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

Authors

DOI:

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

Keywords:

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

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.

Author Biographies

І. В. Сідорова, “DILA”, Kyiv

Medical director of medical laboratory

Т. М. Тутченко, SI “O.M. Lukyanova IPOG of the NAMS of Ukraine” SSI “CIMT of the NAS of Ukraine» DILA medical laboratory, Kyiv

PhD, researcher at the Department of Endocrine Gynecology

Department of Reproductive Health

Scientific consultant

О. А. Бурка, A.A. Bogomolets National Medical University DILA medical laboratory, Kyiv

PhD, associate professor, Department of Obstetrics and Gynecology No. 1

Scientific consultant

Л. М. Семенюк, Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the MoH of Ukraine, Kyiv

MD, assosiate professor, Head of the Department of reproductive medicine and surgery

I. Г. Ноговська, P.L. Shupik NMAPE “Gynecology center ‘Nadiya’” LLC, Kyiv

Graduate student at the Department of Obstetrics, Gynecology and Perinatology

Obstetrician gynecologist

Л. В. