0 Bewertungen0% fanden dieses Dokument nützlich (0 Abstimmungen)
47 Ansichten6 Seiten
Androgenetic (or pattern) alopecia is a genetically determined disorder. It is characterized by the gradual conversion of terminal hairs into indeterminate, and finally into vellus hairs. The disease is extremely common that affects men and women.
Androgenetic (or pattern) alopecia is a genetically determined disorder. It is characterized by the gradual conversion of terminal hairs into indeterminate, and finally into vellus hairs. The disease is extremely common that affects men and women.
Androgenetic (or pattern) alopecia is a genetically determined disorder. It is characterized by the gradual conversion of terminal hairs into indeterminate, and finally into vellus hairs. The disease is extremely common that affects men and women.
Author: Robert P Feinstein, MD; Chief Editor: Dirk M Elston, MD more...
Updated: Mar 18, 2013 Practice Essentials Androgenetic (or pattern) alopecia is a genetically determined disorder characterized by the gradual conversion of terminal hairs into indeterminate, and finally into vellus, hairs. It is an extremely common disease that affects men and women. Essential update: Androgenetic alopecia linked to prostate cancer In a meta-analysis of 7 case-control studies, an association was found between androgenetic alopecia of the scalps vertex and a significantly increased risk of prostate cancer (OR 1.25; 95% confidence interval 1.09-1.44; Z = 3.13; P = .002). In the study, which involved a total of 8994 patients (including 4916 controls), Amoretti et al examined odds ratios for a link between prostate cancer and individual hair loss patterns. The association was found only for balding at the vertex. [1] Signs and symptoms Signs of androgenetic alopecia include the following: Gradual onset Increased hair shedding Transition in the involved areas from large, thick, pigmented terminal hairs to thinner, shorter, indeterminate hairs and finally to short, wispy, nonpigmented vellus hairs End result can be an area of total denudation; this area varies from patient to patient and is usually most marked at the vertex Diffuse alopecia areata may mimic the androgenetic form. The presence of exclamation point hairs, pitted nails, or a history of periodic regrowth or tapered fractures noted on hair counts suggests the diagnosis of diffuse alopecia areata. Males Men note a gradual recession of the frontal hairline early in the process Men present with gradual thinning in the temporal areas, producing a reshaping of the anterior part of the hairline Females Hair generally is lost diffusely over the crown; this produces a gradual thinning of the hair rather than an area of marked baldness; the part is widest anteriorly The frontal hairline is often preserved in women Bitemporal recession does occur in women but usually to a lesser degree than in men See Clinical Presentation for more detail. Diagnosis Today News Reference Education Log Out My Account G Molinero Discussion
Androgenetic Alopecia http://emedicine.medscape.com/article/1070167-overview 1 de 6 12/12/2013 19:55 Laboratory studies History and the physical examination are the most important aspects of diagnosis in patients with androgenetic alopecia. The following laboratory tests, however, can play a role in patient assessment: Dehydroepiandrosterone (DHEA)-sulfate and testosterone analysis: In women, if virilization is evident Iron, total iron-binding capacity, and transferrin saturation: To test for iron deficiency, if telogen effluvium is present Thyrotropin level: If a thyroid disorder is suspected Biopsy and histology A biopsy is rarely necessary to make the diagnosis of androgenetic alopecia. If a single biopsy specimen is obtained, it should generally be sectioned transversely if pattern alopecia is suspected. In androgenetic alopecia, hairs are miniaturized. Although the condition is considered a noninflammatory form of hair loss, a superficial, perifollicular, inflammatory infiltrate is noted at times. A mildly increased telogen-to-anagen ratio is often observed. See Workup for more detail. Management The following drugs have been approved by the FDA for the treatment of androgenetic alopecia: Minoxidil: Androgen-independent hair-growth stimulator Finasteride: 5-Alpha reductase type 2 inhibitor The cosmetic results of surgical treatment for androgenetic alopecia are often satisfactory. Micrografting produces a more natural appearance than does the old technique of transplanting plugs. See Treatment and Medication for more detail. Background Androgenetic alopecia, or pattern alopecia, is an extremely common disorder affecting both men and women. The incidence