Frequency, severity and related factors of androgenetic alopecia in dermatology outpatient clinic: hospital-based cross-sectional study in Turkey

Abstract: BACKGROUND: Androgenetic alopecia (AGA) is a patterned hair loss occurring due to systemic androgen and genetic factors. It is the most common cause of hair loss in both genders. In recent years, many studies investigating the relation between systemic diseases and androgenetic alopecia presented controversial results. OBJECTIVES: In this study we aimed to investigate the frequency of androgenetic alopecia, the presence of accompanying systemic diseases, the relation between body mass index and androgenetic alopecia severity and the association of hyperandrogenemia signs with androgenetic alopecia in patients who referred to our outpatient clinic. METHODS: Patients who referred to our clinic between October 2013 and May 2014 were included in the study. Diagnosis of androgenetic alopecia was made upon clinical findings. Presence of seborrhea and acne in both genders, and hirsutism in women, were examined. Age, gender, smoking habit and alcohol consumption, age of onset of androgenetic alopecia, family history, accompanying systemic diseases and abnormalities of menstrual cycle were recorded. RESULTS: 954 patients (535 women, 419 men) were included in the study. Androgenetic alopecia prevalence found was 67.1% in men and 23.9% in women. Androgenetic alopecia prevalence and severity were correlated with age in both genders (p=0,0001). Frequency of accompanying systemic diseases were not significantly different between patients with and without androgenetic alopecia (p=0,087), except for hypertension, which was significantly more frequent in men with androgenetic alopecia aged between 50 and 59 years. Study limitations: Despite the exclusion of other causes of alopecia, differentiation of Ludwig grade 1 AGA from telogen effluvium based on clinical features alone is difficult. CONCLUSIONS: In our study the rate of androgenetic alopecia was found to be higher than the other studies made in Asian and Caucasian populations.

The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia.

Background: The effectiveness of finasteride and dutasteride in women with androgenetic alopecia has been the subject of debate. Aim: To evaluate the effectiveness of finasteride and dutasteride on hair loss in women with androgenetic alopecia over a period of 3 years. Methods: From a database containing systematically retrieved data on 3500 women treated for androgenetic alopecia between 2002 and 2012 with finasteride 1.25 mg or dutasteride 0.15 mg, a random sample stratified for age and type of medication was taken to yield 30 women in two age categories: below and above 50 years, and for both medications. Hair thickness of the three thinnest hairs was measured from standardized microscopic images at three sites of the scalp at the start of the treatment and after 3 years of continuous medication intake. The macroscopic images were evaluated independently by three European dermatologists/hair experts. The diagnostic task was to identify the image displaying superior density of the hair. Results: Both age categories showed a statistically significant increase in hair thickness from baseline over the 3‑year period for finasteride and dutasteride (signed rank test, P = 0.02). Hair thickness increase was observed in 49 (81.7%) women in the finasteride group and in 50 (83.3%) women in the dutasteride group. On average, the number of post‑treatment images rated as displaying superior density was 124 (68.9%) in the finasteride group, and 118 (65.6%) in the dutasteride group. Dutasteride performed statistically significantly better than finasteride in the age category below 50 years at the central and vertex sites of the scalp. Conclusions: Finasteride 1.25 mg and dutasteride 0.15 mg given daily for 3 years effectively increased hair thickness and arrested further deterioration in women with androgenetic alopecia.

