DOI: https://doi.org/10.18370/2309-4117.2020.52.39-48

Androgen-associated and androgen-independent causes of alopecia and acne in women. Literature reviewgen-associated and androgen-independent causes of alopecia and acne in women. Literature review

І. В. Сідорова, Т. М. Тутченко, О. А. Бурка, Л. М. Семенюк, I. Г. Ноговська, Л. В. Дем’яненко

Abstract


This article refers to the issues of alopecia and acne pathogenesis: anatomy of hair and sebaceous glands, biological factors affecting the stages of hair development and function of sebaceous glands. Alopecia is divided into two large groups: scaring and non-scaring alopecia, the later is represented by alopecia areata, telogen effluvium, and female pattern hair loss/androgenetic alopecia (FPHL/AGA). Before starting the search for systemic causes it is necessary to predetermine the type of alopecia on the basis of medical history and external manifestations. FPHL /AGA as a most common form of alopecia can often coexist with another common pathology – telogen effluvium, this fact determines therapeutic approaches and their results.

Main pathogenetic mechanisms, approaches to differential diagnostics and treatment of the main specified types of non-scarring alopecia are reviewed. FPHL/AGA is a main type of alopecia which is often referred to gynecologists/endocrinologists. It is now regarded a multifactorial pathology with the involvement of a genetic component, androgen receptor gene expression, dihydrotestosterone synthesis and local low grade inflammation specifics. FPHL/AGA can be with and without hyperandrogenism, in both cases it can be accompanied by an increased risk of metabolic syndrome. In case of FPHL/AGA with hyperandrogenism the success of treatment depends on the consistent coordinated work of gynecologist/endocrinologist and dermatologist/trichologist, which allows combining systemic and local therapy in a timely manner.

Also contemporary views on the acne pathogenesis are reviewed. Given the complex nature of acne its therapy is also complex and stepwise. According to current clinical guidelines and recent studies of the microbial component of acne pathogenesis the following conclusions are formulated. Patients with acne require assessment of androgen status, determination of the hyperandrogenism source, including evaluation of tissue androgens; phenotype of the syndrome and cardio-metabolic risks should be determined in patients with polycystic ovary syndrome; it is advisable to determine antimicrobial susceptibility of pathogens isolated from the inflamed pilosebaceous unit if acne form requires the local or systemic antibacterial therapy.


Keywords


androgens; testosterone; androstenedione; dihydrotestosterone; alopecia; androgenetic alopecia; telogen effluvium; acne; antimicrobial resistance

References


Montgomery, K., White, C., Thompson, A. «A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia.» BMJ Open 7 (2017): e015468. DOI: 10.1136/bmjopen-2016-015468

Randall, V.A. «The endocrine control of the hair follicle.» In: Hair, Hair Growth Hair Disord. Springer Berlin Heidelberg (2008): 23–39. DOI: 10.1007/978-3-540-46911-7_2

Chandrashekar, B.S., ed. IADVL Textbook of Trichology, 1st edition. Jaypee Brothers Medical Pub (2018): 565 p.

Koch, S.L., Tridico, S.R., Bernard, B.A., et al. «The biology of human hair: A multidisciplinary review.» Am J Hum Biol 32 (2020). DOI: 10.1002/ajhb.23316

De Falco, M.D., Pisano, M.M., De Luca, A.D. «Embryology and anatomy of the skin.» In: Ski. Cancer A Pract. Approach. Springer New York (2014): 1–15. DOI: 10.1007/978-1-4614-7357-2_1

Dréno, B., Pécastaings, S., Corvec, S., et al. «Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates.» J Eur Acad Dermatology Venereol 32 (2018): 5–14. DOI: 10.1111/jdv.15043

Lee, L.W., Holbrook, K.A. «Embryogenesis of the Skin.» In: Harper’s Textbook of Pediatric Dermatology. Wiley (2019): 1–35. DOI: 10.1002/9781119142812.ch1

Irvine, A.D., Hoeger, P.H., Yan, A.C., eds. Harper’s Textbook of Pediatric Dermatology. Wiley (2019). DOI: 10.1002/9781119142812.

