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Objective: To investigate the relationship between homocysteine (HCY) and androgenetic alopecia (AGA)., Methods: A case control study and two observational experiments on mice were conducted. In the first part, a total of 528 Chinese AGA patients and 500 age-matched healthy controls were included. Serum HCY levels of AGA and controls were compared. In the second part, eight mice were divided into two groups. Both groups of mice had their hair removed. AGA group received a DHT injection, and the other as control group. HCY levels in hair follicles (HFs) were detected by ELISA and compared. In the third part, twelve mice were divided into three groups and fed with different concentrations of methionine. After 4 weeks, serum HCY levels, parameters related to hair growth through observation and HE staining, and expression of immunohistochemistry (IHC) hair-growth-related markers Ki67, VEGF, IGF-1, Krt27, FGF9, and TGF-β1 were compared among the three groups., Results: In the first part, HCY levels were higher in AGA than the controls of both genders. However, there was no difference in HCY levels between groups with varying severity. Rates of hyperhomocysteinemia was higher in AGA patients than the controls. Logistic regression analysis showed serum HCY levels was positively correlated with the incidence of AGA. In the second part, HCY of the HFs in the AGA group was significantly higher than that in the control group. The third part showed that the increase in serum HCY levels inhibited the growth of mice hair, with the less expressed stimulative markers Ki67, VEGF, IGF-1, Krt27, and FGF9, while there was no difference in the expression of inhibitory markers TGF-β1., Conclusion: There is a potential relationship between HCY and AGA. HCY had an inhibitory effect on hair growth. Further studies are necessary to explore the specific mechanism., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Polycystic ovary syndrome (PCOS) is the leading endocrine disorder in young women of childbearing age. Dermatological issues, particularly acne, are a major reason for medical consultations. The aim of this study is to determine the prevalence of PCOS in patients presenting with acne as their main dermatological complaint and to compare the metabolic and hormonal clinical characteristics of acne patients with PCOS to those with isolated acne. This was a prospective study with analytical aims, carried out in the Endocrinology Department and the Dermatology Department of Farhat Hached University Hospital in Sousse. The study included patients seeking treatment for acne from January 2023 to January 2024, divided into two groups: those with confirmed PCOS (G1) and those with isolated acne (G2). All patients underwent hormonal assessment and ovarian ultrasound. We conducted a study involving 212 patients. We found that 65.6% of acne patients had been diagnosed with PCOS. Nodular lesions were significantly more frequent in 'PCOS' (p = 0.02). Acne was linked with hirsutism, which was more prevalent in 'PCOS' (94.2% 'PCOS' vs. 67.1% 'isolated acne'), as well as androgenic alopecia (51% 'PCOS' vs. 21.9% 'isolated acne') (p < 10 - 3 ). 'PCOS' showed evidence of biological hyperandrogenism, with a mean testosterone level of 0.72 ± 0.27 ng/mL, significantly higher than in 'isolated acne'. The LH/FSH ratio was greater than 1 in 72.7% of cases in 'PCOS', demonstrating a significant difference compared to 'isolated acne', where it was greater than 1 in 24.7% of cases (p < 10 - 3 ). In our study, acne in 'PCOS' appeared to be more severe and was associated with hypertestosteronemia (p = 0.041) and hyperprolactinemia (p = 0.008). According to our results, phenotype A was the most likely to cause severe acne (p = 0.043). Our work is unique in that it brings to light this hidden aspect of the dermatological impact of PCOS, prompting physicians to screen for this endocrine disorder in all adult women seeking acne treatment., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

There are studies revealing the effects of estrogen receptors alpha (α) and beta (β) on hair follicles. However, the effects of G protein-coupled estrogen receptors (GPER-1) on hair follicles have not been elucidated. This study aims to evaluate the relationship between serum GPER-1 levels and the severity and duration of the disease in patients with androgenetic alopecia (AGA). The study included 81 patients with AGA aged 18 to 50 years (22 men and 19 women with an onset of AGA more than 5 years, and 20 men and 20 women with an onset of AGA less than 5 years) and 40 healthy controls (20 men, 20 women). The mean age of participants with AGA was 29.12 ± 8.15 (18-50), and the mean age of the control group was 25.21± 4.71 (19-42). Serum GPER-1 levels were measured, and the relationship between GPER-1 levels and duration of the disease, severity of the disease, and sex was statistically evaluated. The serum level of GPER-1 was significantly higher in patients with AGA as compared to the control group (p < 0.001). A negative correlation was found between serum GPER-1 levels and the duration of the disease in both men and women (p < 0.001, r = 0.793; p < 0.001, r = 0.711, respectively). There was a significant relationship between serum GPER-1 levels and the severity of the disease in both men and women (p = 0.003; p = 0.002, respectively). Additionally, a significant difference in GPER-1 levels was noted between male and female patients with AGA (p = 0.001). However, no statistically significant relationship was identified between GPER-1 levels and estrogen levels (p = 0.097). The higher levels of GPER-1 in patients with AGA compared to the control group, and the significant relationship between GPER-1 levels and both the duration and severity of the disease, suggest an estrogen-independent role of GPER-1 in the pathogenesis of AGA. The fact that GPER-1 levels are high in the early stages of AGA when inflammation is prominent suggests that treatments targeting these receptors may be effective at this stage., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To determine the association of androgenetic alopecia (AGA) with metabolic syndrome (MetS) in either gender., Study Design: Descriptive study. Place and Duration of the Study: OPD complex, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from February to August 2021., Methodology: The study included a total of 90 patients who met the specified criteria for enrolment. Each group (case and control) contains 45 patients. Diagnosis of androgenetic 2 alopecia was done clinically and grading was based on the Norwood-Hamilton classification in males and Ludwig classification in females. Body mass index (BMI) was calculated and blood pressure was measured for all enrolled patients. Following an overnight fasting period, blood samples were collected from each patient to measure clinical parameters including triglycerides (TGs), fasting blood sugar (FBS), and high-density lipoprotein (HDL) levels., Results: There were 85.6% males and 4.4% females with a mean age of 43.38 years. Out of which, 34.4% and 15.6% of patients fell in severity 1 and severity 2 Class. Patients were stratified on the basis of AGA with respect to TGs, FBS, HDL, and BMI. The p-value was significant when stratified on the basis of BMI, FBS, and HDL except TGs. Odd ratio of both groups on the basis of (MetS) 8.1. Odd ratio between androgenic alopecia and metabolic syndrome was of 2.4., Conclusion: An association existed between androgenetic alopecia and metabolic syndrome indicating the potential benefit of early MetS screening for individuals with androgenic alopecia. This proactive approach could help prevent unforeseen complications through timely lifestyle adjustments., Key Words: Metabolic syndrome, Androgenic alopecia, Cholesterol, Triglycerides.

Background: Male androgenetic alopecia (MAA) is a multifactorial disease, with patients presenting at a younger age, which is a risk factor for many metabolic diseases., Aims: To explore the risk factors associated with early-onset of MAA and its metabolic characteristics., Methods: Forty patients with MAA and 45 healthy controls were collected. The serum levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total testosterone (TT), uric acid (UA), and 25-hydroxyvitamin D (25(OH)D) were measured. Meanwhile, lipid metabolites were detected by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS)., Results: 37.50% MAA patients had metabolic syndrome, compared to 17.78% in control group (p < 0.05). The levels of HDL-C, UA, and 25(OH)D were decreased in patients with MAA compared to healthy controls (p < 0.05). However, there was no significant difference in the level of TT between the two groups. Additionally, there were no significant differences in the levels of HDL-C, UA, 25(OH)D, and TT among different grades of hair loss (p > 0.05). The lipid profile of early-onset MAA differed significantly from healthy controls. In early-onset MAA, the levels of ceramide (Cer) and sphingomyelin (SM) were significantly lower. Cer(d38:5) and TG(15:0/18:1/18:1) may be the biomarkers., Conclusion: Low HDL-C, UA, and 25(OH)D may be the independent risk factors for early-onset MAA. Abnormal lipid metabolism was observed in early-onset MAA, wherein Cer and SM may serve as protective factors., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Despite numerous studies investigating the association between androgenetic alopecia (AGA) and serum uric acid (SUA), the causal relationship between AGA and SUA remains unknown., Methods: We utilized bidirectional Mendelian randomization (MR) to explore the causality between AGA and SUA. Our study chose single nucleotide polymorphisms associated with genome-wide significance (p < 5×10 -8 ) for the exposure and showing low linkage disequilibrium (R 2  < 0.001) as IVs. Various MR methods were employed to evaluate causality, including inverse-variance weighted (IVW), Weighted Median, MR-Egger, Weighted Mode and Simple Mode. Sensitivity analyses were performed to test the robustness of the results., Results: Using the IVW method, we did not find a significant causal relationship between AGA and SUA (OR = 1.00, 95% CI 0.99-1.01; p = 0.451). Similarly, the IVW method did not reveal evidence of causality between SUA and AGA (OR = 0.97, 95% CI = 0.91-1.03; p = 0.301). The results from other methods were consistent with those of the IVW approach., Conclusion: The study did not identify a causal relationship between AGA and SUA. Future research should involve larger cohorts and advanced methods to validate the findings and explore the complex interactions between AGA and SUA levels in different populations., (© 2024 The Author(s). Skin Research and Technology published by John Wiley & Sons Ltd.)

Previous observational studies revealed controversy about the effect of circulating antioxidants on risk of alopecia. In the present study, we investigated the causal relationships between diet-derived circulating antioxidants and 2 non-scarring alopecia using Mendelian randomization (MR). Instrumental variables for antioxidants (lycopene, retinol, ascorbate, β-carotene, α-tocopherol, and γ-tocopherol) were selected from published studies. Data for alopecia areata (AA) and androgenetic alopecia (AGA) was obtained from the FinnGen study project (R9 released in 2023), including 195 cases and 201,019 controls for AGA and 682 cases and 361,140 controls for AA. We used the inverse variance weighted method as the primary MR method. Three additional methods were used as sensitivity analysis to validate the robustness of the results. We found a causal relationship between absolute β-carotene levels and AGA risk (P = .039), but not with AA (P = .283). The results of Wald ratio showed a protective effect of absolute β-carotene levels against AGA, with per 0.1 ln-transformed β-carotene being associated with a 76% lower risk of AGA (OR: 0.24, 95% CI: 0.06-0.93). Based on the fixed effects inverse variance weighting results, we found that α-tocopherol was protective against both AGA (P = .026) and AA (P = .018). For each unit increase in α-tocopherol, the effects of change in AGA and AA were 0.02 (95% CI: 0.00-0.61) and 0.10 (95% CI: 0.01-0.67), respectively. The results did not reveal any other causal relationships. Our study identified 3 causal associations of antioxidants with the risk of non-scarring alopecia. These results provide new insights into the prevention of non-scarring alopecia through diet., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Telogen effluvium is characterized by excessive hair shedding usually following a stressful event. Ferritin has been used in clinical practice as a biomarker of nonanemic iron deficiency in cases of telogen effluvium. During the years of the COVID19 pandemic, telogen effluvium was reported as a part of post covid manifestations. As ferritin was also a biomarker for inflammation in cases with covid infection, this study was designed to evaluate the value of ferritin in cases with postcovid telogen effluvium one hundred patients recovering from covid 19 for 4-12 weeks were included in the study, detailed drug and laboratory history was obtained and serum ferritin level was measured. the mean serum level of ferritin among telogen effluvium patients was significantly lower than controls (68.52 ± 126 and 137 ± 137.597 ug/L respectively). Patients with telogen effluvium used significantly more azithromycin and ivermectin and significantly less vitamin C, D, lactoferrin and zinc than the controls Although serum ferritin is lower among telogen effluvium patients, it was still higher than the cutoff value for diagnosing nonanemic iron deficiency, we suggest that it will not be a good biomarkers in these cases. Our secondary outcomes showed that dietary supplements used during active infection such as vitamin C, D, lactoferrin and zinc might have a preventive value on postcovid hair loss, while azithromycin and ivermectin could have a negative long term effect on telogen effluvium., (© 2024. The Author(s).)

Introduction: Non-scarring alopecia mainly includes androgenetic alopecia (AGA), female pattern hair loss (FPHL), alopecia areata (AA), telogen effluvium (TE), anagen effluvium (AE) and so on. Many studies had investigated the serum 25-hydroxyvitamin D level and vitamin D deficiency of patients with these diseases, but opinions varied, and no conclusion was reached., Methods: Relevant articles were retrieved through PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other databases. Serum 25-hydroxyvitamin D [25(OH) D] levels and vitamin D deficiency were used as our primary outcome. The odds ratio (OR) and the standardized mean difference (SMD) with 95% confidence interval were both examined for vitamin D deficiency and levels., Results: Our meta-analysis had included a total of 3374 non-scarring alopecia patients and 7296 healthy controls from 23 studies through the inclusion criteria and exclusion criteria. We found non-scarring alopecia had decreased serum 25(OH)D level (WMD -7.29; 95% CI -9.21, -5.38) and increased vitamin D deficiency incidence (OR 3.11 95% CI 2.29, 4.22), compared with healthy controls. This meta-analysis chose to conduct random-effect model and subgroup analysis, because of the high heterogeneity (serum 25(OH)D level: I 2 =  95%, vitamin D deficiency: I 2  = 0%)., Conclusion: Patients with non-scarring alopecia (including AA, FPHL, AGA and TE) have insufficient serum level of 25(OH)D and increased incidence of vitamin D deficiency. Vitamin D supplementation and monitoring for vitamin D deficiency may be helpful in treating non-scarring alopecia., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Abstract: Women with polycystic ovary syndrome are at a high cardiometabolic risk. Early-onset male-pattern baldness is considered the phenotypic equivalent of polycystic ovary syndrome in men. The aim of this study was to assess whether early-onset androgenetic alopecia modifies cardiometabolic effects of lisinopril in men with arterial hypertension. The study population consisted of 62 young men with grade 1 hypertension, 31 of whom were diagnosed with early-onset male-pattern baldness (group A). Thirty-one blood pressure-matched men with normal hair growth (group B) served as a control group. All participants were treated with lisinopril (10-40 mg daily). Blood pressure, glucose homeostasis markers, urinary albumin-to-creatinine ratio (UACR), as well as plasma levels of uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, total and calculated free testosterone, dehydroepiandrosterone sulfate, and estradiol were assessed before lisinopril treatment and 6 months later. At baseline, levels of all cardiometabolic risk factors were higher in group A than group B. Although lisinopril reduced systolic and diastolic blood pressure, UACR, hsCRP, and fibrinogen in both study groups, these effects were stronger in group B than in group A. Only in group B, the drug decreased levels of uric acid and homocysteine, as well as improved insulin sensitivity. The impact of lisinopril on uric acid, hsCRP, fibrinogen, homocysteine, and UACR correlated weakly with its hypotensive properties, androgen levels, and insulin sensitivity. The obtained results suggest that cardiometabolic effects of lisinopril in men are less pronounced in case of coexisting early-onset androgenetic alopecia., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The prevalence of telogen effluvium (TE) has increased during COVID-19. In this study we describe the clinical characteristics of patients with COVID-19-related TE and review the current literature on COVID-19-associated TE. We conducted a retrospective chart review of 66 patients, all of which had COVID-19 infection (confirmed by PCR or antibodies) and had either non-scarring hair loss or TE in Elmhurst, Queens. Our data suggest that this form of TE is similar to other forms of TE, after which many patients experience regrowth within several months.

