Androgenetic Alopecia: update on Etiology, Pathophysiology, Diagnosis and Treatment
DOI:
https://doi.org/10.25004/IJPSDR.2024.160220Keywords:
Androgenetic alopecia, patterned hair loss, non-scarring alopecia, trichoscopy.Abstract
Alopecia means loss of hair. Androgenetic alopecia (AGA) now called as patterned hair loss (male pattern hair loss; MPHL, female pattern hair loss; FPHL) is caused by androgens in a predisposed individual. It is modulated by factors like age, sex, genes, smoking, and alcohol. If untreated this leads to psychological problems like stress, anxiety, depression and decrease self-confidence which affect quality of life. A thorough clinical examination and a certain hormonal estimation could reveal levels of androgens, hyperandrogenism, adrenal hyperplasia, (PCOS) polycystic ovarian syndrome, and ovarian/adrenal tumors. A simple Trichoscopy could show the typical picture of hair miniaturization commonly seen in this condition. Finally, a biopsy of the scalp could help in clinching conclusive diagnosis. Out of the many treatments at our disposal, the non-pharmacologic methods like temporary camouflage techniques, synthetic hair wigs, hair-thickening fibers, hair weaving, pigmented powders are useful. Semi-permanent options like scalp micro-pigmentation (thorough tattooing) are useful to enhance appearances. Presently the United States Food and Drug Administration (USFDA) approved pharmacologic treatments are Minoxidil and Finasteride. The non-USFDA approved methods of treatments like various surgical procedures {[hair transplantation]: follicular unit transplantation (FUT), follicular unit extraction (FUE), microneedling, light therapy, indigenous medicines, Platelet-Rich Plasma (PRP)}, and various loco-regional hair care practices are in vogue. The outcome of this review is to offer the latest update and insights into the newer novel therapies in patterned hair loss. Also, the patients could enhance their knowledge about the condition, the benefits and prognosis of each treatment.
Downloads
References
Devjani S, Ezemma O, Kelley KJ, Stratton E, Senna M. Androgenetic Alopecia: Therapy Update. Drugs. 2023 Jun;83(8):701-715. doi: 10.1007/s40265-023-01880-x. Epub 2023 May 11. PMID: 37166619; PMCID: PMC10173235.
Monil G, Snehal M, Veligandla KC, Rahul R, Gauri D, Bhavesh K, Snehal S. Epidemiology and Treatment Aspects of Hair Loss in India – A Cross-Sectional, Multicentre, Database Study (HAILO). AJRDES [Internet]. 2023 May 10 [cited 2024 Apr. 18];6(1):22-3. Available from: https://journalajrdes.com/index.php/AJRDES/article/view/81
Asfour L, Cranwell W, Sinclair R. Male Androgenetic Alopecia. 2023 Jan 25. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905192.
Kaiser M, Abdin R, Gaumond SI, Issa NT, Jimenez JJ. Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs. Clin Cosmet Investig Dermatol. 2023 May 31;16:1387-1406. doi: 10.2147/CCID.S385861. PMID: 37284568; PMCID: PMC10239632.
Chen S, Xie X, Zhang G, Zhang Y. Comorbidities in Androgenetic Alopecia: A Comprehensive Review. Dermatol Ther (Heidelb). 2022 Oct;12(10):2233-2247. doi: 10.1007/s13555-022-00799-7. Epub 2022 Sep 17. PMID: 36115913; PMCID: PMC9483356.
Ho CH, Sood T, Zito PM. Androgenetic Alopecia. [Updated 2024 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430924/
Dhurat RS, Daruwalla SB. Androgenetic alopecia: Update on etiology. Dermatological Reviews 2021; 1-7. https://doi.org/10.1002/der2.58
Thiedke CC. Alopecia in women. Am Fam Physician. 2003 Mar 1;67(5):1007-14. PMID: 12643360.
