Psychological effect, pathophysiology, and management of androgenetic alopecia in men

Androgenetic alopecia In men, or male pattern baldness, is recognized increasingly as a physically and psychologically harmful medical condition that can be managed effectively by generalist clinicians. This article discusses the clinical manifestations, epidemiology, physical and psychosocial importance, pathophysiology, diagnosis, and management of androgenetic alopecia in men. Androgenetic alopecia affects at least half of white men by the age of 50 years. Although androgenetic alopecia does not appear to cause direct physical harm, hair loss can result in physical harm because hair protects against sunburn, cold, mechanical injury, and ultraviolet light. Hair loss also can psychologically affect the balding individual and can Influence others' perceptions of him. A progressive condition, male pattern baldness is known to depend on the presence of the androgen dihydrotestosterone and on a genetic predisposition for this condition, but its pathophysiology has not been elucidated fully. Pharmacotherapy, hair transplantation, and cosmetic aids have been used to manage male pattern baldness. Two US Food and Drug Administration-approved hair-loss pharmacotherapies-the potassium channel opener minoxidil and the dihydrotestosterone synthesis inhibitor finasteride--are safe and effective for controlling male pattern baldness with long-term daily use. Regardless of which treatment modality is chosen for male pattern baldness, defining and addressing the patient's expectations regarding therapy are paramount in determining outcome.     

Hair loss. What causes it and what can be done about it

Although both men and women throughout history have seen hair as an important aspect of appearance, it is especially important today, in light of the great emphasis on youthfulness. A new interest in preventing baldness has been stimulated recently by the publicity given to certain products now under investigation that have shown an ability to retard or reverse male pattern baldness in certain individuals. Hair loss has many possible causes, such as systemic diseases, infections, toxic agents, and hormone imbalances. Treatment of the underlying disorder alleviates the shedding of hair. Balding may also be a normal physiologic occurrence in women taking oral contraceptives or after parturition and in men with male pattern baldness. The latter can be treated topically with progesterone or minoxidil. Minoxidil has been studied extensively and has been shown to improve balding at the vertex of the scalp, particularly in young men who have only begun to lose hair. Cases of more extensive male pattern baldness and baldness secondary to scarring can be treated effectively with surgical procedures.     

Male pattern baldness is not associated with established cardiovascular risk factors in the general population

A number of studies have shown an association between male pattern baldness (MPB) and cardiovascular disease. Few of these studies, however, have examined whether MPB is a novel risk factor, or is associated with abnormalities of established coronary risk factors. We have therefore performed an analysis of MPB and cardiovascular risk factors in the general population. A total of 1219 male participants aged 18-70 years from the Victorian Family Heart Study were surveyed using a validated questionnaire for degree and pattern of baldness. Carefully standardized measures of height, weight, blood pressure, pulse rate, total and high-density lipoprotein cholesterol, and plasma fibrinogen were made. Subjects were grouped according to the degree and pattern of baldness as: no baldness, frontal baldness and vertex baldness. Bald men were older than non-bald men (P < 0.0001). Age was also associated with increased levels of coronary risk factors (P < 0.0001). When multiple regression was used to adjust for age differences, the levels of coronary risk factors were not significantly different between the bald and non-bald groups. The lack of association between baldness and established coronary risk factors implies that baldness may predispose to coronary heart disease through novel mechanisms yet to be defined.     

Male pattern baldness: classification and incidence.

The need for a widely accepted, accurate, and reproducible standard of classification for male pattern baldness has increased with the advent and increasing popularity of hair transplant surgery. This report establishes such a classification, and reports its use in determining the incidence of male pattern baldness at various ages in 1,000 white adult male subjects. The action of testosterone as an incitant in male pattern baldness is well known, but this study points out the continued effect of time, even in later years. Since most hair transplant surgery is peformed on subjects with male pattern baldness, and because the success of hair transplant surgery is largely dependent on proper patient selection, a complete understanding of male pattern baldness is essential for consistently good results with hair transplantation.     