Alopecia androgenética femenina: etiología y diagnóstico / Female androgenetic alopecia: etiology and diagnosis

La alopecia de patrón femenino es un problema clínico cada día más frecuente en las mujeres. El cuadro clínico de la alopecia androgenética femenina (FAGA) típica comienza con una específica “pérdida difusa de cabellos de las regiones parietal y frontovertical respetando la línea de implantación frontal”. Ludwig llamó a este proceso “rarefacción”. En la clasificación de Ludwig se describieron tres grados o tipos progresivos de FAGA. Grado I o mínimo, grado II o moderado y grado III o intenso. Ludwig también describió la alopecia androgenética femenina de patrón masculino que debe ser subclasificada de acuerdo con la graduación de Ebling; es decir, FAGA.M desde grado I a V. Generalmente se observa en mujeres con nivelesde testosterona elevados o con hipersensibilidad del órgano diana a esta hormona. La FAGA.M puede observarse en cuatro situaciones: síndrome de persistencia de la adrenarquía, alopecia por tumor suprarrenal u ovárico, alopecia posmenopáusica y alopecia involutiva. Hay otras propuestas de clasificación como la Olsen que considera la alopecia de patrón femenino de dos tipos: de comienzo precoz o tardío y cada unode ellos con o sin exceso de andrógenos. El diagnóstico debe efectuarse con la historia clínica, exploración con el “signo del arrancamiento”, signo de la tracción”, trichoscan®, tricoscopía, test del lavado y tricograma, y con test bioquímicos, especialmente determinaciones androgénicas. Como en el varón, la alopecia femenina causa importantes problemas psicológicosa la mujer, siendo la depresión el síntoma más constante. Con frecuencia se asocia a efluvio telogénico crónico y alopecia frontal fibrosante.

Female pattern hair loss is a clinical problem which every day is more common in women. The clinical picture of typical female androgenetic alopecia (FAGA) begins with a specific “diffuse loss of hair from the parietal or frontovertical areas with an intact frontal hair implantation line”. Ludwig called this process “rarefaction”. In the Ludwig’s classification three degrees or progressive type of FAGA were described: grade I or minimal, grade II or moderate and grade III or severe. Ludwig also described female androgenetic alopecia of male pattern that should be sub- classified according to Ebling’s degrees; that is to say, FAGA.M from grade I to V. It is usually seen in women with increased testosterone levels, or with a hypersensitivity of the target organ to this hormone. FAGA.M may be present in four situations: persistence adrenarche syndrome, alopecia due to an adrenal or an ovarian tumor, post-hysterectomy and as an involutive alopecia. There were other proposal of classification as the most recent Olsen’s classification of female pattern hair loss (FPHL) with two types: of early and late onset and in each one with or without androgens excess. Diagnosis must be made by clinical history, clinical examination with the “pull-out sign”, “tug sign”, trichoscan®, trichoscopy, wash test and trichograms and laboratory test, especially androgenic determinations. FPHL causes important psychological problems in women, being depression the most constant symptom. Frequently, FPHL is associated with chronic telogen effluvium and frontal fibrosing alopecia.

Alopecias / Alopecia

Desde los inicios de la humanidad el cabello ha tenido una importancia trascendental desde el punto de vista religioso, racial, sexual y ornamental. En los seres humanos el pelo es un vestigio evolutivo, a diferencia de otros seres vivos, que cumple funciones de protección y regulación de la temperatura. El número de pelos que se desprenden normalmente es de aproximadamente 100 por día y esta tasa aumenta al final del verano y principios de otoño, quizás debido a efectos de la mayor radiación solar y temperatura. La alopecia es la pérdida anormal del cabello, resultado de un proceso patológico. Las causas de alopecia son diversas y representan un desafío tanto para el médico como para el paciente. El objetivo de esta revisión es profundizar en la fisiopatología del cabello, las causas de alopecia y su tratamiento.

Hair has been always an important issue for humanity, from a religious, racial, sexual and ornamental point of view. In human beings hair is an evolution vestige. In other animals, hair serves to regulate body temperature and also has protective functions. Normally one hundred hairs fall in a day, and this rate increases by the end of summer and the first days of autumn, may be because of the more temperature end radiation. Alopecia is the abnormal loss of hair because of a pathologic process. The causes of alopecia are diverse, and they represent a challenge for the doctor and patient. The aim of this study is to deepen in the physiopathology of hair, causes of hair loss and their management.