Sasaki, G.H. «Review of Human Hair Follicle Biology: Dynamics of Niches and Stem Cell Regulation for Possible Therapeutic Hair Stimulation for Plastic Surgeons.» Aesthetic Plast Surg 43 (2019): 253–66. DOI: 10.1007/s00266-018-1248-1.

Burka, O.A., Tutchenko, T.M. «Modern approaches to diagnostics of hyperandrogenism distributed forms in reproductive aged women.» Reproductive Endocrinology 46 (2019): 39–45. DOI: 10.18370/2309-4117.2019.46.39-45

Sam, S., Ehrmann, D.A. «Hormonal Evaluation of Hyperandrogenism in Women.» JAMA 314 (2015): 2557. DOI: 10.1001/jama.2015.11612

Bienenfeld, A., Azarchi, S., Lo Sicco, K., et al. «Androgens in Women: Androgen mediated skin disease and patient evaluation (Part I).» J Am Acad Dermatol (2018). DOI: 10.1016/J.JAAD.2018.08.062.

Slominski, A.T., Manna, P.R., Tuckey, R.C. «On the role of skin in the regulation of local and systemic steroidogenic activities.» Steroids 103 (2015): 72–88. DOI: 10.1016/j.steroids.2015.04.006

Ceruti, J.M., Leirós, G.J., Balañá, M.E. «Androgens and androgen receptor action in skin and hair follicles.» Mol Cell Endocrinol 465 (2018): 122–33. DOI: 10.1016/j.mce.2017.09.009

Skowron, K.J., Booker, K., Cheng, C., et al. «Steroid receptor/coactivator binding inhibitors: An update.» Mol Cell Endocrinol 493 (2019): 110471. DOI: 10.1016/j.mce.2019.110471

Essah, P.A., Wickham, E.P., Nunley, J.R., Nestler, J.E. «Dermatology of androgen-related disorders.» Clin Dermatol 24 (2006): 289–98. DOI: 10.1016/j.clindermatol.2006.04.004

Zouboulis, C.C., Chen, W.C., Thornton, M.J., et al. «Sexual hormones in human skin.» Horm Metab Res 39 (2007): 85–95. DOI: 10.1055/s-2007-961807

Yilmaz, B., Yildiz, B.O. «Endocrinology of Hirsutism: From Androgens to Androgen Excess Disorders.» In: Front. Horm. Res. S. Karger AG (2019): 108–19. DOI: 10.1159/000494907

Deplewski, D., Rosenfield, R.L. «Role of hormones in pilosebaceous unit development.» Endocr Rev 21 (2000): 363–92. DOI: 10.1210/edrv.21.4.0404

Lai, J.J., Chang, P., Lai, K.P., et al. «The role of androgen and androgen receptor in skin-related disorders.» Arch Dermatol Res 304 (2012): 499–510. DOI: 10.1007/s00403-012-1265-x

Leirós, G.J., Ceruti, J.M., Castellanos, M.L., et al. «Androgens modify Wnt agonists/antagonists expression balance in dermal papilla cells preventing hair follicle stem cell differentiation in androgenetic alopecia.» Mol Cell Endocrinol 439 (2017): 26–34. DOI: 10.1016/j.mce.2016.10.018.

Telerman, S.B., Rognoni, E., Sequeira, I., et al. «Dermal Blimp1 Acts Downstream of Epidermal ТФРβ and Wnt/β-Catenin to Regulate Hair Follicle Formation and Growth.» J Invest Dermatol 137 (2017): 2270–81. DOI: 10.1016/j.jid.2017.06.015

Carmina, E., Azziz, R., Bergfeld, W., et al. «Female pattern hair loss and androgen excess: A report from the Multidisciplinary androgen excess and PCOS committee.» J Clin Endocrinol Metab (2019). DOI: 10.1210/jc.2018-02548

Stepto, N.K., Cassar, S., Joham, A.E., et al. «Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp.» Hum Reprod 28 (2013): 777–84. DOI: 10.1093/humrep/des463

Tosti, A., Asz-Sigall, D., Pirmez, R., eds. Hair and Scalp Treatments: A Practical Guide. Springer International Publishing (2019): 359 p.

Coleman, E. «Types and Treatment of Hair Loss in Men and Women.» Plast Surg Nurs 40 (2020): 6–19. DOI: 10.1097/PSN.0000000000000285

Carmina, E., Azziz, R., Bergfeld, W., et al. «Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee.» J Clin Endocrinol Metab 104 (2019): 2875–91. DOI: 10.1210/jc.2018-02548

Malkud, S. «A Hospital-based Study to Determine Causes of Diffuse Hair Loss in Women.» J Clin Diagnostic Res 9 (2015): WC01.

Villablanca, S., Fischer, C., et al. «Primary Scarring Alopecia: Clinical-Pathological Review of 72 Cases and Review of the Literature.» Ski Appendage Disord 3 (2017): 132–43. DOI: 10.1159/000467395

Mathur, M., Acharya, P. «Trichoscopy of primary cicatricial alopecias: an updated review.» J Eur Acad Dermatology Venereol 34 (2020): 473–84. DOI: 10.1111/jdv.15974

Fischer, J., Degenhardt, F., Hofmann, A., et al. «Genomewide analysis of copy number variants in alopecia areata in a Central European cohort reveals association with MCHR2.» Exp Dermatol 26 (2017): 536–41. DOI: 10.1111/exd.13123

Redler, S., Basmanav, F.B.Ü., Blaumeiser, B., et al. «Parent-of-origin effect in alopecia areata: A large-scale pedigree study.» Acta Derm Venereol 97 (2017): 862–3. DOI: 10.2340/00015555-2658

Strazzulla, L.C., Wang, E.H.C., Avila, L., et al. «Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis.» J Am Acad Dermatol 78 (2018): 1–12. DOI: 10.1016/j.jaad.2017.04.1141

Waśkiel, A., Rakowska, A., Sikora, M., et al. «Trichoscopy of alopecia areata: An update.» J Dermatol 45 (2018): 692–700. DOI: 10.1111/1346-8138.14283

Tognetti, L., Cinotti, E., Perrot, J.-L., et al. «Syphilitic alopecia: uncommon trichoscopic findings.» Dermatol Pract Concept 7 (2017): 55–9. DOI: 10.5826/dpc.0703a12

Doche, I., Hordinsky, M.K., Valente, N.Y.S., et al. «Syphilitic Alopecia: Case Reports and Trichoscopic Findings.» Ski Appendage Disord 3 (2017): 222–4. DOI: 10.1159/000477415

Lai, V.W.Y., Chen, G., Gin, D., Sinclair, R. «Systemic treatments for alopecia areata: A systematic review.» Australas J Dermatol 60 (2019): e1–e13. DOI: 10.1111/ajd.12913

Rebora, A. «Telogen effluvium: A comprehensive review.» Clin Cosmet Investig Dermatol 12 (2019): 583–90. DOI: 10.2147/CCID.S200471

Rebora, A. «Intermittent Chronic Telogen Effluvium.» Ski Appendage Disord 3 (2017): 36–8. DOI: 10.1159/000455882

Cheung, E.J., Sink, J.R., English, J.C. «Vitamin and mineral deficiencies in patients with telogen effluvium: A retrospective cross-sectional study.» J Drugs Dermatology 15 (2016): 1235–7.

Trüeb, R.M. «E-Mail Editorial Comment Telogen Effluvium: Is There a Need for a New Classification?» Ski Appendage Disord 2 (2016): 39–44. DOI: 10.1159/000446119.

Orme, S., Cullen, D.R., Messenger, A.G. «Diffuse female hair loss: are androgens necessary?» Br J Dermatol 141 (1999): 521–3. DOI: 10.1046/j.1365-2133.1999.03049.x

Cousen, P., Messenger, A. «Female pattern hair loss in complete androgen insensitivity syndrome, Br. J. Dermatol. 162 (2010) 1135–7. DOI: 10.1111/j.1365-2133.2010.09661.x.