Aging is associated with widespread physiological changes, including skeletal muscle weakening, neuron system degeneration, hair loss, and skin wrinkling. Previous studies have identified numerous molecular biomarkers involved in these changes, but their regulatory mechanisms and functional repercussions remain elusive. In this study, we conducted next-generation sequencing of DNA methylation and RNA sequencing of blood samples from 51 healthy adults between 20 and 74 years of age and identified aging-related epigenetic and transcriptomic biomarkers. We also identified candidate molecular targets that can reversely regulate the transcriptomic biomarkers of aging by reconstructing a gene regulatory network model and performing signal flow analysis. For validation, we screened public experimental data including gene expression profiles in response to thousands of chemical perturbagens. Despite insufficient data on the binding targets of perturbagens and their modes of action, curcumin, which reversely regulated the biomarkers in the experimental dataset, was found to bind and inhibit JUN, which was identified as a candidate target via signal flow analysis. Collectively, our results demonstrate the utility of a network model for integrative analysis of omics data, which can help elucidate inter-omics regulatory mechanisms and develop therapeutic strategies against aging.

Aim: The aim of this randomized trial was to find whether resveratrol could improve menstrual dysfunction, clinical signs (i.e., acne and hair loss), and the biochemical evidence of hyperandrogenism in the women with PCOS., Methods: Women, in the age range of 18-40 years, diagnosed with PCOS, as defined by the Rotterdam criteria, and no other known cause of abnormal menstruation, were recruited. Participants were randomized based on a 1:1 ratio, to either 1000 mg resveratrol or 1000 mg placebo daily groups, for a period of 3 months., Results: Seventy-eight patients were randomized: 39 to the resveratrol group and 39 to placebo. Results were analyzed according to the intention-to-treat principle. At the end of study, it was found that women who received resveratrol had a statistically higher regular menstruation rate, as compared to those who got placebo (76.47% vs. 51.61%; p = 0.03), and lower hair loss (32.10% vs. 68.00%; p = 0.009). We also found no significant differences between the two groups in terms of ovarian and adrenal androgens, sex hormone binding globulin (SHBG) levels, free androgen index (FAI), glycoinsulinemic metabolism and lipid profile. Moreover, the resveratrol treatment did not interfere with the thyroid, liver and kidney functions. The negative effect of resveratrol on the body composition was also observed, though not influencing changes in the weight, relative to the placebo group., Conclusion: Resveratrol improved menstrual cyclicity and hair loss, even though levels of androgens, insulin and lipids remained unchanged., (Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Previously, we have demonstrated that policosanol from Chinese wax suppressed testosterone(T)-induced alopecia in mice. However, the underlying mechanism remained to be determined. Herein, we investigated the mechanism of policosanol against androgenetic alopecia (AGA). AGA was induced in Kunming mice by subcutaneous administration of testosterone propionate for 60 d. Policosanol (0.5 %, 1% or 2%) was applied topically on the back of mice. Finasteride (2%) was applied topically as a positive control. The serum T and estradiol (E2) concentrations were determined by ELISA after 28 and 60 days of treatment. The cutaneous expression or activity of key mediators of hair growth, such as alkaline phosphatase (ALP), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF), was measured. MTS assay was performed to evaluate cell proliferation in cultured human dermal papilla cells (DPCs) treated with dihydrotestosterone (DHT). Western blotting was performed to evaluate the protein expression of Bax, Bcl2, TGF-β2, caspase-9, and caspase-3. We found lower T and T/E2 ratio in mice treated with policosanol than in the model group. Policosanol suppressed premature hair follicle entry into the regression phase, as shown by improving VEGF and EGF expression and ALP activity. The MTS assay showed that policosanol markedly inhibited the apoptosis of DHT-treated DPCs. Western blotting showed that policosanol significantly reduced the protein expression of TGF-β2, cleaved caspese-9, cleaved caspase-3, and Bax, and increased that of Bcl2. The optimal effect was obtained with 12.50 g/mL policosanol. In conclusion, policosanol prevents androgenetic alopecia by regulating hormone levels and suppressing premature hair follicle entry into the regression phase., (Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background and Aim: The coronavirus disease 2019 (COVID-19) pandemic is a global health emergency. According to the findings, male patients with COVID-19 infection are at an increased risk for severe complications than females. The causes of this issue are unknown and are most probably multifactorial. Sexual hormones affect the immune system, so estrogen strengthens the immune system, and testosterone suppresses it. Due to the reports of the high prevalence of androgenic alopecia in hospitalized patients with COVID-19 and a higher risk of respiratory disease and increased use of allergy/asthma medications among patients with polycystic ovary syndrome (PCOS) as a hyperandrogenism condition compared with non-PCOS women, this review aimed to evaluate androgens role in COVID-19., Methods: 42 related articles from 2008 to 2020 were reviewed with the keywords of androgens, hormonal factors, and hair loss in combination with COVID-19 in medical research databases., Results: The evidence of transmembrane protease, serine 2 (TMPRSS2) expression in lung tissue, which is an androgen-regulated gene and expressed mainly in the adult prostate may interpret the increased susceptibility of the male gender to severe COVID-19 complications. Moreover, angiotensin-converting enzyme 2 (ACE-2) acts as a functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and male hormones are effective in the ACE-2 passageway and simplify SARS-CoV-2 entry into host cells., Conclusion: Further studies on the severity of symptoms in patients with COVID-19 in other hyperandrogenism conditions compared to the control group are recommended., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Platelet α-granules release growth factors (GFs) that promote healing and tissue regeneration. Platelet-rich plasma (PRP) is shown to be beneficial in treating alopecia, and however, clinical response can be inconsistent. Due to several fold enrichment of platelets secreting large quantities of GFs following PRP injections, heterogeneity in amounts of GFs secreted by platelets may contribute to inconsistent clinical responses. Herein, we evaluated factors that could potentially contribute to heterogeneous secretion of GFs by platelets. We measured platelet secretion of transforming growth factor beta1 (TGFβ1), platelet-derived growth factor (PDGF-BB), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF2) in aliquots of de-identified PRP samples from female patients undergoing therapy in the hair disease clinic. Although secretion of GFs by platelets was comparable in PRP samples of patients with non-cicatricial and cicatricial alopecia, a Shapiro-Wilk test for normal distribution indicated significant variability across all patient samples. The amount of GF secreted by platelets was comparable when PRP prepared from two FDA-cleared devices with distinct techniques were compared. We provide evidence of platelets secreting heterogeneous amounts of GFs within each sample as high and low secretion of random factors could be simultaneously detected. These results suggest inherent heterogeneity in secretion of GFs by platelets in patient samples that are not influenced by the device used to prepare PRP. Since some GFs could have antagonistic effects on hair growth, a balance between amounts of growth promoting and inhibiting factors may be crucial in determining clinical response to PRP therapy., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