63例头皮扩张法治疗瘢痕性秃发的护理

目的 探讨用头皮扩张法治疗瘢痕性秃发的护理措施。方法 对63例瘢痕性秃发患I期行扩张器置入术，注水扩张2个月—3个月后行Ⅱ期瘢痕切除皮瓣转移修复头皮缺损区。结果 63例患头皮创面愈合良好，与正常头皮处毛发分布相似。结论 术前做好患心理护理，术后做好扩张囊内注水的护理、引流管的护理、切口护理和并发症的观察及护理等至关重要。     

Therapeutic approaches to the management of common baldness

Common baldness or androgenetic alopecia is a universal problem, having affected both sexes of all races to different extents for as long as mankind has existed. The progressive androgen dependent hair loss follows specific patterns and is a physiological process, which may take on disease quality due to psychosocial compontents. These should be taken into consideration when discussing the several treatment options available, particularly as a cure cannot be offered. Cosmetic measures range from back-combing over perms to hairpieces and wigs. Medical therapies include systemic antiandrogens and topical minoxidil; surgical options comprise follicular transplantation, scalp reduction and rotation. Before starting treatment, however, careful consideration should be given to the differential diagnosis which includes drug-induced hair thinning, anagen effluvium, diffuse alopecia areata, metabolic disturbances, nutritional deficiencies and acute as well as chronic telogen effluvium.     

Tissue distribution and ontogeny of steroid 5 alpha-reductase isozyme expression.

The synthesis of dihydrotestosterone is catalyzed by steroid 5 alpha-reductase isozymes, designated types 1 and 2. Mutation of type 2 results in male pseudohermaphroditism, in which the external genitalia are phenotypically female at birth. Two striking and unexplained features of this disorder are that external genitalia of affected males undergo virilization during puberty and that these individuals have less temporal hair regression. The tissue-specific and developmental expression patterns of the 5 alpha-reductase isozymes were investigated by immunoblotting. The type 1 isozyme is not detectable in the fetus, is transiently expressed in newborn skin and scalp, and permanently expressed in skin from the time of puberty. There was no qualitative difference in 5 alpha-reductase type 1 expression between adult balding vs. nonbalding scalp. The type 2 isozyme is transiently expressed in skin and scalp of newborns. Type 2 is the predominant isozyme detectable in fetal genital skin, male accessory sex glands, and in the prostate, including benign prostatic hyperplasia and prostate adenocarcinoma tissues. Both isozymes are expressed in the liver, but only after birth. These results are consistent with 5 alpha-reductase type 1 being responsible for virilization in type 2-deficient subjects during puberty, and suggest that the type 2 isozyme may be an initiating factor in development of male pattern baldness.     

Hair disorders

Disorders of the hair are commonplace in the primary care practice. Among these disorders are male pattern baldness, Telogen effluvium, alopecia areata, Trichotillomania, and fungal infections involving the hair shaft. A review of the normal anatomy and life cycle of hair also is presented.     

Idiopathic hirsutism: excessive bodily and facial hair in women

Hirsutism is the excessive and increased bodily and facial hair growth in women in locations where hair is normally minimal or absent. It refers to the growth of hair in a pattern normally occurring only in men, and therefore primarily raises psychological, cosmetic and social concerns. Idiopathic hirsutism (IH), where the cause of excessive hair growth is unknown, is considered to be the most common form of hirsutism. It is suspected that this type of hirsutism may be familial, as there is often a family history of the condition. Women with IH will generally have normal menses and normal levels of testosterone. There are many treatment modalities that fall into two broad groups: medical and mechanical treatment. An example of a medical treatment is when an agent is used, which interferes with the synthesis of androgen at the ovarian or adrenal level, or by inhibiting the effect of androgen at the receptor level. An example of a mechanical treatment is laser hair removal, where the hair follicle is destroyed; however, much depends on the on the skill of the treating practitioner, laser type, laser spot size, skin type, hair colour, and the stage at which the hair follicles were during their hair growth cycle, and the delivered wavelength. Laser offers the fastest method of hair loss. Other mechanical treatments include electrolysis, depilatory creams, plucking and waxing. This article presents a general overview of IH, including a definition, diagnostic measures, clinical manifestations, normal and abnormal physiology, and treatment options.     

Anticancer chemotherapy accelerates scalp hair loss with no androgenic involvement

The involvement of plasma testosterone in patients associated with scalp hair loss accelerated by anticancer drugs including aclarubicin and cisplatin was investigated. Scalp hair loss observed was minor in 12 and severe in 2 out of 31 patients. In patients without significant hair loss, the combination of aclarubicin and cisplatin produced a significant decrease in the plasma testosterone concentration in male patients and a significant increase in female patients 3 days after the anticancer chemotherapy. Six days after the chemotherapy, however, these concentrations returned to pretreatment values. Similar changes were observed in patients with minor or severe scalp hair loss induced by these drugs. These results suggest that aclarubicin and/or cisplatin may accelerate scalp hair loss with no androgenic involvement.     

Distribution of zinc, copper and iron in biological samples of Pakistani myocardial infarction (1st, 2nd and 3rd heart attack) patients and controls

BACKGROUND: The pathogenesis of some heart diseases has been associated with changes in the balance of certain trace elements. We examined the association of iron, copper and zinc between biological samples (scalp hair, whole blood and urine) and mortality from myocardial infarction (MI) patients of (first, second and third heart attack). METHODS: The biological samples were from 130 MI patients (77 male and 53 female, age range 45-60 years) and 61 healthy age-matched controls (33 male and 28 female). The metals in the biological samples were measured by the flame atomic absorption spectrophotometry, prior to microwave assisted acid digestion. The validity of the methodology was checked by the biological certified reference materials. RESULTS: During this study, 78% of the 32 patients aged >50 years, registered after the third MI attack died. In these subjects the concentration of Fe and Cu were increased by 0.83% and 3.12% in the scalp hair while in blood samples 9.7% and 22.5% were enhanced respectively, as compared to those who tolerated 3rd MI attack (p=0.072). The concentrations of Zn in whole blood and scalp hair samples were lower in MI patients as compared to normal subjects. CONCLUSION: Deficiency of zinc and high concentration of copper and iron may play a role in the development of heart disease.     

High dose androgen therapy in male pseudohermaphroditism due to 5 alpha-reductase deficiency and disorders of the androgen receptor.

We describe the clinical and biochemical features of six men with male pseudohermaphroditism due to androgen resistance. Each of the subjects had male-gender behavior but incomplete virilization. The underlying defects in androgen metabolism were defined by studies of the 5 alpha-reductase enzyme and the androgen receptor in fibroblasts cultured from biopsies of genital skin. Four of the six have 5 alpha-reductase deficiency, and two have defects of the androgen receptor (the Reifenstein syndrome). The responses of these men to androgen treatment were assessed by monitoring nitrogen balance, plasma luteinizing hormone (LH) values, and clinical parameters of virilization including penile growth, potency and ejaculatory volume, muscle bulk, and growth of body and facial hair. In all of the subjects with 5 alpha-reductase deficiency and one man with the Reifenstein syndrome significant response occurred, as evidence by nitrogen retention, lowered plasma LH levels, and improved virilization, with doses of parenteral testosterone esters that raised plasma testosterone levels above the normal male range and brought plasma dihydrotestosterone levels into the normal male range. The subject who did not respond with clinical virilization nevertheless showed nitrogen retention in response to acute testosterone administration. This patient had a profound deficiency of the androgen receptor, whereas the man with a receptor defect who did respond clinically to therapy had normal amounts of a qualitatively abnormal receptor. We conclude that high dose androgen therapy may be of benefit in improving virilization, self-image, and sexual performance in subjects with 5 alpha-reductase deficiency who have male-gender behavior and in some subjects with defects of the androgen receptor.     

Diffuse hair loss in women

The complaint "Doctor, I am losing my hair" represents a particular challenge to the physician, and involves making a specific diagnosis, selecting an appropriate therapy, and expressing empathy for the patient's anxiety. Diffuse hair loss in women was formerly classified as an entity of its own. Since the identification of female pattern hair loss, most cases have been recognized to be due to androgenetic alopecia, often during phases of life characterized by fluctuations of sexual hormone levels or in connection with intake or cessation of hormonal therapy. The most difficult differential diagnosis includes androgenetic alopecia, chronic telogen effluvium, and psychogenic pseudo efflvuium. Androgenetic alopecia is due to androgen-induced, non-synchronized, progressive shortening of the hair growth cycle and gradually leads to thinning of the central scalp area. Idiopathic chronic telogen effluvium typically occurs in women, starting abruptly without a recognizable initiating factor, and involves the entire scalp area with increased shedding of telogen hair. It is believed to be due to synchronization phenomena of the cyclic hair growth. Psychogenic pseudo effluvium affects fashion-oriented, self-conscious women suffering of a discrepancy between the actual state of their hair and idealized expectations. Later the problem of age-related hair thinning oft becomes a surrogate for the more generalized problem of senescence. Rational therapy of androgenetic alopecia aims at blocking the androgen effect on hair follicles with estrogens and antiandrogens or at pharmacologically reversing vellus hair transformation with topical minoxidil. In contrast, women with idiopathic chronic telogen effluvium should be reassured that their problem is rather a state of exaggerated "hair shedding" than of actual "hair loss".     