Natarelli N, Gahoonia N, Sivamani RK. Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss. J Clin Med. 2023 Jan 23;12(3):893. doi: 10.3390/jcm12030893. PMID: 36769541; PMCID: PMC9917549.
DA Burns, SM Breathnach, NH Cox and CEM Griffiths. Rook’s Textbook of Dermatology. 8th edition. West Sussex. Wiley Blackwell Publishing; 2010
Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol. 2018 Jun 19;4(4):203-211. doi: 10.1016/j.ijwd.2018.05.001. PMID: 30627618; PMCID: PMC6322157.
Ellis JA, Harrap SB. The genetics of androgenetic alopecia. Clin Dermatol. 2001 Mar-Apr;19(2):149-54. doi: 10.1016/s0738-081x(00)00125-5. PMID: 11397593.
Ntshingila S, Oputu O, Arowolo AT, Khumalo NP. Androgenetic alopecia: An update. JAAD Int. 2023 Jul 22;13:150-158. doi: 10.1016/j.jdin.2023.07.005. PMID: 37823040; PMCID: PMC10562178.
Trüeb RM. Molecular mechanisms of androgenetic alopecia. Exp Gerontol. 2002 Aug-Sep;37(8-9):981-90. doi: 10.1016/s0531-5565(02)00093-1. PMID: 12213548.
Martinez-Jacobo L, Villarreal-Villarreal CD, Ortiz-López R, Ocampo-Candiani J, Rojas-Martínez A. Genetic and molecular aspects of androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2018 May-Jun;84(3):263-268. doi: 10.4103/ijdvl.IJDVL_262_17. PMID: 29595184.
Feinstein RP, Butler DF, Chan EF, Khardori R, Sperling L. Androgenetic Alopecia. Medscape Updated Mar 25, 2024.
Tamashunas NL, Bergfeld WF. Male and female pattern hair loss: Treatable and worth treating. Cleve Clin J Med. 2021 Mar 1;88(3):173-182. doi: 10.3949/ccjm.88a.20014. PMID: 33648970.
Singh S, Muthuvel K. Practical Approach to Hair Loss Diagnosis. Indian J Plast Surg. 2021 Dec 27;54(4):399-403. doi: 10.1055/s-0041-1739240. PMID: 34984076; PMCID: PMC8719967.
Pathoulas JT, Flanagan KE, Walker CJ, Wiss IMP, Azimi E, Senna MM. Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment. J Am Acad Dermatol. 2021 Dec;85(6):1640-1641. doi: 10.1016/j.jaad.2020.12.059. Epub 2021 Jan 7. PMID: 33421478.
Serrano-Falcón C, Fernández-Pugnaire MA, Serrano-Ortega S. Hair and scalp evaluation: the trichogram. Actas Dermosifiliogr. 2013 Dec;104(10):867-76. English, Spanish. doi: 10.1016/j.ad.2013.03.004. Epub 2013 Jul 18. PMID: 23871642.
Kasumagic-Halilovic E. Trichoscopic Findings in Androgenetic Alopecia. Med Arch. 2021 Apr;75(2):109-111. doi: 10.5455/medarh.2021.75.109-111. PMID: 34219869; PMCID: PMC8228579.
Pekmezci E, Turkoğlu M, Gökalp H, Kutlubay Z. Minoxidil Downregulates Interleukin-1 Alpha Gene Expression in HaCaT Cells. Int J Trichology. 2018 May-Jun;10(3):108-112. doi: 10.4103/ijt.ijt_18_17. PMID: 30034189; PMCID: PMC6029000.
Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad Dermatol. 2020 Jan;82(1):252-253. doi: 10.1016/j.jaad.2019.08.060. Epub 2019 Aug 29. PMID: 31473295.
Sinclair R, Trindade de Carvalho L, Ferial Ismail F, Meah N. Treatment of male and female pattern hair loss with sublingual minoxidil: a retrospective case-series of 64 patients. J Eur Acad Dermatol Venereol. 2020 Dec;34(12):e795-e796. doi: 10.1111/jdv.16616. Epub 2020 Jul 28. PMID: 32386429.
Starace M, Orlando G, Alessandrini A, Piraccini BM. Female Androgenetic Alopecia: An Update on Diagnosis and Management. Am J Clin Dermatol. 2020 Feb;21(1):69-84. doi: 10.1007/s40257-019-00479-x. PMID: 31677111.
Dhurat R, Sharma A, Rudnicka L, Kroumpouzos G, Kassir M, Galadari H, Wollina U, Lotti T, Golubovic M, Binic I, Grabbe S, Goldust M. 5-Alpha reductase inhibitors in androgenetic alopecia: Shifting paradigms, current concepts, comparative efficacy, and safety. Dermatol Ther. 2020 May;33(3):e13379. doi: 10.1111/dth.13379. Epub 2020 Apr 24. PMID: 32279398.
Rossi A, Cantisani C, Scarnò M, Trucchia A, Fortuna MC, Calvieri S. Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up. Dermatol Ther. 2011 Jul-Aug;24(4):455-61. doi: 10.1111/j.1529-8019.2011.01441.x. PMID: 21910805.
Arif T, Dorjay K, Adil M, Sami M. Dutasteride in Androgenetic Alopecia: An Update. Curr Clin Pharmacol. 2017;12(1):31-35. doi: 10.2174/1574884712666170310111125. PMID: 28294070.
Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004 May;89(5):2179-84. doi: 10.1210/jc.2003-030330. PMID: 15126539.
Zhou Z, Song S, Gao Z, Wu J, Ma J, Cui Y. The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: a systematic review and meta-analysis. Clin Interv Aging. 2019 Feb 20;14:399-406. doi: 10.2147/CIA.S192435. PMID: 30863034; PMCID: PMC6388756.
Inui S, Itami S. Reversal of androgenetic alopecia by topical ketoconzole: relevance of anti-androgenic activity. J Dermatol Sci. 2007 Jan;45(1):66-8. doi: 10.1016/j.jdermsci.2006.08.011. Epub 2006 Sep 25. PMID: 16997533.
Hebert A, Thiboutot D, Stein Gold L, Cartwright M, Gerloni M, Fragasso E, Mazzetti A. Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne: Two Phase 3 Randomized Clinical Trials. JAMA Dermatol. 2020 Jun 1;156(6):621-630. doi: 10.1001/jamadermatol.2020.0465. PMID: 32320027; PMCID: PMC7177662.
Sun HY, Sebaratnam DF. Clascoterone as a novel treatment for androgenetic alopecia. Clin Exp Dermatol. 2020 Oct;45(7):913-914. doi: 10.1111/ced.14292. Epub 2020 Jun 23. PMID: 32421862.
Cervantes J, Perper M, Wong LL, Eber AE, Villasante Fricke AC, Wikramanayake TC, Jimenez JJ. Effectiveness of Platelet-Rich Plasma for Androgenetic Alopecia: A Review of the Literature. Skin Appendage Disord. 2018 Jan;4(1):1-11. doi: 10.1159/000477671. Epub 2017 Jun 24. PMID: 29457005; PMCID: PMC5806173.
Gentile P, Garcovich S. Advances in Regenerative Stem Cell Therapy in Androgenic Alopecia and Hair Loss: Wnt pathway, Growth-Factor, and Mesenchymal Stem Cell Signaling Impact Analysis on Cell Growth and Hair Follicle Development. Cells. 2019 May 16;8(5):466. doi: 10.3390/cells8050466. PMID: 31100937; PMCID: PMC6562814.
Starace M, Alessandrini A, Brandi N, Piraccini BM. Preliminary results of the use of scalp microneedling in different types of alopecia. J Cosmet Dermatol. 2020 Mar;19(3):646-650. doi: 10.1111/jocd.13061. Epub 2019 Jun 29. PMID: 31254437.
