Androgenic alopecia in post-menopausal female: a clinical presentation

Androgenic alopecia is a patterned hair loss occurring due to systemic androgens and genetic factors. It is the most common cause of hair loss in both genders. The appearance of this condition is the cause of significant stress and psychological problems, making appropriate management important. A 68-year-old postmenopausal female presented with complaints of increased hair loss from scalp, excessive hair growth at undesired sites and hirsutism not corrected with medications. On thorough investigations, CT scan whole abdomen and endocrinological workup, a clinical diagnosis of alopecia and hirsutism due to hyperandrogenemia secondary to ovarian tumor made. Abdominal hysterectomy with B/L salpingo-oophorectomy was done. Histopathological examination revealed an encapsulated tumor in right ovary-sex cord stromal tumor consistent with Leydig cell tumor in right ovary, no evidence of malignancy. Left ovary was normal. Patient showed significant regression of clinical signs and symptoms on follow up after 1 month. All women with severe hirsutism or androgenic alopecia needs further work up to locate the source of androgen over production.

Does microneedling with 5% minoxidil offer added advantage for treatment of androgenetic alopecia in comparison to use of topical 5% minoxidil alone?

Background: Androgenetic alopecia is the most common cause of chronic hair loss. The FDA approved treatment for male androgenetic alopecia are Finasteride and Minoxidil. But many patients do not respond to these medications. Microneedling is a recent modality that releases several growth factors and enhances penetration of minoxidil, thereby promoting hair growth.Methods: 60 patients, aged 21-40 years, with androgenetic alopecia were divided into 2 groups. In group A, patients were subjected to microneedling twice monthly, immediately followed by application of topical 5% minoxidil solution over the scalp and then 1 ml twice daily. In group B, patients were treated with application of 1ml of topical 5% minoxidil solution over the scalp twice daily. The results were evaluated based on patient’s and physician’s assessment based on the standardized 7-point evaluation scale.Results: Patients in group A showed statistically significant improvement (p value<0.05) compared to group B. Headache and erythema were the most common side effects encountered in both the groups.Conclusions: Microneedling with 5% minoxidil is a safe, simple and cost-effective modality and is a promising treatment option for patients with androgenetic alopecia. It showed much better results when compared to use of topical 5% minoxidil solution alone.

A Study on Association between Androgenetic Alopecia and Cardiovascular Risk Factors in Males with History of Hair Fall.

Review of literature revealed that Androgenetic Alopecia (AGA) or Male Pattern Baldness (MPB) and Coronary Artery Disease (CAD) are closely associated. Few studies showed an increased incidence of certain factors such as family history of CAD, family history of baldness, hypertension, increased Body Mass Index (BMI), central obesity, hyperglycaemia, and dyslipidaemia in all men with MPB, which were considered as cardiovascular risk factors. Recently newer risk factors such as Serum Lipoprotein a (SL-a), serum homocysteine (SH), and serum adiponectin are reported. A meta-analysis study showed that vertex type of baldness is more commonly associated with CAD. We wanted to study the association between androgenetic alopecia and cardiovascular risk factors in male patients with history of hair fall and family history of coronary artery disease.METHODSThis study was done among 136 men aged between 20 and 65 years with the history of hair fall and a family history of coronary artery disease. In all the subjects, blood pressure and pulse rate were recorded. Lipid profile and fasting blood sugar were done. Other parameters such as weight, height, BMI, waist circumference, and the pattern of baldness were documented.RESULTSIn majority of the subjects, 42.6 % belonged to the age group of 45-65 years with mean age of 48.63 years. Vertex type of baldness was observed in 78 persons constituting 57.3%. Among the grades of baldness, Grade - IV, V, and VI baldness were observed in majority of the subjects in the age group of 31-40 years. 73.0 % of persons with vertex type had positive family history of baldness and family history suggestive of ischemic heart disease. All subjects with vertex type had more cardiovascular risk factors in comparison to none type such as total Cholesterol, low LDL, high VLDL, and TC/HDL more than 5 and diabetes. Hence vertex type may be considered as a marker for the evaluation of well-known cardiovascular risk factors.CONCLUSIONSAll persons having history of hair fall and MPB especially vertex type should be evaluated for the well-known cardiovascular risk factors and should be advised to have periodical tests to be done to reduce the co-morbidity associated with increased cardiovascular risk factors.

Trichorhinophalangeal Syndrome with Rapidly Progressive Childhood Male Pattern Baldness / 대한피부과학회지

No abstract available.