of androgenetic alopecia is generally considered to be greater in males than females, although some evidence suggests that the apparent differences in incidence may be a reflection of different expression in males and females. Pathophysiology Androgenetic alopecia is a genetically determined disorder and is progressive through the gradual conversion of terminal hairs into indeterminate hairs and finally to vellus hairs. Patients with androgenetic alopecia have a reduction in the terminal-to-vellus hair ratio, normally about 4:1. Following miniaturization of the follicles, fibrous tracts remain. Patients with this disorder usually have a typical patterned distribution of hair loss. In androgenetic alopecia, studies have indicated a self-renewal of the hair follicle via keratinocyte stem cells located at the area of the bulge of the hair follicle. In addition, a series of studies using mice has indicated that interfollicular keratinocyte stem cells could generate de novo hair follicles in adult mouse skin. These regenerated hair follicles cycled through stages of telogen to anagen. However, these transitions between bulge and epidermal keratinocytes have not been seen yet in human studies. [2] Another report has indicated that mice lacking in functional vitamin D receptors develop a functional first coat of hair, but lack the cyclic regeneration of hair follicles leading to the development of alopecia. [3] Whether these findings will lead to a new area of exploration into the cause of androgenetic alopecia in humans is unknown at this time. A lymphocytic microfolliculitis targeting the bulge epithelium, along with deposits of epithelial basement membrane zone immunoreactants, are frequently seen in androgenetic alopecia in both sexes. Those cases with a positive immunoreactant profile respond better to combined-modality therapy than do those with a negative result. [4] Numerous studies have identified 2 major genetic risk loci for androgenetic alopecia. These are the X-chromosomal AR/EDA2R locus and the PAX1/FOXA2 locus on chromosome 20. A recent genome-wide association study compared move than 1100 severely affected cases of androgenetic alopecia and controls to note differences in the 2 Androgenetic Alopecia http://emedicine.medscape.com/article/1070167-overview 2 de 6 12/12/2013 19:55 groups. The study indicated that HDAC9 is the third androgenetic alopecia susceptibility gene. The results of this German study were further analyzed by fine-mapping and then individually replicated in an Australian sample. [5] Epidemiology Frequency International Androgenetic alopecia is an extremely common disorder that affects roughly 50% of men and perhaps as many women older than 40 years. As many as 13% of premenopausal women reportedly have some evidence of androgenetic alopecia. However, the incidence of androgenetic alopecia increases greatly in women following menopause, and, according to one author, it may affect 75% of women older than 65 years. A community-based study of androgenetic alopecia in 6 cities in China indicated that the prevalence of androgenetic alopecia in both Chinese males and females was lower than that seen in whites but similar to the incidence among Koreans. [6] Mortality/Morbidity Androgenetic alopecia is essentially a cosmetic disorder. Other than affecting the patient psychologically, [7] androgenetic alopecia is significant only in that it allows ultraviolet light to reach the scalp and, thus, increases the amount of actinic damage. Males with androgenetic alopecia may have an increased incidence of myocardial infarction. [8] An increase in benign prostatic hypertrophy has also been associated with androgenetic alopecia. [9] Arias-Santiago et al measured prostatic volume by transrectal ultrasound and urinary flow by urinary flowmetry in order to study this hypothesis. Their findings suggest that a relationship exists between early-onset androgenetic alopecia and prostate growth associated urinary symptoms, most likely owing to their pathophysiological similarity. They suggest that future studies may clarify whether treatment of patients with androgenetic alopecia might benefit concomitant benign prostatic hypertrophy. [10] If these associations are proven conclusively, androgenetic alopecia will be of greater clinical significance. Race The incidence and the severity of androgenetic alopecia tend to be highest in white men, second highest in Asians and African Americans, and lowest in Native Americans and Eskimos. Age Almost all patients with androgenetic alopecia have an onset prior to age 40 years, although many of the patients (both male and female) show evidence of the disorder by age 30 years.