About 1-2% of European population are redheaded, meaning they synthesize more pheomelanin than eumelanin, the main melanin pigment in humans. Several mutations could be responsible for this phenotype. It has been suggested that corresponding mutations spread in Europe due to a founder effect shaped either by a relaxation of selection for dark, UV-protective phenotypes or by sexual selection in favour of rare phenotypes. In our study, we investigated the levels of vitamin D precursor 25(OH)D3 (calcidiol) and folic acid in the blood serum of 73 redheaded and 130 non-redheaded individuals. In redheaded individuals, we found higher 25(OH)D3 concentrations and approximately the same folic acid concentrations as in non-redheaded subjects. 25(OH)D3 concentrations correlated with the intensity of hair redness measured by two spectrophotometric methods and estimated by participants themselves and by independent observers. In non-redheaded individuals, 25(OH)D3 levels covaried with the amount of sun exposure and intensity of suntan while in redheaded individuals, this was not the case. It suggests that increased 25(OH)D3 levels in redheaded individuals are due to differences in physiology rather than in behaviour. We also found that folic acid levels increased with age and the intensity of baldness and decreased with the frequency of visiting tanning salons. Our results suggest that the redheaded phenotype could be an evolutionary adaptation for sufficient photosynthesis of provitamin D in conditions of low intensity of UVB radiation in central and northern parts of Europe., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Congenital atrichia (CA) is a rare form of irreversible alopecia with an autosomal recessive mode of inheritance. This form of hair loss is mainly associated with mutations in the human hairless (HR) gene located at chromosome 8p21.3. An additional unique feature atrichia with papular lesions (APL) comprises keratin-filled cysts known as papules. The present study aimed to uncover the underlying genetic causes of APL in two consanguineous Kashmiri families., Methods: In the present study, two consanguineous families of Kashmiri origin with APL displaying an autosomal recessive mode of inheritance were investigated. Whole exome and Sanger sequencing followed by bioinformatic studies, variant prioritization, Sanger validation and segregation analysis was performed to find the mutation., Results: A recurrent nonsense (NM&#95;005144: c.2818C > T:p.Arg940*) mutation was detected in exon 13 of the human HR gene., Conclusions: Whole exome sequencing analysis has widely been used in the screening of single gene disorders mutations, both in research and diagnostic laboratories. Sanger sequencing alone for genes such as HR becomes expensive and time consuming. Instead, it is recommended that a patient is to screen by whole exome sequencing and then special attention first focuses on known genes of the APL phenotype. This is helpful for intime diagnosis, being more efficient and economic. The results obtained in the present study may contribute to prenatal diagnosis, carrier secreening and the genetic counseling of families with the APL phenotype in Kashmiri poplution., (© 2020 John Wiley & Sons, Ltd.)

Background: Platelet-rich plasma (PRP), processed from autologous peripheral blood, is used to treat androgenetic alopecia (AGA)., Objective: To determine the efficacy of PRP for hair growth promotion in AGA patients in a randomized, blinded, placebo-controlled, pilot clinical trial (NCT02074943)., Methods: The efficacy of an 8 week, five session, PRP treatment course was determined by measuring hair density and hair caliber changes in 10 AGA affected patients. For each PRP sample, the concentrations of selected growth factors were determined using a multiplex assay system. The clinical results were then correlated with the growth factor concentrations in PRP., Results: At 16 weeks, 8 weeks after the last PRP injection, treated areas exhibited increased mean hair density (+12.76%) over baseline compared to placebo (+0.99%). Mean hair caliber decreased in both treated and placebo regions (-16.22% and -19.46%, respectively). Serial analysis of PRP significant variability in concentrations between patients. Overall, there was a positive correlation between GDNF concentration and hair density (P = .004). Trends, though not statistically significant, were also observed for FGF2 and VEGF., Limitations: Small sample size and lack of comparative cohorts receiving protocol variations limit confidence in the study data., Conclusions: This small pilot clinical trial suggests PRP treatment may be beneficial for AGA. However, the variable hair growth responses between patients indicate there is a significant opportunity to improve PRP therapy protocols for hair growth promotion. The variability in growth factor concentration in PRP suggests standardization of growth factors postprocessing might improve hair growth responses., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia mostly affecting the frontotemporal hairline. Its aetiology and associated factors remain unclear., Objective and Methods: An observational, cross-sectional and descriptive study was conducted in France and Germany to identify demographic and health characteristics associated with the severity of FFA., Results: Of 490 included patients, 95% were female, of which 84% were postmenopausal. Age at onset of FFA symptoms ranged between 15 and 89 years, but diagnosis was frequently delayed up to 24 years. Lichen Planopilaris Activity Index scores were low (median 1.8, IQR 1.0 to 3.5). Thyroid function disorders were reported in 13% of men and 35% of women. Abnormal blood lipid levels were found in 42% of tested men and 47% of women. In the bivariate analyses, LPPAI scores were negatively correlated with abnormal testosterone (r s  = -0.775) and oestrogen values (r s  = -0.664), regular use of face cleaning products (r s  = -0.465), hair colourants (r s  = -0.679) and hairspray (r s  = -0.500)., Conclusions: The most common comorbidity was thyroid disease, with proportions higher than in the European population, possibly reflecting a role of thyroid hormones in FFA pathogenesis. The association of abnormal testosterone and oestrogen values with lesser disease activity needs to be explored in further studies. Our correlation analyses do not support a role of leave-on cosmetic products in the pathophysiology of FFA., (© 2019 European Academy of Dermatology and Venereology.)

Background: The relationship between female pattern hair loss (FPHL) and androgenic hormones is not well established, but some evidence indicates oral finasteride may be efficacious in FPHL. Use of a topical formulation has been proposed to minimize unwanted effects., Objectives: Our objective was to compare the efficacy and safety of topical 0.25% finasteride combined with 3% minoxidil solution and 3% minoxidil solution as monotherapy in the treatment of FPHL., Methods: This was a prospective, randomized, double-blind study in 30 postmenopausal women with FPHL. Each participant was randomized to receive either topical 0.25% finasteride combined with topical 3% minoxidil or topical 3% minoxidil solution as monotherapy for 24 weeks. To determine efficacy, the hair density and diameter was measured and global photographic assessment was conducted at baseline and 8, 16, and 24 weeks. Side effects and serum dihydrotestosterone levels were also evaluated., Results: By 24 weeks, hair density and diameter had increased in both groups, and finasteride/minoxidil was significantly superior to minoxidil solution in terms of hair diameter (p = 0.039). No systemic side effects were reported. However, serum dihydrotestosterone levels in the finasteride/minoxidil group significantly decreased from baseline (p = 0.016)., Conclusion: A topical combination of 0.25% finasteride and 3% minoxidil may be a promising option in the treatment of FPHL with an additional benefit of increasing hair diameter. Nevertheless, as it may be absorbed percutaneously, it should be reserved for postmenopausal women., Trial Registration: clinicaltrials.in.th; identifier TCTR20160912002.

Background: There are limited data on the association between obstructive sleep apnea (OSA), which is characterized by intermittent hypoxia, and male-pattern baldness (MPB). Low blood iron levels are reportedly associated with hypoxia and hair loss. This study explored a possible link among OSA, iron status, and MPB., Methods: Polysomnography (PSG) and hair assessments were conducted in a cross-sectional study including 932 men aged 46-76 years. OSA was defined as an apnea-hypopnea index ≥5 by PSG evaluation and MPB as scales from IV to VII according to the Norwood-Hamilton scale classification. Serum transferrin saturation (TSA) levels were assessed., Results: A total of 224 men (24%) were identified as MPB cases and 495 men (53%) as having OSA. After considering potential risk factors, OSA and other sleep-related variables were not associated with MPB. In joint analysis of OSA and family history of hair loss, men with these two factors showed a sevenfold higher multivariate odds ratio (95% confidence interval: 3.70, 12.56) for MPB than those without both of them (P < 0.05 for the interaction between OSA and family history of hair loss). TSA levels were significantly associated with MPB and OSA. OSA cases without MPB as well as MPB cases showed lower TSA levels than those with neither OSA nor MPB (P < 0.05)., Conclusions: These findings suggest that OSA may be a risk factor for MPB in men who have a family history of hair loss and that low serum TSA levels associated with hypoxia may be involved in a pathway linking OSA and MPB., (© 2018 The International Society of Dermatology.)