Kanti V, Messenger A, Dobos G, Reygagne P, Finner A, Blumeyer A, Trakatelli M, Tosti A, Del Marmol V, Piraccini BM, Nast A, Blume-Peytavi U. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short version. J Eur Acad Dermatol Venereol. 2018 Jan;32(1):11-22. doi: 10.1111/jdv.14624. Epub 2017 Nov 27. PMID: 29178529.
Zito PM, Raggio BS. Hair Transplantation. 2023 Feb 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 31613520.
Avram MR, Watkins SA. Robotic follicular unit extraction in hair transplantation. Dermatol Surg. 2014 Dec;40(12):1319-27. doi: 10.1097/DSS.0000000000000191. PMID: 25418806.
Nestor MS, Ablon G, Gade A, Han H, Fischer DL. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. J Cosmet Dermatol. 2021 Dec;20(12):3759-3781. doi: 10.1111/jocd.14537. Epub 2021 Nov 6. PMID: 34741573; PMCID: PMC9298335.
Lee GS, Hong EJ, Gwak KS, Park MJ, Choi KC, Choi IG, Jang JW, Jeung EB. The essential oils of Chamaecyparis obtusa promote hair growth through the induction of vascular endothelial growth factor gene. Fitoterapia. 2010 Jan;81(1):17-24. doi: 10.1016/j.fitote.2009.06.016. Epub 2009 Jul 2. PMID: 19576968.
Viveiros EP, Carvalho ALM, Lopes TB de C, Ramos IF da S, Alves PNN. Essential oils in androgenetic alopecia management: An integrative review. Editora [Internet]. 2023 Apr. 10 [cited 2024 Apr. 18];. Available from: https://sevenpublicacoes.com.br/index.php/editora/article/view/848
Fischer TW, Herczeg-Lisztes E, Funk W, Zillikens D, Bíró T, Paus R. Differential effects of caffeine on hair shaft elongation, matrix and outer root sheath keratinocyte proliferation, and transforming growth factor-β2/insulin-like growth factor-1-mediated regulation of the hair cycle in male and female human hair follicles in vitro. Br J Dermatol. 2014 Nov;171(5):1031-43. doi: 10.1111/bjd.13114. Epub 2014 Oct 30. PMID: 24836650.
Völker JM, Koch N, Becker M, Klenk A. Caffeine and Its Pharmacological Benefits in the Management of Androgenetic Alopecia: A Review. Skin Pharmacol Physiol. 2020;33(3):93-109. doi: 10.1159/000508228. Epub 2020 Jun 29. PMID: 32599587.
Dhurat R, Chitallia J, May TW, Jayaraaman AM, Madhukara J, Anandan S, Vaidya P, Klenk A. An Open-Label Randomized Multicenter Study Assessing the Noninferiority of a Caffeine-Based Topical Liquid 0.2% versus Minoxidil 5% Solution in Male Androgenetic Alopecia. Skin Pharmacol Physiol. 2017;30(6):298-305. doi: 10.1159/000481141. Epub 2017 Oct 21. PMID: 29055953; PMCID: PMC5804833.
Ring C, Heitmiller K, Correia E, Gabriel Z, Saedi N. Nutraceuticals for Androgenetic Alopecia. J Clin Aesthet Dermatol. 2022 Mar;15(3):26-29. PMID: 35342503; PMCID: PMC8944288.
Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med. 2002 Apr;8(2):143-52. doi: 10.1089/acm.2002.8.143. Erratum in: J Altern Complement Med. 2006 Mar;12(2):199. PMID: 12006122.
Gupta AK, Talukder M, Bamimore MA. Natural products for male androgenetic alopecia. Dermatol Ther. 2022 Apr;35(4):e15323. doi: 10.1111/dth.15323. Epub 2022 Jan 27. PMID: 35044013.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 babiker bashir
This work is licensed under a Creative Commons Attribution 4.0 International License.