Primary cicatricial alopecias: a review of histopathologic findings in 38 patients from a clinical University Hospital in Sao Paulo, Brazil

BACKGROUND: Scarring alopecias are classified into primary and secondary types according to the initial site of inflammation. In primary scarring alopecias, the hair follicle is the main target of destruction; the term secondary cicatricial alopecia implies that follicular destruction is not the primary pathologic event. AIMS: To review the histopathologic diagnoses of cases of cicatricial alopecia in order to classify them according to the North American Hair Research Society. PATIENTS AND METHODS: Patients with biopsy specimens diagnosed as cicatricial alopecia seen from 2000 to 2005 at the Dermatologic Department of Hospital das Clinicas, São Paulo University Medical School had hematoxylin and eosin, Periodic acid-Schiff and Weigert stained slides reevaluated and sub-typed into different primary cicatricial alopecias. RESULTS: Thirty-eight cases of primary cicatricial alopecias were reclassified as: chronic cutaneous lupus (17), lichen planus pilaris (4), pseudopelade of Brocq (12), folliculitis decalvans (3), dissecting folliculitis (1), and non-specific scarring alopecia (1). In our cases, the methods employed allowed an accurate diagnosis in 12 of 13 cases (92.3 percent) previously classified as non-specific cicatricial alopecias. CONCLUSIONS: Even in the late, pauci or non-inflammatory phases, an approach with systematic evaluation of a constellation of criteria in routine hematoxylin and eosin stain, Periodic acid-Schiff and Weigert stain allowed for a more accurate diagnosis of cicatricial alopecias.

Alopecia / Alopecia

Alopecia é a diminuição excessiva de pêlos no corpo com causas e padrões que variam. A alopecia é tanto um sinal quanto um sintoma de doença, interna, na maioria das vezes, ou externa, que se manifesta de diferentes maneiras e acomete diferentes tipos de pacientes, abrangendo todas as faixas etárias. Este artigo é uma revisão da literatura e dos últimos guidelines e tem como finalidade instruir o leitor sobre os aspectos clínicos e anatomopatólogicos das alopecias cicatriciais e não-cicatriciais. Além disso, os tipos de tratamentos vigentes para tais afecções são brevemente comentados. É um resumo de aspectos relevantes das alopecias mais prevalentes e sem pretensão de esgotar o assunto.

Tricologia / Tricology

A queda de cabelos ou alopécia possui muitas causas e pode surgir em qualquer momento da vida. É um assunto de extrema importância médica e social, já que podemos diagnosticar doenças sistêmicas a partir dessa queixa e, dependendo da extensäo do quadro clínico pode desencandear alteraçöes na vida social e profissional do paciente. Nesse artigo, os autores fazem uma revisäo das principais apresentaçöes clínicas, diagnóstico e avanços no tratamento das alopécias.

O tricograma: Parte II. Resultados e interpretaçäo / The trichogram: Part II. Results and interpretation

O tricograma é um exame que avalia o ciclo de crescimento do cabelo. Desta forma pode ser usado para o diagnóstico, evoluçäo e prognóstico de um processo patológico, bem como parâmetro para avaliar o uso de drogas em tricologia e cancerologia

Síndrome de Netherton estudo de dois casos / Netherton syndrome: a two-case study

Sao apresentados dois casos de Síndrome de Netherton, afecçao nao registrada, até hoje, na literatura brasileira, 20 e 21 casos de literatura mundial. É feito confronto com os casos publicados, desde 1958 até 1971, revendo-se casos referidos em 14 publicaçoes. Os casos relatados sao irmaos de sexos diferentes, nos quais, sao estudados os seguintes aspectos: clínico, laboratoriais de rotina, exames micológicos direto e cultura, histopatológico de pele do tronco e couro cabeludo, microscopia dos cabelos, desenvolvimento somático e psíquico, exame neurológico, pesquisa alergológica, determinaçao da amino-acidúria e amino-acidemia e estudo genético