Effect of Finasteride on Male Pattern Baldness in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Finasteride, an inhibitor of 5alpha-reductase, is used for the treatment of benign prostatic hyperplasia (BPH) and male pattern baldness, by inhibiting the conversion of testosterone to dihydrotestosterone (DHT). We attempted to determine whether finasteride treatment led to a clinical improvement in BPH patients with male pattern baldness. MATERIALS AND METHODS: This was a one year, single blind, prospective study, conducted on BPH patients. Eighty two men participated in the study, and received either 5mg finasteride plus 0.2mg tamsulosin (group I, n=43) or 0.2mg tamsulosin alone (group II, n=39). The efficacies were evaluated, bimonthly, by baldness grade, international prostate symptom score (IPSS) and peak flow rate (PFR), for 12 months. The estimation of baldness grade was based on the modified Norwood's classification (from grades I to VII). Patients with grade IV or higher were categorized as having moderate to severe male pattern baldness. The numbers of moderate to severe male pattern baldness were 11 and 16 in groups I and II, respectively. RESULTS: At the baseline, there were no significant differences in the baldness grade, age and prostatic volume between the two groups. Group I exhibited a gradual and continuous improvement in the baldness grade at 10 and 12 months compared to baseline (p<0.05), while group II displayed no significant change in the baldness grade. Thirteen patients (30.2%) of group I manifested improvements in their baldness grade, whereas none of group II demonstrated an improvement. In group I, of the eleven patients with moderate to severe male pattern baldness, seven (63.6%) showed an improvement in their baldness grade, whereas of the thirty two mild grade patients, six (18.7%) showed an improvement. The improvement in baldness grade from the baseline to 10 and 12 months were statistically significant, but from the baseline to 8 months was insignificant. CONCLUSIONS: The combined treatment of 5mg finasteride and 0.2mg tamsulosin, for BPH patients, resulted in an improvement in male pattern baldness.

Trichorhinophalangeal Syndrome Type I / 대한피부과학회지

Trichorhinophalangeal syndrome(TRPS) type I is characterized by sparse and slow-growing hairs, pear-shaped nose, elongated philtrum, thin upper lip, and bone deformities, especially, cone-shaped epiphyses of the phalanges. The syndrome is inherited in an autosomal dominant manner. We report a case of TRPS type I with alopecia like male pattern baldness and Perthes-like changes on the right hip joint.

Changes of androgen and estrogen receptors in male pattern baldness after hair autografting / 中华医学美学美容杂志

Objective To explore the role of androgen receptor (AR) and estrogen receptor (ER) on male pattern baldness (MPB). Methods The contents of AR and ER in donor and recipient sites of scalps after hair autografting were determinated in 13 cases of MPB. Fluorescent steroid hormone conjugate technique was employed in this study. Results There was no statistical difference in the contents of AR and ER between donor site and grafted scalps in recipient site. Conclusion After the donor tissues are transplanted to the recipient site (the former baldness site), there is no change in contents of AR and ER. The abnormal change of the content of AR and ER in scalp plays an important role in MPB development.

Clinical Application of Single Hair Graft Using Choi Hair Transplanter

The transplantation of a large number of hair graft has become an important method in hair restoration surgery and reconstruction of pubic hair and eyebrows. Between September 1996 and December 1998, single hair graft using Choi hair transplanter was performed for 22 patients with male pattern baldness, 8 patients with alopecia of pubis, 6 patients with alopecia of eyebrows ranging from 20 to 59 years of age. Usually between 1000 and 1500 single hair grafts per session are performed on male pattern baldness, between 350 and 500 grafts on alopecia of pubis, between 150 and 250 grafts on alopecia of eyebrows. All procedures were done under intravenous sedation and local anesthesia. A donor horizontal ellipse of scalp is harvested from the occipital area. Questionaires regarding cosmetic satisfaction, side effects and general efficacy of hair transplantation were recorded by patients themselves one year after surgery. The procedure has been proved to be safe and patients can expect aesthetically satisfactory results. No serious complications were reported The complications including facial edema, temporary sensory change on the donor site, and folliculitis were observed and resolved spontaneously. The use of single hair graft using Choi hair transplanter for the correction of male pattern baldness, alopecia of pubis and alopecia of eyebrows has been proven as one of the safe and effective method in obtaining excellent results.

HAIR TRANSPLANTATION FOR MALE PATTERN BALDNESS AND OTHER ALOPECIAS

The increasingly successful results of hair restoration surgery in the last years have developed the interest and the confidence of patients and it is the most frequently performed esthetic surgery among male patients. Currently, various kinds of techniques for hair restoration surgery including hair transplantation, scalp reduction, and scalp flaps are performed in our clinic. Among these, hair transplantation is the basic and the most popular procedure, which can be performed not only by itself but also in conjunction with other procedures. 123 consecutive cases of hair transplantations were peformed from Jan. 1995 to Feb. 1996 for male pattern baldness, traumatic alopecia, and female pattern baldness under out patient base. The authors introduced a new classification for male pattern baldness, which are the type M, O, C, U, M-O, and C-O after alphabet to make simple and easy for clinical application. The ancillary procedures were scalp reduction, preauricular flap, and scalp expansion. An ellipsis of hair bearing scalp taken from the occipital area was sliced into slit-, mega-, mini-, and micro-grafts. The survival rate of the grafts was over 90% with minimal complications. This hair transplantation technique enabled us to achieve a good density and more natural looking hair with avoidance of cobble stoning and apparent scar.