Birch, M.P., Lalla, S.C., Messenger, A.G. «Female pattern hair loss.» Clin Exp Dermatol 27 (2002): 383–8. DOI: 10.1046/j.1365-2230.2002.01085.x

Gan, D.C.C., Sinclair, R.D. «Prevalence of male and female pattern hair loss in Maryborough.» J Investig Dermatol Symp Proc 10 (2005): 184–9. DOI: 10.1111/j.1087-0024.2005.10102.x

Izci, B., Douglas, N.J. «Obstructive sleep apnea-hypopnea syndrome.» In: Obstr Sleep Apnea Causes Treat Heal Implic. Nova Science Publishers, Inc. (2012): 129–82. DOI: 10.5005/jp/books/10485_38.

Xing Wu, D., Feng Wu, L., Xing Yang, Z. «Association between androgenetic alopecia and metabolic syndrome: a meta-analysis.» Zhejiang Da Xue Xue Bao Yi Xue Ban 43 (2014): 597–601.

Fabbrocini, G., Cantelli, M., Masarà, A., et al. «Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review.» Int J Women’s Dermatology 4 (2018): 203–11. DOI: 10.1016/j.ijwd.2018.05.001

Brenner, F.M., Oldoni, C. «Telogen effluvium x female pattern hair loss: Is there correlation?» An Bras Dermatol 94 (2019): 486–7. DOI: 10.1590/abd1806-4841.20198427

Ummiti, A., Priya, P., Chandravathi, P., Kumar, C. «Correlation of trichoscopic findings in androgenetic alopecia and the disease severity.» Int J Trichology 11 (2019): 118–22. DOI: 10.4103/ijt.ijt_103_17

Ramos, P.M., Brianezi, G., Martins, A.C.P., et al. «Apoptosis in follicles of individuals with female pattern hair loss is associated with perifollicular microinflammation.» Int J Cosmet Sci 38 (2016): 651–4. DOI: 10.1111/ics.12341

Kolivras, A., Thompson, C. «Distinguishing diffuse alopecia areata (AA) from pattern hair loss (PHL) using CD3+ T cells.» J Am Acad Dermatol 74 (2016): 937–44. DOI: 10.1016/j. jaad.2015.12.011

Gerkowicz, A., Chyl-Surdacka, K., Krasowska, D., Chodorowska, G. «The role of vitamin D in non-scarring alopecia.» Int J Mol Sci 18 (2017). DOI: 10.3390/ijms18122653

Tan, A.U., Schlosser, B.J., Paller, A.S. «A review of diagnosis and treatment of acne in adult female patients.» Int J Women’s Dermatology 4 (2018): 56–71. DOI: 10.1016/j.ijwd.2017.10.006

Rocha, M.A., Bagatin, E. «Adult-onset acne: Prevalence, impact, and management challenges.» Clin Cosmet Investig Dermatol 11 (2018): 59–69. DOI: 10.2147/CCID.S137794

Bhate, K., Williams, H.C. «Epidemiology of acne vulgaris.» Br J Dermatol 168 (2013): 474–85. DOI: 10.1111/bjd.12149

Dreno, B., Bagatin, E., Blume-Peytavi, U., et al. «Female type of adult acne: Physiological and psychological considerations and management.» JDDG J Der Dtsch Dermatologischen Gesellschaft 16 (2018): 1185–94. DOI: 10.1111/ddg.13664

Bienenfeld, A., Azarchi, S., Lo Sicco, K., et al. «Androgens in women: Androgen-mediated skin disease and patient evaluation.» J Am Acad Dermatol 80.6 (2019): 1497–506. DOI: 10.1016/j.jaad.2018.08.062

Thiboutot, D., Harris, G., Iles, V., et al. «Activity of the type 1 5α-reductase exhibits regional differences in isolated sebaceous glands and whole skin.» J Invest Dermatol 105 (1995): 209–14. DOI: 10.1111/1523-1747.ep12317162

O’Neill, S., O’Driscoll, L. «Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies.» Obes Rev 16 (2015): 1–12. DOI: 10.1111/obr.12229

Dréno, B., Pécastaings, S., Corvec, S., et al. «Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates.» J Eur Acad Dermatology Venereol 32 (2018): 5–14. DOI: 10.1111/jdv.15043

