Modern concept of the etiology and pathogenesis of androgenetic alopecia
Abstract
Introduction. The understanding of the etiology and pathogenesis of androgenetic alopecia (AGA) has formed modern therapeutic strategies for the treatment of this trichopathy. However, the significant prevalence of this pathology, limited therapeutic success, and differences in the response to standard therapy in male and female patients determine the interest in a more in-depth study and search for new links in the etiopathogenesis of AGA. Goal. Using a review of scientific publications in recent years on AGA in male and female patients, analyze and formulate the modern concept of the etiology and pathogenesis of this disease in order to further search for new treatment methods. Materials and methods. We searched and analyzed publications for the query «androgenetic alopecia, etiology, pathogenesis», the search was carried out using Google Scholar, considered articles that have been published since 2016. Results. The effect of androgens on hair follicles in androgen-dependent areas of the scalp under conditions of genetic predisposition is considered as the most studied and proven concept of AGA etiopathogenesis. However, recent studies have also revealed nonandrogenic cofactors, among which the pathological cascade of events «oxidative stress-microinflammation-fibrosis», which are determined at different stages of disease progression, is potentially interesting for further study. Knowledge of the phenomenon of apoptosis as an important factor in the disturbance of the dynamics of the hair cycle has been expanded. The management of perifollicular microinflammation and apoptosis can allow the control of the processes of sequential hair miniaturization and give a pronounced clinical result during the treatment of AGA. Thus, the nonandrogenic mechanisms of AGA pathobiology require further study. Conclusions. New data on the causes and mechanism of development of androgenetic alopecia in women and men have expanded our understanding of these processes. The need to supplement knowledge on this topic causes significant scientific interest and is very relevant, since they can be used to improve treatment for use in practical medicine.
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References
Lolli F, Pallotti F, Rossi A, Fortuna MC, Caro G, Lenzi A, et al. Androgenetic alopecia: a review. Endocrine. 2017; 57 (1): 9–17. https://doi.org/10.1007/s12020-017-1280-y
Betul T, Kulacaoglu F, Belli H, Altuntas M. The tendency towards the development of psychosexual disorders in androgenetic alopecia according to the different stages of hair loss: a cross-sectional study. An Bras Dermatol. 2018; 93 (2): 185–90. https://doi.org/10.1590/abd1806-4841.20185658
Shannon F, Christa S, Lewei D, Carolyn G. Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy. J Am Acad Dermatol. 2015; 73 (4): 705–6. https://doi.org/10.1016/j.jaad.2015.06.063
Martinez-Jacobo L, Villarreal-Villarreal CD, Ortiz-López R, Ocampo-Candiani J, Rojas-Martínez A. Genetic and molecular aspects of androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2018; 84 (3): 263–8. https://doi.org/10.4103/ijdvl.IJDVL_262_17
Heilmann S, Brockschmidt FF, Hillmer AM, Hanneken S, Eigelshoven S, Ludwig KU, et al. Evidence for a polygenic contribution to androgenetic alopecia. Br J Dermatol. 2013; 169 (4): 927–30. https://doi.org/10.1111/bjd.12443
Ho CH, Sood T, Zito PM. Androgenetic Alopecia [Internet]. Treasure Island (FL): StatPearls Publishing, 2020 [cited 2020 Dec 5]. Available from: https://www.statpearls.com/articlelibrary/
Manabe M, Tsuboi R, Itami S, Osada Sh, Amoh Y, Ito T, et al. Guidelines for the diagnosis and treatment of male-pattern and female-pattern hair loss, 2017 version. J Dermatol. 2018; 45 (9): 1031–43. https://doi.org/10.1111/1346-8138.14470
Redler S, Messenger AG, Betz RC. Genetics and other factors in the aetiology of female pattern hair loss. Exp Dermatol. 2017; 26 (6): 510–7. https://doi.org/10.1111/exd.13373
Litus A, editor. Trihology. 2nd ed. Kiev: Rud’;2016. 276 p. [in Russian].
Liu S, Yamauchi H. Different patterns of 5alpha-reductase expression, cellular distribution, and testosterone metabolism in human follicular dermal papilla cells. Biochem Biophys Res Commun. 2008; 368 (4): 858–64. https://doi.org/10.1016/j.bbrc.2008.01.130
Hibberts NA, Howell AE, Randall VA. Balding hair follicle dermal papilla cells contain higher levels of androgen receptors than those from non-balding scalp. J Endocrinol. 1998; 156 (1): 59–65. https://doi.org/10.1677/joe.0.1560059
Futterweit W, Dunaif A, Yeh HC, Kingsley P. The prevalence of hyperandrogenism in 109 consecutive female patients with diffuse alopecia. J Am Acad Dermatol. 1988;19(5 Pt 1): 831–6. https://doi.org/10.1016/s0190-9622(88)70241-8
Inui S, Itami S. Androgen actions on the human hair follicle: perspectives. Exp Dermatol. 2013; 22 (3): 168–71. https://doi.org/10.1111/exd.12024
Moltz L. Hormonelle Diagnostik der sog. androgenetischen Alopezie der Frau. Geburtshife Frauenheil. 1988;48:203–14.