Modified hair apposition technique as the primary closure method for scalp lacerations

Objective

The aim of this study is to report the usability of our modified hair apposition technique (modHAT) in repairing scalp lacerations.

Methods

Data were collected prospectively over a 36-month period regarding our routine repair of scalp lacerations: those in areas with hair 1 cm or longer were repaired with our modHAT technique (10-15 hairs bundled and twisted with clamps) using cyanoacrylate glue, whereas wounds in areas with hair less than 1 cm long, with irregular wound edges, or which continued to bleed after pressure, were repaired with sutures or staples. Two days later, a wound check was performed. At least 30 days later, all patients were contacted again by telephone to assess satisfaction with care, preference regarding the method of repair in the future, and occurrence of any complication, infection, or need for additional health care.

Results

One hundred two consecutive patients (ages 2-92 years) with scalp lacerations (mean length, 24 mm; range, 4-100 mm) presented for care. Wound closure was accomplished with the modHAT technique in 66%. Sutures were used in 32% and staples in 2% because of baldness/short hair in 6% and continued bleeding after pressure in 28%. Satisfaction in both hair apposition technique and suture groups was high, and no patient sought further health care.

Conclusion

Most scalp lacerations can be repaired with the modHAT technique primarily. Care should be taken to apply the glue to the twist of hair only and avoid excess glue running onto the scalp or into the wound. Wider use of this inexpensive, quick technique should be encouraged.     

Coexisting lower urinary tract symptoms and erectile dysfunction: a systematic review of epidemiological data

Objective: Assess and categorise the available prevalence data on coexistent LUTS and ED in the general population and among individuals consulting a healthcare provider for any reason or when seeking treatment for LUTS and/or ED. Methods: Literature search of English‐language articles published during the last 15 years. Results: Of 23 relevant studies identified, 12 used both the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) as assessment tools and 11 used alternative approaches. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS/ED of any severity was not assessable for men in the general population, but rates ranged from 14–37% based on alternative assessments. In the general male population, 13–29% had moderate to severe LUTS and 8–35% had moderate to severe ED. In studies using both IPSS and IIEF, overall prevalence of coexistent LUTS and ED of any severity was 71–80% among men seeking treatment for LUTS, and 74% based on alternative assessments. Among men who sought treatment for either condition, 67–100% had moderate to severe LUTS and 43–59% had moderate to severe ED. Coexistence of LUTS and ED increased with age, ranging from 59–86% among men aged 40s to 60s in primary care to 79–100% in treatment‐seeking men with LUTS aged 50s to 70s. Impact on QoL varied, but health‐related QoL was generally worse in treatment‐seeking men compared with men in the general population. Conclusions: Although less than one‐third of middle‐aged and older men in the general population have coexisting LUTS and ED, most men seeking treatment for either LUTS or ED have both conditions. Symptom severity and impact on QoL in each condition increase when LUTS and ED coexist.     

细胞色素P450酶17基因多态性与迟发型男性性腺功能减退症的相关性研究

目的探讨细胞色素P450酶17(CYP17)基因多态性与迟发型男性性腺功能减退症(LOH)的关系,研究LOH的发病机制。方法纳入年龄在49~79岁的中老年男性356例,其中36例诊断为迟发性性腺功能减退症患者,随机抽取130例正常健康中老年男性,测量身高、体质量、腰围(WC)、血压,测定三酰甘油(TG)、总胆固醇(TC)、空腹血糖(FBG)、血清总睾酮(T)、雌二醇(E2),并应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术检测CYP17基因多态位点的片段,产物在2%琼脂糖凝胶上电泳确定出CYP17基因型,比较两组各指标之间的差异。结果 CYP17基因呈多态性:A1/A1、A1/A2和A2/A2。正常健康中老年男性的SBP、BMI、TG、TC和,FBG较LOH患者低(P0.05),而T和T/E2比值较LOH组显著升高(P0.01),两组间E2差异无统计学意义(P0.05)。正常健康中老年男性组CYP17不同基因型之间T和T/E2比值差异无统计学意义(P0.05);LOH组CYP17不同基因型之间T和T/E2比值差异有统计学意义(P0.05),两组不同基因型之间E2差异无统计学意义(P0.05)。LOH组较正常健康中老年男性组CYP17基因杂合变异型A1/A2呈现低频率分布(33.3%),而纯合变异型A2/A2呈高频率分布(47.3%),差异有统计学意义(P0.05)。结论 CYP17基因多态性可能与LOH患者的T水平有关,低水平的T和T/E2比值可能是LOH发病的危险因素。     

Health issues unique to the aging man

Several health conditions specifically involve men, including impotence (erectile dysfunction), androgen deficiency syndrome, benign prostatic hypertrophy, prostate cancer, baldness, and gynecomastia. This article reviews the major features of these syndromes and highlights the specific nursing issues involved.     