Nast, A., Dréno, B., Bettoli, V., et al. «European evidence-based (S3) guideline for the treatment of acne - update 2016 - short version.» J Eur Acad Dermatology Venereol 30 (2016): 1261–8. DOI: 10.1111/jdv.13776

Thiboutot, D.M., Dréno, B., Abanmi, A., et al. «Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne.» J Am Acad Dermatol 78 (2018): S1-S23.e1. DOI: 10.1016/j.jaad.2017.09.078

Adler, B.L., Kornmehl, H., Armstrong, A.W. «Antibiotic resistance in acne treatment.» JAMA Dermatology 153 (2017): 810–1. DOI: 10.1001/jamadermatol.2017.1297

Margolis, D.J., Bowe, W.P., Hoffstad, O., Berlin, J.A. «Antibiotic treatment of acne may be associated with upper respiratory tract infections.» Arch Dermatol 141 (2005): 1132–6. DOI: 10.1001/archderm.141.9.1132


GOST Style Citations


1.            Montgomery, K., White, C., Thompson, A. «A mixed methods survey of social anxiety, anxiety, depression and wig use in alopecia.» BMJ Open 7 (2017): e015468. DOI: 10.1136/bmjopen-2016-015468

2.            Randall, V.A. «The endocrine control of the hair follicle.» In: Hair, Hair Growth Hair Disord. Springer Berlin Heidelberg (2008): 23–39. DOI: 10.1007/978-3-540-46911-7_2

3.            Chandrashekar, B.S., ed. IADVL Textbook of Trichology, 1st edition. Jaypee Brothers Medical Pub (2018): 565 p.

4.            Koch, S.L., Tridico, S.R., Bernard, B.A., et al. «The biology of human hair: A multidisciplinary review.» Am J Hum Biol 32 (2020). DOI: 10.1002/ajhb.23316

5.            De Falco, M.D., Pisano, M.M., De Luca, A.D. «Embryology and anatomy of the skin.» In: Ski. Cancer A Pract. Approach. Springer New York (2014): 1–15. DOI: 10.1007/978-1-4614-7357-2_1

6.            Dréno, B., Pécastaings, S., Corvec, S., et al. «Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates.» J Eur Acad Dermatology Venereol 32 (2018): 5–14. DOI: 10.1111/jdv.15043

7.            Lee, L.W., Holbrook, K.A. «Embryogenesis of the Skin.» In: Harper’s Textbook of Pediatric Dermatology. Wiley (2019): 1–35. DOI: 10.1002/9781119142812.ch1

8.            Irvine, A.D., Hoeger, P.H., Yan, A.C., eds. Harper’s Textbook of Pediatric Dermatology. Wiley (2019). DOI: 10.1002/9781119142812.

9.            Sasaki, G.H. «Review of Human Hair Follicle Biology: Dynamics of Niches and Stem Cell Regulation for Possible Therapeutic Hair Stimulation for Plastic Surgeons.» Aesthetic Plast Surg 43 (2019): 253–66. DOI: 10.1007/s00266-018-1248-1.

10.          Бурка, O.А. Сучасні підходи до діагностики розповсюджених форм гіперандрогенії в жінок репродуктивного віку / О.А. Бурка, Т.М. Тутченко // Репродуктивна ендокринологія. – 2019. – № 46. – С. 39–45.

11.          Sam, S., Ehrmann, D.A. «Hormonal Evaluation of Hyperandrogenism in Women.» JAMA 314 (2015): 2557. DOI: 10.1001/jama.2015.11612

12.          Bienenfeld, A., Azarchi, S., Lo Sicco, K., et al. «Androgens in Women: Androgen mediated skin disease and patient evaluation (Part I).» J Am Acad Dermatol (2018). DOI: 10.1016/J.JAAD.2018.08.062.

13.          Slominski, A.T., Manna, P.R., Tuckey, R.C. «On the role of skin in the regulation of local and systemic steroidogenic activities.» Steroids 103 (2015): 72–88. DOI: 10.1016/j.steroids.2015.04.006

14.          Ceruti, J.M., Leirós, G.J., Balañá, M.E. «Androgens and androgen receptor action in skin and hair follicles.» Mol Cell Endocrinol 465 (2018): 122–33. DOI: 10.1016/j.mce.2017.09.009

15.          Skowron, K.J., Booker, K., Cheng, C., et al. «Steroid receptor/coactivator binding inhibitors: An update.» Mol Cell Endocrinol 493 (2019): 110471. DOI: 10.1016/j.mce.2019.110471

16.          Essah, P.A., Wickham, E.P., Nunley, J.R., Nestler, J.E. «Dermatology of androgen-related disorders.» Clin Dermatol 24 (2006): 289–98. DOI: 10.1016/j.clindermatol.2006.04.004

17.          Zouboulis, C.C., Chen, W.C., Thornton, M.J., et al. «Sexual hormones in human skin.» Horm Metab Res 39 (2007): 85–95. DOI: 10.1055/s-2007-961807

18.          Yilmaz, B., Yildiz, B.O. «Endocrinology of Hirsutism: From Androgens to Androgen Excess Disorders.» In: Front. Horm. Res. S. Karger AG (2019): 108–19. DOI: 10.1159/000494907

19.          Deplewski, D., Rosenfield, R.L. «Role of hormones in pilosebaceous unit development.» Endocr Rev 21 (2000): 363–92. DOI: 10.1210/edrv.21.4.0404

20.          Lai, J.J., Chang, P., Lai, K.P., et al. «The role of androgen and androgen receptor in skin-related disorders.» Arch Dermatol Res 304 (2012): 499–510. DOI: 10.1007/s00403-012-1265-x

21.          Leirós, G.J., Ceruti, J.M., Castellanos, M.L., et al. «Androgens modify Wnt agonists/antagonists expression balance in dermal papilla cells preventing hair follicle stem cell differentiation in androgenetic alopecia.» Mol Cell Endocrinol 439 (2017): 26–34. DOI: 10.1016/j.mce.2016.10.018.

22.          Telerman, S.B., Rognoni, E., Sequeira, I., et al. «Dermal Blimp1 Acts Downstream of Epidermal ТФРβ and Wnt/β-Catenin to Regulate Hair Follicle Formation and Growth.» J Invest Dermatol 137 (2017): 2270–81. DOI: 10.1016/j.jid.2017.06.015

23.          Carmina, E., Azziz, R., Bergfeld, W., et al. «Female pattern hair loss and androgen excess: A report from the Multidisciplinary androgen excess and PCOS committee.» J Clin Endocrinol Metab (2019). DOI: 10.1210/jc.2018-02548

24.          Stepto, N.K., Cassar, S., Joham, A.E., et al. «Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp.» Hum Reprod 28 (2013): 777–84. DOI: 10.1093/humrep/des463

25.          Tosti, A., Asz-Sigall, D., Pirmez, R., eds. Hair and Scalp Treatments: A Practical Guide. Springer International Publishing (2019): 359 p.

26.          Coleman, E. «Types and Treatment of Hair Loss in Men and Women.» Plast Surg Nurs 40 (2020): 6–19. DOI: 10.1097/PSN.0000000000000285

27.          Carmina, E., Azziz, R., Bergfeld, W., et al. «Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee.» J Clin Endocrinol Metab 104 (2019): 2875–91. DOI: 10.1210/jc.2018-02548

28.          Malkud, S. «A Hospital-based Study to Determine Causes of Diffuse Hair Loss in Women.» J Clin Diagnostic Res 9 (2015): WC01.

29.          Villablanca, S., Fischer, C., et al. «Primary Scarring Alopecia: Clinical-Pathological Review of 72 Cases and Review of the Literature.» Ski Appendage Disord 3 (2017): 132–43. DOI: 10.1159/000467395

30.          Mathur, M., Acharya, P. «Trichoscopy of primary cicatricial alopecias: an updated review.» J Eur Acad Dermatology Venereol 34 (2020): 473–84. DOI: 10.1111/jdv.15974

31.          Fischer, J., Degenhardt, F., Hofmann, A., et al. «Genomewide analysis of copy number variants in alopecia areata in a Central European cohort reveals association with MCHR2.» Exp Dermatol 26 (2017): 536–41. DOI: 10.1111/exd.13123