Aim: The aim of this study was to evaluate the prevalence of hair loss after laparoscopic sleeve gastrectomy (LSG). The effects of variables on the likelihood that patients developed hair loss were also examined., Material and Methods: Fifty patients who underwent LSG were enrolled in this prospective study. Demographics, hematocrit, iron, zinc, folic acid, vitamin B12, total proteins, and albumin were evaluated preoperatively and 6 months postoperatively., Results: Hair loss was observed in 56% of patients and particularly in 46% in females and in 10% in males. Analysis of variance indicated statistical differences for hair loss among the groups with and without hair loss concerning preoperative zinc (p < 0.001), postoperative zinc (p < 0.001), preoperative B12 (p < 0.001), postoperative B12 (p < 0.001), postoperative folic acid (p = 0.039), and postoperative use of supplements (p < 0.001). Patients with hair loss had lower values of zinc preoperatively and postoperatively compared to patients without hair loss (0.61 vs 0.81 mcg/ml) (0.46 vs 0.73 mcg/ml) and also lower values of vitamin B12 preoperatively and postoperatively compared to patients without hair loss (243.04 vs 337.41 pg/ml) (261.54 vs 325.68 pg/ml). Interestingly, the zinc levels were normal preoperatively and lower to normal levels postoperatively and the levels of vitamin B12 were lower than normal values preoperatively in patients with hair loss. Patients with hair loss had mean lower levels of postoperative folic acid of 8 ng/ml., Conclusion: The prevalence of hair loss was 56% 6 months after LSG. Preoperative monitoring and counseling of these micronutrients may be a preventive and therapeutic measure.

Background: The synergism of combined use between oral finasteride and topical minoxidil has been established in treating androgenetic alopecia among men. However, the concern regarding adverse effects of finasteride use has been rising., Objective: To compare the efficacy and safety of topical solution of 0.25% finasteride admixed with 3% minoxidil vs. 3% minoxidil solution in men with androgenetic alopecia., Methods: Forty men aged 18-60 years with androgenetic alopecia were randomized to 24 weeks of treatment with a finasteride/minoxidil or minoxidil solution twice daily. Primary efficacy endpoint was the change from baseline in hair density and hair diameter at week 24. Secondary endpoints included global photographic assessment by treatment-blinded investigators and subjects. Changes in plasma dihydrotestosterone levels and adverse events were recorded., Results: At week 24, the combined solution of finasteride and minoxidil was significantly superior to minoxidil alone in improvements of hair density, hair diameter and global photographic assessment (all P < 0.05). About 90% of patients treated with the combined solution experienced moderate to marked improvement. The combined solution also had minimal effect on plasma dihydrotestosterone levels, approximately 5% reduction. There were also no systemic adverse events reported by patients in both groups., Conclusion: Treatment with topical solution of 0.25% finasteride admixed with 3% minoxidil was significantly superior to 3% minoxidil solution for promoting hair growth in male androgenetic alopecia, and well tolerated., (© 2018 European Academy of Dermatology and Venereology.)

We investigated a subtype of Telogen Effluvium associated with Dysesthesia, (TED) which was defined as the presence of Telogen Effluvium with severe itch, pain, soreness, burning, or formication in the absence of any inflammatory scalp disorder or medication associated with Telogen Effluvium or Dysesthesia. These are patients who present with a “burning” scalp or other dysesthesia associated with increased telogen hair shedding. Telogen Effluvium is not typically associated with any scalp symptoms.3 Other scalp dysesthesia studies have mentioned occasional patients in their study that were also diagnosed with Telogen Effluvium,1,2 but the clinical association of Scalp Dysesthesia and Telogen Effluvium has never been made as a distinct entity.

Background: Androgenetic alopecia (AGA) seems to be a marker of increased risk of prostate cancer (PCa)., Objective: We sought to investigate potential pathophysiological differences between frontal and vertex balding that might have the impact on the incidence of PCa., Methods: Serum concentrations of testosterone (T), dihydrotestosterone (DHT) and prostate-specific antigen (PSA) were measured in 88 subjects with AGA., Results: We have examined sixty patients with frontal baldness and 28 patients with vertex baldness. The subgroups did not differ significantly in age, BMI and as regards age of AGA onset, duration of AGA and comorbidities. The mean value of DHT in serum of the men with vertex baldness was higher than those in the men with frontal baldness with statistical significance (P < 0.05). The groups did not show significant differences in mean value of serum T and PSA levels, and DHT/T ratio. No correlation was found between the serum PSA level and serum androgen levels as well as DHT/T ratio., Conclusions: Vertex baldness may signal higher exposures to circulating DHT. Serum PSA level cannot serve as surrogate diagnostic marker of increased androgenic activity in men with AGA., (© 2017 European Academy of Dermatology and Venereology.)

Background: Cutaneous features of hyperandrogenism in polycystic ovary syndrome (PCOS) include acne, hirsutism, seborrhea, androgenic alopecia (AGA), and acanthosis nigricans (AN). However, the relationships have not been well known broadly in terms of clinical hyperandrogenism and biochemical markers., Objectives: The aim of this study was to investigate biochemical and metabolic parameters in relation to cutaneous characters women in with and without PCOS., Methods: This was a cross-sectional retrospective study including 186 women with PCOS and 113 age-matched without PCOS women. Acne grade, hirsutism, seborrhea, AGA, and AN were recorded. Hormonal and metabolic parameters were measured., Results: The most common finding was acne, and AN was the least dermatological manifestations between PCOS and non-PCOS groups. The severity location and type of acne did not differ in PCOS women compared to non-PCOS women. Significant differences were found with respect to free androgen index (FAI) (P = .036), sex hormone-binding globulin (SHBG) (P = .023), and body mass index (BMI) (P = .001) between PCOS with acne and PCOS without acne groups. Overall, age (P = .005) was significantly decreased, while BMI (P = .004) was significantly higher in PCOS with hirsutism. The mean serum total testosterone (TT), dehydroepiandrosterone sulfate, and FAI were significantly elevated, but SHBG was decreased between PCOS with and without hirsutism groups. There were significantly different BMI (P = .018) and triglyceride (P = .024) except other hormonal parameter of without AGA group., Conclusion: This study indicated a strong correlation between hirsutism and metabolic abnormalities. Hirsutism is the most common cutaneous finding in PCOS women. Acne and AGA are associated with other manifestations of clinical hyperandrogenism, but not obvious markers of biochemical hyperandrogenemia and metabolic dysfunction., (© 2017 Wiley Periodicals, Inc.)

