Androgen-dependent Alopecia Research Articles

The Pregnancy Outcome in Women with Polycystic Ovary Syndrome

Background: In women of reproductive age, polycystic ovarian syndrome (PCOS) is a prevalent endocrine condition. Menstrual irregularities (oligomenorrhea or amenorrhea), hirsutism, persistent acne, androgen-dependent alopecia, abdominal obesity, hypertension, and infertility are all clinical signs of PCOS.Objective: To assess the success of pregnancy in patients with polycystic ovary syndrome.Materials and Methods: This observational cross-sectional study was carried out in the Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj, Bangladesh from June 2020 to May 2022 for a period of two years. Women diagnosed with PCOS were willing to participate in our study were recruited from obstetrics Out patient Department (OPD) and antenatal ward of Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital. After obtaining an informed consent from them, a detailed interview schedule containing socio- demographic details, menstrual/marital/ obstetric/past/personal/ family history was taken.Results: Concerning complications Preeclampsia was found in 5 (9.1%) of the PCOS patients but not in the non-PCOS patients. The differences in gestational age and mode of birth between the two groups were not statistically significant (p>0.05). Perinatal outcome: 21 (39.6%) PCOS patients were admitted to the Neonatal Intensive Care Unit (NICU), compared to 11 (20.0%) non-PCOS patients. Which of the two groups was statistically significant (p<0.05).Conclusion: The present study suggested that preeclampsia is a relatively common condition, and complications such gestational hyperglycemia, gestational hypertension, and preeclampsia were frequent in the PCOS group. In comparison to the non-PCOS group, the PCOS group had considerably greater rates of low birth weight and NICU admission. KYAMC Journal Vol. 14, No. 01, April 2023: 30-34

Steroid sulfatase inhibitors for the tropical treatment of skin disorders

Inhibition of steroid sulfatase (STS) activity in skin is a potential new treatment strategy for a number of skin disorders, including hirsutism, androgen-dependent alopecia, acne and psoriasis. In skin and its appendages, STS regulates the hydrolysis of dehydroepiandrosterone sulfate to dehydroepiandrosterone, a weak androgen, which can be converted to the biologically active androgens testosterone and 5 alpha-dihydrotestosterone by other steroidogenic enzymes also present in skin. A number of potent, irreversible STS inhibitors have been developed based around a core arylsulfamate ester motif, the active pharmacophore required for potent STS inhibition. Such inhibitors include AHBS and STX-64. Topical application of AHBS to the skin of mice or pigs resulted in almost complete inhibition of skin STS activity. Furthermore, when applied to the skin of Gottingen minipigs daily for 2 weeks, by day 10 AHBS had inhibited sebum production, a desired requisite for an antiacne drug. When applied topically to the skin of nude mice at 1.0 and 10.0 mg/kg STX-64 inhibited skin STS activity by > 90%, but it also inhibited liver STS activity. While preclinical studies have confirmed the ability of topically applied STS inhibitors to inhibit skin STS activity, further studies using preclinical models of skin disorders and clinical trials are needed to test their efficacy in treating skin disorders.

Polycystic ovary syndrome: an endocrine and metabolic disease

Polycystic ovary syndrome (PCOS) is a common disorder occurring during female reproductive years, characterized by a number of heterogeneous clinical and biochemical features.Clinical presentation is characterized by hirsutism, acne, androgen-dependent alopecia, menstrual dysfunction, infertility and ultrasonographically-documented cystic ovaries. Tonic elevation of luteinizing hormone (LH) secretion is a regular feature of PCOS. Abnormal secretion of estrogen and high serum levels of free testosterone are also present. In addition to these endocrine abnormalities, specific metabolic alterations, such as hyperinsulinemia and insulin resistance are more frequent.Metabolic derangements associated with PCOS may predispose the patient to a range of diseases with attendant morbidity and mortality risks, so it is important to consider the syndrome in terms of both endocrine and metabolic aspects, achieving a correct hormone equilibrium and preventing metabolic alterations.

Messenger RNA expression of steroidogenesis enzyme subtypes in the human pilosebaceous unit.