Ramos PM, Miot HA. Female pattern hair loss: a clinical and pathophysiological review. An Bras Dermatol. 2015; 90 (4): 529–43. https://doi.org/10.1590/abd1806-4841.20153370
Cousen P, Messenger AG. Female pattern hair loss in complete androgen insensitivity syndrome. Br J Dermatol. 2010; 162 (5): 1135–7. https://doi.org/10.1111/j.1365-2133.2010.09661.x
Lynfield YL. Effect of pregnancy on the human hair cycle. J Investig Dermatol. 1960; 35: 323–7. https://doi.org/10.1038/jid.1960.54
Saggar V, Wu S, Dickler MN, Lacouture ME. Alopecia with endocrine therapies in patients with cancer. Oncologist. 2013; 18 (10): 1126–34. https://doi.org/10.1634/theoncologist.2013-0193
Adenuga P, Summers P, Bergfeld W. Hair regrowth in a male patient with extensive androgenetic alopecia on estrogen therapy. J Am Acad Dermatol. 2012; 67 (3): 121–3. https://doi.org/10.1016/j.jaad.2011.10.017
Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Dermatologic care for lesbian, gay, bisexual, an d transgender persons: epidemiology, screening, and disease prevention. J Am Acad Dermatol. 2019; 80 (3): 591–602. https://doi.org/10.1016/j.jaad.2018.02.045
Prodi DA, Pirastu N, Maninchedda G, Sassu A, Picciau A, Palmas MA, et al. EDA2R is associated with androgenetic alopecia. J Invest Dermatol. 2008; 128 (9): 2268–70. https://doi.org/10.1038/jid.2008.60
Heilmann S, Brockschmidt FF, Hillmer AM, Hanneken S, Eigelshoven S, Ludwig KU, et al. Evidence for a polygenic contribution to androgenetic alopecia. Br J Dermatol. 2013; 169 (4): 927–30. https://doi.org/10.1111/bjd.12443
Heilmann S, Kiefer AK, Fricker N, Drichel D, Hillmer AM, Herold C, et al. Androgenetic alopecia: Identification of four genetic risk loci and evidence for the contribution of WNT signaling to its etiology. J Invest Dermatol. 2013; 133 (6): 1489–96. https://doi.org/10.1038/jid.2013.43
Shimomura Y, Agalliu D, Vonica A, Luria V, Wajid M, Baumer A, et al. APCDD1 is a novel wnt inhibitor mutated in hereditary hypotrichosis simplex. Nature. 2010; 464 (7291): 1043–7. https://doi.org/10.1038/nature08875
Miao Y, Qu Q, Jiang W, Liu X-M, Shi P-L, Fan Zh-X, et al. Identification of functional patterns of androgenetic alopecia using transcriptome profiling in distinct locations of hair follicles. J Invest Dermatol. 2018; 138 (4): 972–5. https://doi.org/10.1016/j.jid.2017.10.027
Jaworsky C, Kligman AM, Murphy GF. Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis. Br J Dermatol. 1992; 127 (3): 239–46. https://doi.org/10.1111/j.1365-2133.1992.tb00121.x
Upton JH, Hannen RF, Bahta AW, Farjo N, Farjo B, Philpott MP. Oxidative stress-associated senescence in dermal papilla cells of men with androgenetic alopecia. J Invest Dermatol. 2015; 135 (5): 1244–52. https://doi.org/10.1038/jid.2015.28
Ramos PM, Brianezi G, Martins ACP, da Silva MG, Marques MEA, Miot HA. Apoptosis in follicles of individuals with female pattern hair loss is associated with perifollicular microinflammation. Int J Cosmet Sci. 2016; 38 (6): 651–4. https://doi.org/10.1111/ics.12341
Rossi A, Anzalone A, Fortuna MC, Caro G, Garelli V, Pranteda G, Carlesimo M. Multi-therapies in androgenetic alopecia: review and clinical experiences. Dermatol Ther. 2016; 29 (6): 4, 24–32. https://doi.org/10.1111/dth.12390
Ovcharenko YS, Kachuk YV. Androgenetic alopecia. Les Nouvelles Esthetiques (Ukraine). 2015; 3 (91): 70–8. [in Russian].
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