The isolated hypothyroxinemia of pregnancy (IHP) has gained specific attention in the specialized literature during the recent years as the possible factor impeding the intellectual development of fetus and increasing the risk of complications related with pregnancy, delivery and perinatal period. Aim of the study was to define the importance of isolated hypothyroxinemia in the development of obstetric and somatic pathologies in outpatient population of pregnant females. The study of prospective design was performed at the base of "David Gagua Clinic" Ltd. Based on hospital referral we selected the pregnant patients who were diagnosed for isolated hypothyroxinemia in the 1st trimester of pregnancy by clinical-laboratory studies. 104 pregnant females with isolated hypothyroxinemia were included in the main group, and 58 pregrant females of reproductive age who were not identified to have thyroid pathology by screening studies were included in the control group,. The questionnaire used in the study process included the retrospective medical history data, demographic findings, information about premorbid background, genetic burden of somatic pathology, social-economical factors (including education level, living conditions, economic income, family environment etc.) and concomitant somatic pathology. In addition, it included the clinical and para-clinical study data and pregnancy follow-up findings. The test studies for thyroid status were performed every trimester and after one month postpartum. The software packages Microsoft Excel (2010) and SPSS/v.12 was used for statistical treatment of data. The digital data is presented by M±STD, where M is the arithmetic mean and STD is the standard deviation of arithmetic mean. To define the confidence interval for the indices and their relation, we calculated 2 and p, whose critical value was defined to be 0.05. Based on analysis of the acquired data, we found out that pregnant females with isolated hypothyroxinemia were more statistically demonstrating asthenia, dry skin, increased hair loss and fragile nails, and from somatic disorders - pregnancy-associated vomiting and anemia. From concomitant diseases, allergic disorders (18.2%), primary dysmenorrhea (27.8%), spontaneous abortions (25%) were taking the highest incidence rate and other obstetric complications (premature delivery, late delivery) were higher in the main group, though statistically significant difference was not demonstrated. It must be noted that isolated hypothyroxinemia in the studied cohort was mostly found in 1st trimester of pregnancy, whereas according to the literature data, the latter is demonstrated more frequently in the second or third trimester. The above mentioned makes us consider that the iodine deficit in the cohort of pregnant females studied by us was probably present before pregnancy as well and maybe with even higher extent. Thus, the isolated hypothyroxinemia developed in the very first trimester of pregnancy still has its negative impact on the pregnancy course and outcome, despite of applied treatment. According to performed studies and their results, for the prevention of obstetric and perinatal complications, its important to administer iodine preparations together with folic acid at pregravid stage in addition to complete elimination of diet abnormalities, plan the pregnancy in stable normothyroxinemia conditions and at positive energetic balance. In addition, its desirable to perform the repeated thyroid status evaluation in the first trimester of pregnancy and timely administration of adequate therapeutic measures in case of finding any pathology.

Background and Objective: Recent studies have shown that vitamin D plays an important role in many disease processes. However, data is lacking which correlates the common symptoms attributed with vitamin D levels. This study was undertaken to find the correlation of symptoms and Vitamin D levels among ethnic Saudi Arabian population., Methods: A structured questionnaire was made and translated in the Arabic language, which included, age, weight and height, ethnicity and marital status. Patients who were visiting orthopaedic clinics for the first time were included after a detailed history, which ruled out any associated metabolic conditions. Patient's biometric data and the answering of the questionnaire were conducted by one of the senior members of the research group. The symptoms which were included in the questionnaire were fatigue, muscle cramps, joint and back pain, blood sugar levels, recurrent infections, hair loss, mood swings, weight gain, irritable bowel, fractures and history of malignancy. All the scores were graded between 1 and 9 (mildest 1 and severe 9) and only for fracture and malignancy it was yes/no answer. A score of ≤4 was accepted as no impact of the vitamin D levels on symptoms and answer of ≥5 was accepted as impact on the symptoms. Residents whose mother tongue was Arabic conducted all interviews. Blood was collected for 25 OHD levels, calcium and parathyroid hormone levels. Deficiency of vitamin D was defined as ≤20 ng/ml, insufficiency 21-29 ng/ml and normal level ≥30 ng/ml. The data was entered in the data base and analyzed using SPSS Inc Version 20., Results: Two hundred one patients completed the questionnaire but for final analysis the data of 187 was available for analysis as in 14 patients some of the data was missing. All were females and the average age was 55.9 ± 12.4 years, weight 78.9 ± 14.2 kg and height was 1.56 ± 7.01 m. The mean calcium level was 9.12 ± 0.33 mg/dl and, parathyroid hormone was 8.1 ± 6.06 pc/ml. The average 25 hydroxy vitamin D3 (25OHD) level was 21.8 ± 10.22 ng/ml. Forty-four (23.5%) of women had a normal vitamin D level, 51 (27.27%) had insufficiency and 92 (49.19%) had deficiency. Patients who complained of muscle cramps had 25OHD level of 18.86 ± 8.73 compared to patients who had no complains of cramps, 23.45 ± 9.2 ng/ml (p < 0.001) and symptom severity score (SSC) p value of p < 0.000. The results were similar for fatigue, Back pain, hair loss, mood swings and weight gain of P < 0.04, p < 0.07, p < 0.05, <0.03 and p < 0.09 for vitamin D levels and p < 0.001 for SSS. Forty-eight (25.6%) had a previous fracture in their history., Conclusions: This study shows that many symptoms, which have been attributed to low vitamin D levels, are not true. Muscle Cramps, fatigue, mood swings, hair loss, back pain and weight gains appears to be more common in patients with low 25OHD levels., (Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Sertoli-Leydig cell tumour (SLCT) is a rare, androgen-secreting sex cord-stromal tumour of the ovary that usually occurs in young premenopausal women. The major clinical manifestations are virilisation and defeminisation. The following case describes an 88-year-old G1P1 woman, 40 years after menopause, who presented with flushing, hirsutism, voice changes and alopecia along with significantly elevated levels of testosterone. Postoperative report revealed a well-differentiated SLCT in the left ovary. This case is unique in that SLCT is a very rare cancer and even more so in an 88-year-old woman. Taking this case into consideration, it becomes reasonable to check androgen and oestrogen levels in postmenopausal women, not only in patients with signs of virilisation, but also in those with non-classical presentations, such as flushing or heat spells., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Female pattern hair loss (FPHL) is an important hair disorder, especially when young women are affected. However, pharmacological treatments are not successful in all women. Androgens, especially dihydrotestosterone (DHT), may play a role in FPHL, but many women with this disorder have normal serum androgen levels. It therefore appears that hair follicle levels of DHT depend on in situ testosterone (T) metabolism. Because T can be converted to DHT or estradiol (E2) by 5α-reductase (5α-R) and aromatase, respectively, these enzymes would determine DHT and E2 concentrations and their ratio. We propose and apply a low-invasive, sensitive and precise method for the absolute quantification of mRNA levels of aromatase and 5α-R isozymes (type 1, type 2 and type 3) in plucked hair from young women with FPHL. Normoandrogenic women with FPHL and controls were studied. Plucked hair samples were obtained by trichogram from vertex scalp and mRNA levels quantified by real-time RT-PCR. We revealed for the first time the presence of 5α-R3 mRNA in human hair. Interestingly, one, two, or even three 5α-R isozymes were increased in some women with FPHL but not in others, which may explain the lack of response to 5α-R inhibitors in some FPHL cases. Aromatase mRNA levels were significantly lower in women with FPHL than in controls. It may therefore produce a reduction in oestrogen levels and an increase in the androgen/oestrogen ratio in hair. The proposed low-invasive technique offers a molecular aetiologic diagnosis of FPHL for the selection of more appropriate pharmacological treatments with early predicted effectiveness.