32.          Redler, S., Basmanav, F.B.Ü., Blaumeiser, B., et al. «Parent-of-origin effect in alopecia areata: A large-scale pedigree study.» Acta Derm Venereol 97 (2017): 862–3. DOI: 10.2340/00015555-2658

33.          Strazzulla, L.C., Wang, E.H.C., Avila, L., et al. «Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis.» J Am Acad Dermatol 78 (2018): 1–12. DOI: 10.1016/j.jaad.2017.04.1141

34.          Waśkiel, A., Rakowska, A., Sikora, M., et al. «Trichoscopy of alopecia areata: An update.» J Dermatol 45 (2018): 692–700. DOI: 10.1111/1346-8138.14283

35.          Tognetti, L., Cinotti, E., Perrot, J.-L., et al. «Syphilitic alopecia: uncommon trichoscopic findings.» Dermatol Pract Concept 7 (2017): 55–9. DOI: 10.5826/dpc.0703a12

36.          Doche, I., Hordinsky, M.K., Valente, N.Y.S., et al. «Syphilitic Alopecia: Case Reports and Trichoscopic Findings.» Ski Appendage Disord 3 (2017): 222–4. DOI: 10.1159/000477415

37.          Lai, V.W.Y., Chen, G., Gin, D., Sinclair, R. «Systemic treatments for alopecia areata: A systematic review.» Australas J Dermatol 60 (2019): e1–e13. DOI: 10.1111/ajd.12913

38.          Rebora, A. «Telogen effluvium: A comprehensive review.» Clin Cosmet Investig Dermatol 12 (2019): 583–90. DOI: 10.2147/CCID.S200471

39.          Rebora, A. «Intermittent Chronic Telogen Effluvium.» Ski Appendage Disord 3 (2017): 36–8. DOI: 10.1159/000455882

40.          Cheung, E.J., Sink, J.R., English, J.C. «Vitamin and mineral deficiencies in patients with telogen effluvium: A retrospective cross-sectional study.» J Drugs Dermatology 15 (2016): 1235–7.

41.          Trüeb, R.M. «E-Mail Editorial Comment Telogen Effluvium: Is There a Need for a New Classification?» Ski Appendage Disord 2 (2016): 39–44. DOI: 10.1159/000446119.

42.          Orme, S., Cullen, D.R., Messenger, A.G. «Diffuse female hair loss: are androgens necessary?» Br J Dermatol 141 (1999): 521–3. DOI: 10.1046/j.1365-2133.1999.03049.x

43.          Cousen, P., Messenger, A. «Female pattern hair loss in complete androgen insensitivity syndrome, Br. J. Dermatol. 162 (2010) 1135–7. DOI: 10.1111/j.1365-2133.2010.09661.x.

44.          Birch, M.P., Lalla, S.C., Messenger, A.G. «Female pattern hair loss.» Clin Exp Dermatol 27 (2002): 383–8. DOI: 10.1046/j.1365-2230.2002.01085.x

45.          Gan, D.C.C., Sinclair, R.D. «Prevalence of male and female pattern hair loss in Maryborough.» J Investig Dermatol Symp Proc 10 (2005): 184–9. DOI: 10.1111/j.1087-0024.2005.10102.x

46.          Izci, B., Douglas, N.J. «Obstructive sleep apnea-hypopnea syndrome.» In: Obstr Sleep Apnea Causes Treat Heal Implic. Nova Science Publishers, Inc. (2012): 129–82. DOI: 10.5005/jp/books/10485_38.

47.          Xing Wu, D., Feng Wu, L., Xing Yang, Z. «Association between androgenetic alopecia and metabolic syndrome: a meta-analysis.» Zhejiang Da Xue Xue Bao Yi Xue Ban 43 (2014): 597–601.