中国汉族人头皮毛发分布研究

目的:探讨中国汉族人头发正常分布的特点.方法:本研究共入组了146例健康中国汉族人以及41例雄激素性秃发患者,将头顶部、后枕部及颞部3个区域的头发修剪后进行数码拍照,利用图像分析软件计算毛囊单位数及毛发数.结果:146例中国健康汉族人平均毛囊单位密度为(74.36±13.33)个/cm2,平均毛发密度为(143.33±28.08)根/cm2,男女之间无统计学差异(P＞0.05).秃发患者后枕部平均毛囊单位密度为(77.78±2.99)个/cm2,平均毛发数为(148.12±6.98)根/cm2,低于健康汉族人后枕部,差异有统计学意义(P＜ 0.001).中国汉族人以包含2根毛发的毛囊单位类型为主(52.62％).结论:中国健康汉族人毛囊单位密度及毛发密度低于白种人及非洲人.我们的研究为毛发移植医生提供了中国汉族人毛发分布信息,为毛发移植手术中所需的供区量及移植密度提供了定量依据.我们的研究果为中国汉族人头发分部特点提供了一些理论数据,有助于毛发移植医师进行术前评估、手术设计和术后效果评估.     

Fibrinolytic parameters and insulin resistance in young survivors of myocardial infarction with heterozygous familial hypercholesterolemia

A characteristic feature of patients with heterozygous familial hypercholesterolemia (FH) is the premature occurrence of coronary artery disease because of elevated LDL cholesterol levels. Hyperinsulinemia and insulin resistance, important characteristics of the cardiovascular dysmetabolic syndrome (CDS), were found to be associated with coronary artery disease in FH subjects, as in the general population. We investigated whether hypofibrinolysis, as part of CDS, is independently associated with symptomatic coronary artery disease in these high-risk patients. Clinical examination (body mass index, waist circumference, blood pressure) and blood analysis (plasma tissue plasminogen activator (t-PA) antigen, plasminogen activator inhibitor (PAI-1) antigen and activity, fibrinogen, serum lipids and lipoproteins, fasting glucose and insulin) were carried out in 39 male patients with heterozygous FH (aged 46.6 +/- 8.8 years). Insulin resistance was calculated using the homeostasis model assessment (HOMA) mathematical model. Thirteen of the patients had suffered a myocardial infarction (MI) 5 to 8 years ago (aged 47.8 +/- 6.1 years) and 26 were free of coronary artery disease (aged 45.9 +/- 9.9 years). There was no difference in total and LDL cholesterol between the two groups. Patients with previous myocardial infarction had significantly higher levels of insulin, insulin resistance, triglycerides, t-PA antigen, PAI-1 antigen and activity, and significantly lower values of HDL cholesterol. Other widely recognised risk factors for coronary artery disease, such as smoking, systolic and diastolic blood pressure, obesity and age, did not differ significantly between the groups. In the logistic regression model, PAI-1 antigen, as a marker of hypofibrinolysis, emerged as an independent risk factor for the occurrence of myocardial infarction (odds ratio 1.55; p = 0.02). In summary our results suggest that the impairment of fibrinolytic activity resulting from elevated levels of PAI-1 antigen and activity and t-PA antigen is an independent variable in CDS associated with the premature occurrence of myocardial infarction in male patients with FH.     

Autoimmune hair loss (alopecia areata) transferred by T lymphocytes to human scalp explants on SCID mice.

Alopecia areata is a tissue-restricted autoimmune disease of the hair follicle, which results in hair loss and baldness. It is often psychologically devastating. The role of T lymphocytes in this disorder was investigated with cell transfer experiments. Scalp explants from patients were transplanted to severe combined immunodeficiency (SCID) mice and injected with autologous T lymphocytes isolated from involved scalp. T lymphocytes which had been cultured with hair follicle homogenate along with antigen-presenting cells were capable of inducing the changes of alopecia areata, including hair loss and perifollicular infiltrates of T cells, along with HLA-DR and ICAM-1 expression of the follicular epithelium. Similar changes were not noted in grafts injected with scalp-derived T cells that had not been cultured with follicular homogenate. These data indicate that alopecia areata is mediated by T cells which recognize a follicular autoantigen.