Background: Prospective cohort studies of circulating sex steroid hormones and prostate cancer risk have not provided a consistent association, despite evidence from animal and clinical studies. However, studies using male pattern baldness as a proxy of early-life or cumulative androgen exposure have reported significant associations with aggressive and fatal prostate cancer risk. Given that androgens underlie the development of patterned hair loss and chest hair, we assessed whether these two dermatological characteristics were associated with circulating and intraprostatic concentrations of sex steroid hormones among men diagnosed with localized prostate cancer., Methods: We included 248 prostate cancer patients from the NCI Prostate Tissue Study, who answered surveys and provided a pre-treatment blood sample as well as fresh frozen adjacent normal prostate tissue. Male pattern baldness and chest hair density were assessed by trained nurses before surgery. General linear models estimated geometric means and 95% confidence intervals (95%CIs) of each hormone variable by dermatological phenotype with adjustment for potential confounding variables. Subgroup analyses were performed by Gleason score (<7 vs ≥7) and race (European American vs. African American)., Results: We found strong positive associations of balding status with serum testosterone, dihydrotestosterone (DHT), estradiol, and sex hormone-binding globulin (SHBG), and a weak association with elevated intraprostatic testosterone. Conversely, neither circulating nor intraprostatic sex hormones were statistically significantly associated with chest hair density. Age-adjusted correlation between binary balding status and three-level chest hair density was weak (r = 0.05). There was little evidence to suggest that Gleason score or race modified these associations., Conclusions: This study provides evidence that balding status assessed at a mean age of 60 years may serve as a clinical marker for circulating sex hormone concentrations. The weak-to-null associations between balding status and intraprostatic sex hormones reaffirm differences in organ-specific sex hormone metabolism, implying that other sex steroid hormone-related factors (eg, androgen receptor) play important roles in organ-specific androgenic actions, and that other overlapping pathways may be involved in associations between the two complex conditions., (© 2017 Wiley Periodicals, Inc.)

Purpose: In this retrospective cohort study we assessed the effect on prostate specific antigen concentration of low dose finasteride or dutasteride treatment for male androgenetic alopecia in men with baseline serum prostate specific antigen less than 2.5 ng/ml., Materials and Methods: The cohort consisted of 1,379 consecutive male patients who were treated for androgenetic alopecia with finasteride 1.25 mg daily or dutasteride 0.5 mg every 3 days in 2002 to 2012 and who underwent prostate specific antigen measurements at baseline and at least once thereafter. Patients in whom baseline or followup prostate specific antigen after prescription exceeded 2.5 ng/ml were excluded from study to rule out men with a higher likelihood of prostate cancer. Patients were stratified according to age, baseline prostate specific antigen, medication type and treatment duration., Results: Overall low dose 5α-reductase inhibitor treatment reduced prostate specific antigen by 27.8% relative to baseline. Of the patients 1,094 (79.3%) showed prostate specific antigen decreases (average 40.8%). In the remaining 285 patients (20.7%) prostate specific antigen was stable or increased (average 24.2% increase). Closer analysis largely showed that only men with baseline prostate specific antigen 0.5 ng/ml or greater had a treatment related prostate specific antigen reduction. On multivariate logistic analysis low baseline prostate specific antigen was significantly associated with stable/increased prostate specific antigen. Low dose dutasteride and finasteride reduced prostate specific antigen to similar degrees (31.1% and 25.1%, respectively). A marked prostate specific antigen decrease of 26.0% was observed even after short-term treatment (3 to 6 months)., Conclusions: Dutasteride and finasteride reduced prostate specific antigen to similar degrees. This effect was observed soon after commencing treatment. In patients with low baseline prostate specific antigen the levels could remain stable or even increase. These findings are limited to men with baseline prostate specific antigen less than 2.5 ng/ml., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Androgenetic alopecia (AGA) is the most common cause of alopecia in men. In the literature, although there are in vitro studies investigating the relationship between oxidative stress and AGA, any in vivo study does not exist., Aim: Our aim was to evaluate the oxidative stress status in male patients with early-onset AGA by measuring total oxidant levels (TOS), total antioxidant levels (TAS), and oxidative stress index (OSI)., Methods: Our study included 33 male patients with early-onset AGA and 30 healthy men between ages of 18 and 30 years old. TAS and TOS measurements were taken, and OSI was calculated., Results: When TAS, TOS, and OSI levels were compared between patient and control groups, there was no difference for TAS level, while TOS and OSI were significantly higher in patient group. In patient group, correlation between TAS, TOS, and OSI levels and age, and disease onset age and disease duration was evaluated. Highly significant negative correlation was determined between TAS level and both age and disease duration. When TAS, TOS, and OSI levels were assessed according to AGA stage, there was no significant difference between groups, while OSI level was significantly higher in patients with family history., Conclusions: We found increased oxidative stress in younger patients with early-onset AGA. There is need for further molecular studies on the role of oxidative stress in the etiopathogenesis of AGA. We also think that topical or systemic antioxidants can be promising in treatment of AGA, especially for young patients., (© 2016 Wiley Periodicals, Inc.)

Postpartum effluvium is a well-known clinical fact. However, following some minor research activities in the 1960s, very little has happened on the research front of the subject. It was hypothesized that postpartum hair loss might be a manifestation of a change in the hair growth cycle occurring normally during pregnancy. Recently, new research has been published trying to explain the mechanism of action behind this frequently occurring hair growth disruption, and to develop a functional treatment schedule and regime. Under normal circumstances, postpartum effluvium will disappear by itself as a function of time, and therefore adequate information to the patient is important in order to reduce the anxiety that it will not be a permanent problem. However, in some subjects it can manifest itself for longer stages and even become permanent. At the present time, treatments aim at correcting underlying hormonal imbalances and at improving overall cosmetic appearance. Several treatments in the form of thyroid supplementation, topical progesterone and estradiol lotions, and even oral contraceptive have been studied. All the available studies have significant limitations in their scientific basis, such as small sample size, absence of control group, or highly subjective measurement of treatment response. It is evident from the available studies that no specific treatment has been investigated thoroughly enough to justify recommendation in clinical treatment or to be termed "effective." Without the ability to provide a pathogenic diagnosis or causality criteria, chances are low that a treatment by trial and error will adequately be able to control hair effluvium. Current hair treatment strategies are symptomatic and nonspecific; therefore, future research must aim at developing new and targeted methods with a point of departure in observing concomitant biological mechanisms. Based on the research in the 1960s, current knowledge about the hair follicle and the regulation of the hair cycles, we believe that an anagen inducer in the form of a specific proteoglycan replacement therapy (Nourkrin ® with Marilex ® from Pharma Medico) could be a proper solution to shorten the hair eclipse phenomenon - and give the patient a feeling of control and empowerment., (© 2016 Wiley Periodicals, Inc.)

Background: Many studies have reported that androgenetic alopecia (AGA) might be a risk factor for cardiovascular disorders, and the association of AGA with dyslipidaemia has been studied. However, the results were controversial and previous meta-analyses had several critical limitations., Objective: We performed a meta-analysis to clarify whether AGA patients have abnormal lipid profiles., Methods: A literature search was performed using the MEDLINE, EMBASE, The Cochrane Library and KOREA MED databases., Results: We pooled 19 observational studies and performed a meta-analysis to compare serum total cholesterol, serum triglyceride (TG), low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) and the cholesterol levels between AGA and control groups. The serum total cholesterol, TG and LDL cholesterol levels were significantly higher in the AGA group than in the control group, and the standardized mean differences were 0.377 (95% confidence interval [CI]: 0.182-0.572, P < 0.001), 0.426 (95% CI: 0.164-0.688, P = 0.001) and 0.450 (95% CI: 0.171-0.728, P = 0.002) respectively. In addition, HDL cholesterol level was significantly lower in the AGA group than in the control group, and the standardized mean difference was -0.248 (95% CI: -0.472 to -0.023, P = 0.030)., Conclusions: AGA patients showed statistically significant abnormal lipid profiles, and this might partly explain the association between AGA and cardiovascular diseases., (© 2016 European Academy of Dermatology and Venereology.)