48.          Fabbrocini, G., Cantelli, M., Masarà, A., et al. «Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review.» Int J Women’s Dermatology 4 (2018): 203–11. DOI: 10.1016/j.ijwd.2018.05.001

49.          Brenner, F.M., Oldoni, C. «Telogen effluvium x female pattern hair loss: Is there correlation?» An Bras Dermatol 94 (2019): 486–7. DOI: 10.1590/abd1806-4841.20198427

50.          Ummiti, A., Priya, P., Chandravathi, P., Kumar, C. «Correlation of trichoscopic findings in androgenetic alopecia and the disease severity.» Int J Trichology 11 (2019): 118–22. DOI: 10.4103/ijt.ijt_103_17

51.          Ramos, P.M., Brianezi, G., Martins, A.C.P., et al. «Apoptosis in follicles of individuals with female pattern hair loss is associated with perifollicular microinflammation.» Int J Cosmet Sci 38 (2016): 651–4. DOI: 10.1111/ics.12341

52.          Kolivras, A., Thompson, C. «Distinguishing diffuse alopecia areata (AA) from pattern hair loss (PHL) using CD3+ T cells.» J Am Acad Dermatol 74 (2016): 937–44. DOI: 10.1016/j. jaad.2015.12.011

53.          Gerkowicz, A., Chyl-Surdacka, K., Krasowska, D., Chodorowska, G. «The role of vitamin D in non-scarring alopecia.» Int J Mol Sci 18 (2017). DOI: 10.3390/ijms18122653

54.          Tan, A.U., Schlosser, B.J., Paller, A.S. «A review of diagnosis and treatment of acne in adult female patients.» Int J Women’s Dermatology 4 (2018): 56–71. DOI: 10.1016/j.ijwd.2017.10.006

55.          Rocha, M.A., Bagatin, E. «Adult-onset acne: Prevalence, impact, and management challenges.» Clin Cosmet Investig Dermatol 11 (2018): 59–69. DOI: 10.2147/CCID.S137794

56.          Bhate, K., Williams, H.C. «Epidemiology of acne vulgaris.» Br J Dermatol 168 (2013): 474–85. DOI: 10.1111/bjd.12149

57.          Dreno, B., Bagatin, E., Blume-Peytavi, U., et al. «Female type of adult acne: Physiological and psychological considerations and management.» JDDG J Der Dtsch Dermatologischen Gesellschaft 16 (2018): 1185–94. DOI: 10.1111/ddg.13664

58.          Bienenfeld, A., Azarchi, S., Lo Sicco, K., et al. «Androgens in women: Androgen-mediated skin disease and patient evaluation.» J Am Acad Dermatol 80.6 (2019): 1497–506. DOI: 10.1016/j.jaad.2018.08.062

59.          Thiboutot, D., Harris, G., Iles, V., et al. «Activity of the type 1 5α-reductase exhibits regional differences in isolated sebaceous glands and whole skin.» J Invest Dermatol 105 (1995): 209–14. DOI: 10.1111/1523-1747.ep12317162

60.          O’Neill, S., O’Driscoll, L. «Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies.» Obes Rev 16 (2015): 1–12. DOI: 10.1111/obr.12229

61.          Dréno, B., Pécastaings, S., Corvec, S., et al. «Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates.» J Eur Acad Dermatology Venereol 32 (2018): 5–14. DOI: 10.1111/jdv.15043

62.          Nast, A., Dréno, B., Bettoli, V., et al. «European evidence-based (S3) guideline for the treatment of acne - update 2016 - short version.» J Eur Acad Dermatology Venereol 30 (2016): 1261–8. DOI: 10.1111/jdv.13776

63.          Thiboutot, D.M., Dréno, B., Abanmi, A., et al. «Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne.» J Am Acad Dermatol 78 (2018): S1-S23.e1. DOI: 10.1016/j.jaad.2017.09.078

64.          Adler, B.L., Kornmehl, H., Armstrong, A.W. «Antibiotic resistance in acne treatment.» JAMA Dermatology 153 (2017): 810–1. DOI: 10.1001/jamadermatol.2017.1297

65.          Margolis, D.J., Bowe, W.P., Hoffstad, O., Berlin, J.A. «Antibiotic treatment of acne may be associated with upper respiratory tract infections.» Arch Dermatol 141 (2005): 1132–6. DOI: 10.1001/archderm.141.9.1132





Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)