp hair loss in AA women. Patients with type 2 diabetes should be followed closely for central scalp hair loss so that appropriate treatment can be offered.
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Affiliation(s)
| | - Traci N. Bethea
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Yvette C. Cozier
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Julie R. Palmer
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Yolanda Lenzy
- Lenzy Dermatology and Hair Loss Center, Chicopee, Massachusetts
- UCONN Health Dermatology, Farmington, Connecticut
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13
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Palmer MA, Blakeborough L, Harries M, Haslam IS. Cholesterol homeostasis: Links to hair follicle biology and hair disorders. Exp Dermatol 2019; 29:299-311. [PMID: 31260136 DOI: 10.1111/exd.13993] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/24/2019] [Accepted: 06/19/2019] [Indexed: 01/10/2023]
Abstract
Lipids and lipid metabolism are critical factors in hair follicle (HF) biology, and cholesterol has long been suspected of influencing hair growth. Altered cholesterol homeostasis is involved in the pathogenesis of primary cicatricial alopecia, mutations in a cholesterol transporter are associated with congenital hypertrichosis, and dyslipidaemia has been linked to androgenic alopecia. The underlying molecular mechanisms by which cholesterol influences pathways involved in proliferation and differentiation within HF cell populations remain largely unknown. As such, expanding our knowledge of the role for cholesterol in regulating these processes is likely to provide new leads in the development of treatments for disorders of hair growth and cycling. This review describes the current state of knowledge with respect to cholesterol homeostasis in the HF along with known and putative links to hair pathologies.
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Affiliation(s)
- Megan A Palmer
- School of Applied Sciences, Department of Biological and Geographical Sciences, University of Huddersfield, Huddersfield, UK
| | - Liam Blakeborough
- School of Applied Sciences, Department of Biological and Geographical Sciences, University of Huddersfield, Huddersfield, UK
| | - Matthew Harries
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Iain S Haslam
- School of Applied Sciences, Department of Biological and Geographical Sciences, University of Huddersfield, Huddersfield, UK
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Vora RV, Kota RKSK, Singhal RR, Anjaneyan G. Clinical Profile of Androgenic Alopecia and Its Association with Cardiovascular Risk Factors. Indian J Dermatol 2019; 64:19-22. [PMID: 30745630 PMCID: PMC6340244 DOI: 10.4103/ijd.ijd_526_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Androgenic alopecia (AGA) is a hereditary androgen-dependent disorder, characterized by gradual conversion of terminal hair into miniaturized hair and defined by various patterns. Common age group affected is between 30 and 50 years. Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that include diabetes and prediabetes, abdominal obesity, dyslipidemia, and hypertension. The relationship between androgenic alopecia and MetS is still poorly understood. Aim: The aim was to study the clinical profile of androgenic alopecia and its association with cardiovascular risk factors. Materials and Methods: This was a hospital-based cross-sectional study done on men in the age group of 25–40 years. Fifty clinically diagnosed cases with early-onset androgenic alopecia of Norwood Grade III or above and fifty controls without androgenic alopecia were included in the study. Data collected included anthropometric measurements, blood pressure, family history of androgenic alopecia, history of alcohol, smoking; fasting blood sugar, and lipid profile were done. MetS was diagnosed as per the new International Diabetes Federation criteria. Chi-square and Student's t-test were used for statistical analysis. Results: MetS was seen in 5 (10%) cases and 1 (2%) control (P=0.092). Abdominal obesity, hypertension, and lowered high-density lipoprotein were significantly higher in patients with androgenic alopecia when compared to that of the controls. Conclusion: A higher prevalence of cardiovascular risk factors was seen in men with early-onset androgenic alopecia. Early screening for MetS and its components may be beneficial in patients with early-onset androgenic alopecia.
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Affiliation(s)
- Rita V Vora
- Department of Skin and VD, Shree Krishna Hospital, Anand, Gujarat, India
| | | | - Rochit R Singhal
- Department of Skin and VD, Shree Krishna Hospital, Anand, Gujarat, India
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15
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Dissection of genetic variation and evidence for pleiotropy in male pattern baldness. Nat Commun 2018; 9:5407. [PMID: 30573740 PMCID: PMC6302097 DOI: 10.1038/s41467-018-07862-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 11/26/2018] [Indexed: 01/13/2023] Open
Abstract
Male pattern baldness (MPB) is a sex-limited, age-related, complex trait. We study MPB genetics in 205,327 European males from the UK Biobank. Here we show that MPB is strongly heritable and polygenic, with pedigree-heritability of 0.62 (SE = 0.03) estimated from close relatives, and SNP-heritability of 0.39 (SE = 0.01) from conventionally-unrelated males. We detect 624 near-independent genome-wide loci, contributing SNP-heritability of 0.25 (SE = 0.01), of which 26 X-chromosome loci explain 11.6%. Autosomal genetic variance is enriched for common variants and regions of lower linkage disequilibrium. We identify plausible genetic correlations between MPB and multiple sex-limited markers of earlier puberty, increased bone mineral density (rg = 0.15) and pancreatic β-cell function (rg = 0.12). Correlations with reproductive traits imply an effect on fitness, consistent with an estimated linear selection gradient of -0.018 per MPB standard deviation. Overall, we provide genetic insights into MPB: a phenotype of interest in its own right, with value as a model sex-limited, complex trait. Male pattern baldness (MPB) is a polygenic trait that affects the majority of European men. Here, Yap et al. estimate heritability, partitioned by autosomes and the X-chromosome, of MPB in the UK Biobank cohort, perform GWAS for MPB and find genetic correlation with other sex-specific traits.