In order to define the respective involvement of steroidogenesis enzymes subtypes in the control of hair follicle homeostasis, we evaluated, by semiquantitative RT/PCR, the expression levels of mRNAs coding for 17 beta-hydroxysteroid dehydrogenase type 1 and type 2, 3 beta-hydroxysteroid dehydrogenase, Cyt.P450-aromatase, steroid 5 alpha-reductase type 1 and type 2 and 11 beta-hydroxysteroid dehydrogenase. These assays were performed for several components of the pilosebaceous unit (PSU); fresh plucked anagen hairs, sebaceous glands and primary culture of dermal papilla, as well as other tissues involved in an active steroid metabolism (human testis, liver, placenta, prostate, ovary, uterus and adrenals) as controls. We found that plucked hair (i.e. mainly keratinocytes from the inner and outer root sheaths) expressed: (1) very high levels of 17 beta-hydroxysteroid dehydrogenase type 2 corresponding to levels found in liver and placenta; (2) high levels of steroid 5-alpha-reductase type 1 corresponding to levels found in testis, liver and ovary, and moderate levels of 17 beta-hydroxysteroid dehydrogenase type 1, which corresponded to the expression in testis, prostate and uterus. In contrast, Cyt.P450-aromatase, 3 beta-hydroxysteroid dehydrogenase and steroid 5 alpha-reductase type 2 were poorly expressed in the pilosebaceous unit as compared with other tissues. Interestingly, expression patterns of these enzymes in primary cultures of dermal papilla were distinctive since 5 alpha-reductase type 1 and 11 beta-hydroxysteroid dehydrogenase were the only mRNA detected. Taken together, these results suggest that not only sebaceous gland but also outer root sheath keratinocytes may contribute, through the activity of the steroid 5 alpha-reductase type 1, to the pathogenesis of androgen-dependent alopecia.

Polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age. The classical symptoms are those of hyperandrogenism (hirsutism, persistant acne, androgen dependent alopecia) together with symptoms of anovulation (infertility, amenorrhoea, irregular dysfunctional uterine bleeding).1In the last 10 to 15 years, the use of high resolution pelvic ultrasonography has greatly facilitated identification of polycystic ovaries in women with hirsutism or menstrual disturbance. It is now clear that the range of presenting symptoms of women with polycystic ovaries includes not only non-hirsute women with oligomenorrhoea or amenorrhoea but also hirsute subjects with regular, ovulatory cycles. PCOS occurs in nearly 75% of cases of anovulatory infertility and over 80% of subjects with hirsutism.1 The typical biochemical features of PCOS include hyperandrogenaemia and an increase of serum luteinising hormone (LH) (with normal follicle stimulating hormone) but PCOS is also associated with a characteristic metabolic syndrome that includes hyperinsulinaemia, insulin resistance, and dyslipidaemia.1-4 These features are linked to a significantly increased risk of type II (non-insulin-dependent) diabetes in later life and women with PCOS may also have a greater chance of developing premature cardiovascular disease.3 5 6 The presence of polycystic ovaries is necessary for the development of the syndrome but not all women with polycystic ovaries have PCOS. The typical …

Management of Hair Loss in Women

Hair loss in otherwise healthy women presents several challenges for the clinician. The first is to identify the cause, which may be complicated by two or more secondary factors; the second is to find effective treatments; and the third is to establish requirements for long-term management. An optimal hair growth potential is considered to exist when specific parameters for biochemical variables are operating. These include red blood cell and serum folate concentrations within the normal range, serum vitamin B12 levels between 300 and 1000 ng/L, hemoglobin levels greater than 13.0 g/dL, and serum ferritin concentrations of 70 ng/mL or greater. The two predominant disturbances, diffuse androgen-dependent alopecia and chronic telogen effluvium, both require months of treatment before the benefits can be seen. During this time several follow-up investigations and reassuring consultations must occur. Current systemic antiandrogen regimens are highly effective, but the prospect of long-term therapy, possibly for life, is daunting. For some patients there is no systemic choice and topical treatment is the only option. Minoxidil is the only topical preparation currently licensed, but with no quantitative long-term data available, assessing its value in the long-term treatment of androgen-dependent alopecia is difficult.

Scalp immersion proxigraphy (SIP): an improved imaging technique for phototrichogram analysis*

In recent years we have developed the concept of using automated computer assisted image analysis (ACAIA) for hair growth evaluation. The success of this sophisticated technology depends on the quality of the original images that are fed into the mainframe of the image analyzer. Application of immersion oil onto the scalp site to be photographed appears to improve contrast between hair and scalp and has been named ‘Scalp Immersion Proxigraphy’ (SIP) in contrast to crude proxigraphy, that is close-up photography without application of immersion oil, commonly used for phototrichogram analysis (PT). In this paper, we report evidence indicating that besides the qualitative improvement of the image, SIP also contributes to generate more accurate quantitative data. Such a conclusion was reached after hair growth variables were compared as a function of the photographic method (SIP vs. PT: 16 scalp sites; 5 balding subjects with clinical features consistent with androgen dependent alopecia). Each site was photographed with both techniques immediately after clipping and 48 h later. After image recording, we manually re-processed the original pictures on transparencies. The original pictures and the transparencies were analyzed with ACAIA. There was a significant difference between methods in terms of evaluation of linear hair growth rate (LHGR; mm/day, n= 1332 bairs; Scheffe F-test, P < 0.05). LHGR recorded with re-processed SIP pictures (0.317 mm/day) was very close to that measured in our laboratory with micrometric methods. Distorted figures were generated by PT, leading to an underestimation of this parameter by 30% on average (0.224 mm/day). From previous studies, we knew that hair diameter correlates with linear hair growth rate: the thinner the hair fiber, the slower the growth rate. Both variables may be considered as additive in terms of severity of the alopecia. In this comparative trial of two phototrichogram techniques, we showed that linear hair growth rates can only be accurately estimated with SIP. Therefore, SIP should be used instead of crude proxigraphy when a global assessment of hair growth is to be monitored during clinical trials.