Background: Multiple biomarkers have been associated with hair loss in women, but studies have shown inconsistent results., Objectives: We investigated the associations between markers of cardiovascular disease risk (e.g. serum lipid levels and hypertension) and ageing [e.g. 25-hydroxyvitamin D and insulin-like growth factor (IGF)] with hair loss in a population of middle-aged women., Methods: In a random subgroup of 323 middle-aged women (mean age 61·5 years) from the Leiden Longevity Study, hair loss was graded by three assessors using the Sinclair scale; women with a mean score > 1·5 were classified as cases with hair loss., Results: Every 1 SD increase in high-density lipoprotein (HDL) cholesterol was associated with a 0·65-times lower risk [95% confidence interval (CI) 0·46-0·91] of hair loss. For IGF-1 the risk was 0·68 times lower (95% CI 0·48-0·97) per 1 SD increase, independently of the other studied variables. Women with both IGF-1 and HDL cholesterol levels below the medians of the study population had a 3·47-times higher risk (95% CI 1·30-9·25) of having hair loss., Conclusions: Low HDL cholesterol and IGF-1 were associated with a higher risk of hair loss in women. However, further studies are required to infer causal relationships., (© 2016 British Association of Dermatologists.)

Background: Several studies have addressed the association of metabolic syndrome (MetS) with androgenetic alopecia (AGA) in men with few reports focusing on this association in females. The aim of this work was to investigate the association of MetS among Egyptian women with different stages of female pattern hair loss (FPHL) and to compare the results with age- and sex-matched controls., Methods: This study included 90 female participants, 45 cases with different stages of FPHL classified according to the Ludwig scale and 45 healthy control participants that were age- and sex-matched with the cases. Assessment of MetS components was done according to the Adult Treatment Panel III criteria., Results: Compared to the control group, a statistically significant association was found between FPHL and the presence of MetS with a tendency to increase with the severity of FPHL being greater in stage III > stage II > stage I. Among metabolic syndrome components, waist circumference (WC) (OR 5.6, 95% CI 2.2 -13.9, P = 0.0002) and hypertension (HTN) (OR 3.5, 95% CI 1.3-8.9, P = 0.008) were revealed as the most important factors associated with FPHL. WC also tended to increase with the severity of FPHL., Conclusions: We demonstrated a significant association between MetS and FPHL. Women with FPHL, particularly if associated with an increased WC or hypertension, should be screened for MetS criteria for early identification and management., (© 2016 The International Society of Dermatology.)

We aimed to investigate the relationship among urinary stone disease, androgenetic alopecia (AGA), and serum testosterone (T) levels. Between January 2008 and November 2015, we retrospectively investigated the biochemical parameters and anthropometric characteristics (height and weight) of 200 patients who had urinary tract stones. For the control group, we selected at random 168 participants who had no history of urolithiasis. Demographic data, such as participants' age, body mass index (BMI), hypertension (HT), diabetes mellitus (DM), baldness pattern, and serum T level were recorded. All participants were male, over 18 and under 60 years of age. We determined that risk of urolithiasis increased 1.3-fold in patients with vertex pattern alopecia and 2.1-fold in patients with total alopecia compared with those with no hair loss. In the severe balding Groups (Group III and Group IV), presence of testosterone deficiency was more frequent in patients with urinary stone disease (P = 0.041, OR = 2.38). Although in the non- balding and mild balding Groups (Group I and Group II), presence of testosterone deficiency was also more frequent in patients with urinary stone disease, a statistically significant difference was not seen. Significantly, we found that the presence of testosterone deficiency was more frequent in patients with urinary stone disease and who had severe AGA.

Telogen effluvium is one of the most common forms of non-scarring alopecia for which patients present to a dermatologist. It is a challenging disorder to treat and study, primarily owing to its multifactorial etiology which includes both physiologic and non-physiologic factors. Nutritional deficiency has been purported to contribute to hair shedding, and a patient's clinical history usually aids in directing laboratory evaluation. Many prior studies have either supported or failed to find a correlation between telogen effluvium and deficiencies in vitamins and minerals, in particular, vitamin D, ferritin, vitamin B12, folate, and zinc. We performed a retrospective cross-sectional study of patients with telogen effluvium in the greater Pittsburgh, Pennsylvania area, and measured the rates of these deficiencies. Our results demonstrate that the prevalence of vitamin D, ferritin, and zinc deficiencies is non-trivial and therefore justifies including these laboratory studies in initial clinical evaluation. , , J Drugs Dermatol. 2016;15(10):1235-1237.

Importance: Early androgenetic alopecia (AGA) is patterned hair loss occurring before age 30 years. Early AGA in men is frequently reported as the phenotypic equivalent of polycystic ovarian syndrome (PCOS) in women, which carries the risk of developing obesity, metabolic syndrome, and cardiovascular diseases. Very few studies have been conducted to evaluate this., Objective: To study the hormonal profile of men with early AGA and to evaluate if early AGA in men can be considered as the phenotypic equivalent of PCOS, the associated risks of which are well known., Design, Setting, and Participants: This case-control study was conducted from January 1, 2014, to March 31, 2015, in a tertiary care government hospital. Fifty-seven men aged 19 to 30 years presenting with patterned hair loss were recruited as study participants. Thirty-two age-matched men with no evidence of hair loss were recruited as controls. Men who had any established endocrine disorder, diabetes mellitus, or cardiovascular disease and those who took any oral medication or hormonal treatment for hair loss were excluded from the study. The serum concentrations of total testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, fasting plasma glucose, and insulin levels were measured. Insulin resistance (IR) and free androgen index (FAI) were calculated and compared with age- and sex-matched controls., Main Outcomes and Measures: The primary outcome was to measure the clinico-endocrinological profiles (LH, FSH, SHBG, DHEAS, and testosterone levels) of men with early AGA and to compare it with the PCOS profile; the secondary outcome was to establish a relationship between this endocrinological profile and IR., Results: Compared with the 32 controls, the 57 participants with AGA showed significantly increased mean (SD) levels of testosterone (24.61 [7.97] vs 20.57 [4.9] nmol/L; P = .04), DHEAS (3.63 [2.19] vs 2.64 [1.49] µg/mL; P = .02), LH (7.78 [3.19] vs 4.56 [2.01] mIU/mL; P < .001), and prolactin (14.14 [9.48] vs 9.97 [3.12] ng/mL; P = .01) and decreased mean levels of FSH (4.02 [2.69] vs 5.66 [1.93] mIU/mL; P < .001) and SHBG (35.07 [11.11] vs 46.41 [14.03] nmol/L; P < .001). The mean FAI and LH/FSH ratio were was also increased in the AGA group. These hormonal parameters resemble the well-known profile of women with PCOS. The mean (SD) insulin levels did not show any significant difference between the cases and controls (6.34 [3.92] vs 5.09 [3.38] μIU/mL; P = .07). There was no statistically significant association between hormone levels and AGA or IR grade severity., Conclusions and Relevance: Men with early AGA could be considered as male phenotypic equivalents of women with PCOS. They can be at risk of developing the same complications associated with PCOS, including obesity, metabolic syndrome, IR, cardiovascular diseases, and infertility.