Contributor Information and Disclosures Author Robert P Feinstein, MD Associate Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons Robert P Feinstein, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Noah Worcester Dermatological Society, and Phi Beta Kappa Disclosure: Nothing to disclose. Specialty Editor Board Leonard Sperling, MD Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology Disclosure: Nothing to disclose. Androgenetic Alopecia http://emedicine.medscape.com/article/1070167-overview 3 de 6 12/12/2013 19:55 David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa Disclosure: Nothing to disclose. Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology Disclosure: Nothing to disclose. Catherine M Quirk, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology Disclosure: Nothing to disclose. Chief Editor Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology Disclosure: Nothing to disclose. References Amoretti A, Laydner H, Bergfeld W. Androgenetic alopecia and risk of prostate cancer: A systematic review and meta-analysis. J Am Acad Dermatol. Feb 7 2013;[Medline]. 1. Manabu Ohyama. Hair Follicle Stem Cells-New Insights & Clinical Relevance. AccessMedicine. Available at http://www.accessmedicine.com/updatesContent.aspx?aID=1001537. Accessed December 3 2009. 2. Luderer HF, Demay MB. The vitamin D receptor, the skin and stem cells. J Steroid Biochem Mol Biol. Feb 6 2010;[Medline]. 3. Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N. The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. J Drugs Dermatol. Dec 2011;10(12):1404-11. [Medline]. 4. Brockschmidt FF, Heilmann S, Ellis JA, et al. Susceptibility variants on chromosome 7p21.1 suggest HDAC9 as a new candidate gene for male-pattern baldness. Br J Dermatol. Dec 2011;165(6):1293-302. [Medline]. 5. Wang TL, Zhou C, Shen YW, et al. Prevalence of androgenetic alopecia in China: a community-based study in six cities. Br J Dermatol. Jan 22 2010;[Medline]. 6. Stough D, Stenn K, Haber R, et al. Psychological effect, pathophysiology, and management of androgenetic alopecia in men. Mayo Clin Proc. Oct 2005;80(10):1316-22. [Medline]. 7. Lesko SM, Rosenberg L, Shapiro S. A case-control study of baldness in relation to myocardial infarction in men. JAMA. Feb 24 1993;269(8):998-1003. [Medline]. 8. Oh BR, Kim SJ, Moon JD, et al. Association of benign prostatic hyperplasia with male pattern baldness. Urology. May 1998;51(5):744-8. [Medline]. 9. Arias-Santiago S, Arrabal-Polo MA, Buenda-Eisman A, et al. Androgenetic alopecia as an early marker of benign prostatic hyperplasia. J Am Acad Dermatol. Mar 2012;66(3):401-8. [Medline]. 10. Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female 11. Androgenetic Alopecia http://emedicine.medscape.com/article/1070167-overview 4 de 6 12/12/2013 19:55 sex. Br J Dermatol. Sep 1977;97(3):247-54. [Medline]. Hillmer AM, Flaquer A, Hanneken S, et al. Genome-wide scan and fine-mapping linkage study of androgenetic alopecia reveals a locus on chromosome 3q26. Am J Hum Genet. Mar 2008;82(3):737-43. [Medline]. [Full Text]. 12. Alsantali A, Shapiro J. Androgens and hair loss. Curr Opin Endocrinol Diabetes Obes. Jun 2009;16(3):246-53. [Medline]. 13. Krajcik RA, Vogelman JH, Malloy VL, Orentreich N. Transplants from balding and hairy androgenetic alopecia scalp regrow hair comparably well on immunodeficient mice. J Am Acad Dermatol. May 2003;48(5):752-9. [Medline]. 14. Cousen P, Messenger A. Female pattern hair loss in complete androgen insensitivity syndrome. Br J Dermatol. Feb 1 2010;[Medline]. 15. Paladini RD, Saleh J, Qian C, Xu GX, Rubin LL. Modulation of hair growth with small molecule agonists of the hedgehog signaling pathway. J Invest Dermatol. Oct 2005;125(4):638-46. [Medline]. 16. Olsen EA, Reed KB, Cacchio PB, Caudill L. Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups. J Am Acad Dermatol. Dec 2010;63(6):991-9. [Medline]. 17. Lattouf C, Miteva M, Tosti A. Connubial androgenetic alopecia. Arch Dermatol. Nov 2011;147(11):1329-30. [Medline]. 18. Ahouansou S, Le Toumelin P, Crickx B, Descamps V. Association of androgenetic alopecia and hypertension. Eur J Dermatol. May-Jun 2007;17(3):220-2. [Medline]. 19. Su LH, Chen TH. Association of androgenetic alopecia with smoking and its prevalence among Asian men: a community-based survey. Arch Dermatol. Nov 2007;143(11):1401-6. [Medline]. 20. Schmidt, AN, Taylor BR, King LE, and Tourjee SM. The ProScope HR: A promising diagnostic tool. J Am Acad Dermatol. March, 2010;62:AB64. 21. Karadag Kse O, Gle AT. Clinical evaluation of alopecias using a handheld dermatoscope. J Am Acad Dermatol. Aug 2012;67(2):206-14. [Medline]. 22. Headington JT, Novak E. Clinical and histological studies of male pattern baldness treated with topical minoxidil. Curr Ther Res Clin Exp. 1984;36:1098-106. 23. Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. Sep 2002;47(3):377-85. [Medline]. 24. Scarinci F, Mezzana P, Pasquini P, Colletti M, Cacciamani A. Central chorioretinopathy associated with topical use of minoxidil 2% for treatment of baldness. Cutan Ocul Toxicol. Sep 23 2011;[Medline]. 25. Rittmaster RS. Finasteride. N Engl J Med. Jan 13 1994;330(2):120-5. [Medline]. 26. Rossi A, Cantisani C, Scarn 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. Jul 2011;24(4):455-61. [Medline]. 27. Sato A, Takeda A. Evaluation of efficacy and safety of finasteride 1 mg in 3177 Japanese men with androgenetic alopecia. J Dermatol. Jan 2012;39(1):27-32. [Medline]. 28. Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. Oct 2008;59(4):547-66; quiz 567-8. [Medline]. 29. Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: A randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig. 2009;29(5):283-92. [Medline]. 30. Blume-Peytavi U, Lnnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. Aug 27 2011;[Medline]. 31. Androgenetic Alopecia http://emedicine.medscape.com/article/1070167-overview 5 de 6 12/12/2013 19:55
Medscape Reference 2011 WebMD, LLC
Sinclair R, Patel M, Dawson TL Jr, et al. Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness. Br J Dermatol. Dec 2011;165 Suppl 3:12-8. [Medline]. 32. Zimber MP, Ziering C, Zeigler F, et al. Hair regrowth following a Wnt- and follistatin containing treatment: safety and efficacy in a first-in-man phase 1 clinical trial. J Drugs Dermatol. Nov 2011;10(11):1308-12. [Medline]. 33. Lee GY, Lee SJ, Kim WS. The effect of a 1550 nm fractional erbium-glass laser in female pattern hair loss. J Eur Acad Dermatol Venereol. Dec 2011;25(12):1450-4. [Medline]. 34. Avram M, Rogers N. Contemporary hair transplantation. Dermatol Surg. Nov 2009;35(11):1705-19. [Medline]. 35. Hamilton JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. Mar 1951;53(3):708-28. [Medline]. 36. Kaufman KD. Androgen metabolism as it affects hair growth in androgenetic alopecia. Dermatol Clin. Oct 1996;14(4):697-711. [Medline]. 37. Muller SA. Alopecia: syndromes of genetic significance. J Invest Dermatol. Jun 1973;60(6):475-92. [Medline]. 38. Olsen EA. Androgenetic alopecia. In: Olsen EA ed. Disorders of Hair Growth: Diagnosis and Treatment. New York, NY: McGraw-Hill; 1994:257-83. 39. Olsen EA, Messenger AG, Shapiro J, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. Feb 2005;52(2):301-11. [Medline]. 40. Otberg N, Finner AM, Shapiro J. Androgenetic alopecia. Endocrinol Metab Clin North Am. Jun 2007;36(2):379-98. [Medline]. 41. Shapiro J, Price VH. Hair regrowth. Therapeutic agents. Dermatol Clin. Apr 1998;16(2):341-56. [Medline]. 42. Sperling LC. Evaluation of hair loss. Curr Probl Dermatol. 1996;8:97-136. 43. Sperling LC, Lupton GP. Histopathology of non-scarring alopecia. J Cutan Pathol. Apr 1995;22(2):97-114. [Medline]. 44. Stern Rl, Heymann WR. Androgenetic alopecia. Clin Dermatol. 1997;2(32):1-6. 45. Venning VA, Dawber RP. Patterned androgenic alopecia in women. J Am Acad Dermatol. May 1988;18(5 Pt 1):1073-7. [Medline]. 46. Androgenetic Alopecia http://emedicine.medscape.com/article/1070167-overview 6 de 6 12/12/2013 19:55