Female pattern hair loss: an overview with a focus on genetics
Today’s report also covers research into diagnosis and treatment of female alopecia, biologics for refractory pemphigoid gestationis, and more (1,072 words, 5 minutes)
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Good morning, and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We’re pleased to have you join us. This biweekly bulletin will update you on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them. We welcome your feedback and opinions, so let us know if you have any comments, observations, or suggestions. You can email them to us at health@chronicle.org
While most cases of female pattern hair loss (FPHL) are non-scarring and non-inflammatory, the loss of hair density leads to an altered appearance that can cause significant stress in patients, according to a study published in Genes (July 2023; 14(7):1326). The authors note that while male androgenetic alopecia (M-AGA) is known to be genetically determined and androgen-dependent, the role of genetic factors in FPHL is still uncertain.
The pathophysiology of FPHL is complex and involves genetics, sex steroid hormones, and environmental factors, the authors write. Some standard histopathological features of the condition they list are miniaturization of hair follicles, reduced follicle density, and increased fibrous tissue around the follicles. Additionally, the overall prevalence of FPHL varies by age, place of residence, and ethnicity.
The authors note that although the incidence rate varies by country, it increases with age—nearly 55% of women over 70 experience significant pattern hair loss. The authors write that PHL reaches a first peak during the reproductive years and a second peak after menopause. Interestingly, FPHL incidence is also higher in urban areas.
The study also explores the role of sex steroid hormones gene polymorphism, specifically genes related to the transformation of sex hormones. However, the involvement of androgens in FPHL remains unclear, as some patients with FPHL have normal androgen levels.
Finally, the authors say it is essential to note that FPHL tends to cause severe psychological stress, which often leads to depression, anxiety, and damaged self-esteem. These issues affect patients’ interpersonal relationships, work, and quality of life.
Bottom line
The pathophysiology of FPHL involves a combination of genetics, sex steroid hormones, and environmental factors. The genetic factors of the condition remain uncertain. FPHL has profound psychological and social impacts on patients, including depression, anxiety, and self-esteem issues. The involvement of androgens in FPHL is still unclear because some patients with FPHL have average androgen concentrations. Understanding FPHL is crucial for clinical treatment and improving patients’ quality of life.
Diagnosis and treatment of female alopecia: Focusing on the iron deficiency-related alopecia
A study published in the Tzu Chi Medical Journal explored the causes of female alopecia (FA) in Eastern Taiwan. The researchers found diverse causes for FA, with the top contributors being nutrient deficiencies, autoimmune diseases, and thyroid diseases. Notably, iron deficiency was a prevalent issue, present in 70.3% of FA cases. Psychological stress and Covid-19 vaccination were also identified as potential FA causes.
For this study, the authors conducted a retrospective analysis of 155 female patients with FA who visited a dermatology clinic in Eastern Taiwan. They collected detailed information regarding the onset and duration of alopecia, menstrual history, gynecologic conditions, psychological stress, underlying diseases, dietary habits, and more. Blood tests assessed hemoglobin, iron, zinc levels, and autoimmune and thyroid profiles. The results showed that nutrient deficiencies, particularly iron deficiency, were the most prevalent cause of female alopecia.
Biologic therapy for refractory pemphigoid gestationis
Research published in the Journal of the American Academy of Dermatology examined the use of biologics for pemphigoid gestationis (PG) during pregnancy. The researchers found biological treatments that block cytokines and target antibodies have favourable outcomes for PG. Although systemic corticosteroids are still the primary treatment for PG, the findings suggest biologics could be an effective treatment for refractory disease.
The authors analyzed the clinical data of 25 patients, identifying 28 treatment regimens. The results revealed that intravenous immunoglobulin (IVIg) was the most frequently used monotherapy for PG, followed by omalizumab, dupilumab, and rituximab. Complete PG resolution in all patients was observed with dupilumab, rituximab and IVIg/rituximab combination. However, 21.4% of patients experienced PG recurrence. Fetal complications occurred in 21.4% of patients, with preterm premature rupture of membranes reported in 33.3% of those cases.
Dermatologic care of patients with differences in sex development
A study in the International Journal of Women’s Dermatology assessed the most common dermatologic manifestations of Differences in Sex Development (DSD). The authors found that the most common dermatologic manifestations of Turner syndrome are lymphatic malformations, halo nevi, dermatitis, and psoriasis. At the same time, refractory leg ulcers and incontinentia pigmenti are common in patients with Klinefelter syndrome. Finally, individuals with some forms of congenital adrenal hyperplasia often deal with acne and hirsutism as comorbidities.
The researchers emphasized the importance of assessing teratogenic risks when planning skin condition treatments for individuals with DSD, considering their pregnancy potential.
Assessment of occipital involvement among a large population of females with pattern hair loss in Saudi Arabia
A study published in the Journal of Clinical, Cosmetic and Investigational Dermatology assessed the occipital involvement in female pattern hair loss (FPHL) and evaluated its correlation with disease severity. The authors found that many women with FPHL had occipital involvement, which impacts the methods used to diagnose pattern hair loss in women and their treatment plans.
The researchers reviewed a retrospective chart that included 1,000 adult Saudi women with FPHL. Occipital involvement was defined as more than 10% of thin hairs. Occipital involvement was identified in 32.4% of the participants. The risk of occipital involvement increased with the disease severity in the frontal region, but disease progression was slower in the occipital compared to the frontal region.
Minneapolis—based dermatologist Dr. Jenny Liu shares breastfeeding-safe skincare and tips for postpartum.
A case of fatal dermatological sequelae following depot medroxyprogesterone acetate (DMPA) administration
A case study published in the Journal of Clinical Studies and Medical Case Reports described a 25-year-old woman who presented with painful, crusted, and hypertrophic skin lesions covering her entire body for eight months. She could not provide her medical history, so her husband stated she had been in good health until eight months prior when she received three Depot Provera injections for contraception. She had received three injections, and after the last one, she developed a low-grade fever, oral ulcers, and abdominal discomfort.
Her symptoms persisted despite receiving treatment with antipyretics. Later, painful, fluid-filled blisters, which ruptured easily, appeared on her hands and limbs. She was diagnosed with Stevens-Johnson syndrome (SJS) and prescribed linezolid, prednisolone, fexofenadine, and Becefol for three months. While taking the medication, the blisters disappeared but reappeared after discontinuation, worsening her condition. She developed more blisters on the head and torso. The blisters broke, causing painful, crusted, ulcerative lesions in various parts of her body, including her eyelids, cheeks, neck, and chest. The patient expired.
“I maintain a simple targeted skincare regimen that focuses on protection from the sun and environmental triggers (during the day) and correction (overnight). I pay close attention to ingredients and try to ensure that the products are well-formulated and concentrated. More specifically, I opt for fragrance-free products because I (like many of my patients) have a sensitivity to several fragrances and look for moisturizing, yet non-comedogenic ingredients (like ceramides and hyaluronic acid). I also seek out formulas with lots of antioxidants (such as vitamins C and E, peptides, and tea extracts) and anti-inflammatories (like vitamin B3/niacinamide).”
— Dr. Rosemarie Ingleton, a dermatologist based in New York, in an interview with Real Simple.
Registration is open for the 9th annual 2023 Skin Spectrum Summit conference.
This year’s edition of the landmark medical educational congress dedicated to providing better dermatologic care for Canada’s diverse population will be held on Oct. 21, 2023, at the University of Toronto’s Chestnut Conference Centre in Toronto.
Now in its 9th year, the conference provides education on treating patients across all six Fitzpatrick skin types, emphasizing care for Types IV–VI.
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