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Dharam Kumar KC, Kishan Kumar YH, Neladimmanahally V. Association of Androgenetic Alopecia with Metabolic Syndrome: A Case-control Study on 100 Patients in a Tertiary Care Hospital in South India. Indian J Endocrinol Metab 2018; 22:196-199. [PMID: 29911030 PMCID: PMC5972473 DOI: 10.4103/ijem.ijem_650_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Androgenetic alopecia (AGA) is the most common cause of hair loss. Although it is a medically benign condition, it can have a significant psychosocial impact on patients. "Metabolic syndrome" (MetS) is a collection of clinical signs that focus on cardiovascular and diabetes-related parameters. Despite the high burden of AGA and MetS in India, specific data on the participants are relatively sparse. AIM OF THE STUDY The aim of is to study the association of AGA with MetS and its parameters. MATERIALS AND METHODS A case-control study was undertaken in a tertiary care hospital from December 2015 to November 2016 with 100 cases and controls in the age group of 20-50 years. Diagnosis of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III. Independent t-test was used as a test of significance. Categorical data were assessed using Chi-square test of significance. P <0.05 was considered to be significant. RESULTS MetS was seen in 53% of cases and 17% of controls (P = 0.001). The mean serum triglyceride level (P = 0.015, P < 0.05), mean systolic blood pressure (P = 0.003, P < 0.05), high-density lipoprotein levels in males (P < 0.001), and waist circumference in males (P = 0.022, P < 0.05) were statistically significant in patients with androgenetic alopecia when compared to healthy controls. CONCLUSION A higher prevalence of MetS was noted in androgenic alopecia. Early screening for MetS is beneficial in patients with androgenic alopecia.
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Affiliation(s)
- K. C. Dharam Kumar
- Department of Dermatology, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
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17
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Stefanadi EC, Dimitrakakis G, Antoniou CK, Challoumas D, Punjabi N, Dimitrakaki IA, Punjabi S, Stefanadis CI. Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients. Diabetol Metab Syndr 2018; 10:9. [PMID: 29483947 PMCID: PMC5822485 DOI: 10.1186/s13098-018-0311-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 02/12/2018] [Indexed: 02/08/2023] Open
Abstract
There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.
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Affiliation(s)
- Ellie C. Stefanadi
- Dermatology Department, Athens Medical Centre, Athens, Greece
- National and Kapodistrian University of Athens and Athens Medical Center, Papadiamantopoulou 20, Ilisia, Athens, Greece
| | | | | | | | | | | | - Sangeeta Punjabi
- Dermatology Department, Northwick Park and Middlesex Hospitals, London, UK
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18
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Abstract
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.
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Affiliation(s)
| | - Nicholas Leader
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - George Kroumpouzos
- Department of Dermatology,Warren Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, Jundiaí, SP, Brazil, Brazil* GK Dermatology, South Weymouth, MA.
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19
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Cannarella R, La Vignera S, Condorelli RA, Calogero AE. Glycolipid and Hormonal Profiles in Young Men with Early-Onset Androgenetic Alopecia: A meta-analysis. Sci Rep 2017; 7:7801. [PMID: 28798373 PMCID: PMC5552767 DOI: 10.1038/s41598-017-08528-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022] Open
Abstract
Hormonal and metabolic abnormalities have been reported in men with early-onset androgenetic alopecia (AGA). Although this has been ascribed to the existence of a male polycystic ovary syndrome (PCOS)-equivalent, data on this topic are inconsistent and this syndrome has not been already acknowledged. To evaluate if, already before the age of 35 years, any difference occurs in the glycolipid and hormonal profiles and in the body weight in men with AGA compared to age-matched controls, we performed a comprehensive meta-analysis of all the available observational case-control studies of literature, using MEDLINE, Google Schoolar and Scopus databases. Among 10596 papers retrieved, seven studies were finally included, enrolling a total of 1009 participants. Our findings demonstrate that young men with AGA have a slightly but significantly worse glycolipid profile compared to controls and a hormonal pattern resembling those of women with PCOS, already before the age of 35 years. Therefore, early-onset AGA might represent a phenotypic sign of the male PCOS-equivalent. The acknowledgement of this syndrome would be of importance to prevent the long-term consequences on health in the affected men. The glycolipid profile and the body weight should be monitored in men with AGA starting from the second decade of life.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
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Kaya Erdogan H, Bulur I, Kocaturk E, Yildiz B, Saracoglu ZN, Alatas O. The role of oxidative stress in early-onset androgenetic alopecia. J Cosmet Dermatol 2016; 16:527-530. [DOI: 10.1111/jocd.12300] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Hilal Kaya Erdogan
- Faculty of Medicine; Department of Dermatology; Eskişehir Osmangazi University; Eskisehir Turkey
| | - Isıl Bulur
- Faculty of Medicine; Department of Dermatology; Eskişehir Osmangazi University; Eskisehir Turkey
| | - Evin Kocaturk
- Department of Biochemistry; Eskişehir Yunus Emre State Hospital; Eskisehir Turkey
| | - Bahadir Yildiz
- Faculty of Medicine; Department of Dermatology; Eskişehir Osmangazi University; Eskisehir Turkey
| | - Zeynep Nurhan Saracoglu
- Faculty of Medicine; Department of Dermatology; Eskişehir Osmangazi University; Eskisehir Turkey
| | - Ozkan Alatas
- Faculty of Medicine; Department of Biochemistry; Eskişehir Osmangazi University; Eskisehir Turkey
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