Natural progression of male pattern baldness in young men

Twenty-six men who presented with male pattern baldness (androgen-dependent alopecia), were quantitatively evaluated for scalp hair variables and compared with 13 age-matched controls. Compared to controls, significant mean differences for hair variables were found in the frontal-vertex area, while in the occipital area, a reduction in total hair density (hairs/cm2) was the only significant (P less than 0.05) finding. A large proportion (48.5%) of meaningful hair (non-vellus hair) was less than or equal to 40 mm in length, yet had diameters similar to hairs growing much longer. In controls, these hairs accounted for only 12.2% of the total population. Compared to baseline, mean values from the frontal-vertex area of subjects with androgen-dependent alopecia were significantly lower for total hair density, meaningful hair density (non-vellus hairs/cm2) and percentage of hair in the anagen growth phase, 12 and 24 months later. During this time, total hair density decreased by 6.5% after 12 months and by 11.9% after 24 months. Similarly, meaningful hair density declined at 12 months by 10.8% and by 22.7% after 24 months. No change in any hair variable was detected in controls after 12 or 24 months. Our findings suggest that medications capable of maintaining the existing hair population should be regarded as effective treatments for this condition. Left untreated androgen-dependent alopecia progressively deteriorates. The induction of non-vellus hairs less than or equal to 40 mm in length to grow longer, would substantially improve the aesthetic profile without the need to generate new hair.

Biochemical and trichological characterization of diffuse alopecia in women

One hundred women who presented with diffuse alopecia, were quantitatively evaluated for hair variables and compared with 20 controls. Fifty were selected for biochemical and haematological investigations, 44 of whom also underwent endocrine evaluation. Compared to controls, significant changes in hair values were found in the frontal area of all subjects, while 84% had significant changes in the occipital area. A biphasic distribution of hair diameter was evident in subjects who had percentages of vellus hair and telogen hair less than or equal to 30 mm in length that were above the control ranges. No significant difference between the mean hormonal values of women with diffuse alopecia and controls could be found. No correlation between hair values and individual or combined hormonal levels could be established. In 18 subjects (40.9%) hormonal values were within the control ranges and these apparently normal findings were often associated with adverse hair profiles. A raised dihydrotestosterone was found in 13 subjects (29.5%) and was the most frequently elevated androgenic finding. Seventeen (34.0%) had changes in iron metabolism, while in 36 (72.0%) serum ferritin levels were below the lowest control value. All had a decrease in the percentage of hair in the anagen growth phase compared to controls. The hair changes were similar to those observed in genetic hair loss in men, a proven androgen-dependent condition. We propose that diffuse androgen-dependent alopecia is the appropriate name to describe this condition in these women.

Reduced serum vitamin B12 levels during oral cyproterone-acetate and ethinyl-oestradiol therapy in women with diffuse androgen-dependent alopecia

In a group of healthy, non-vegetarian females currently being treated for diffuse androgen-dependent alopecia with 50 or 100 mg of oral cyproterone acetate for 11 days and 30 or 40 micrograms of ethinyl oestradiol for 20 days of the menstrual cycle, significant decreases in mean serum vitamin B12 (P less than 0.0001), haemoglobin (P less than 0.003) and haematocrit (P less than 0.004) values, were observed after 6 months. Serum folic acid, red-cell folate and mean cell volume remained unchanged within the normal range during this time. All patients responded to oral cyanocobalamin, or intramuscular injections of hydroxocobalamin. In patients with baseline serum vitamin B12 levels below 350 ng/l, we would suggest prophylactic cyanocobalamin concurrent with cyproterone-acetate-ethinyl-oestradiol (CPA EE2) therapy. Studies involving other dose regimens of CPA EE2 (Dianette) or cyproterone acetate alone (Androcur, Cyprostat), may require evaluation of the vitamin B12 status if treatment is to be given for periods of longer than 3 months.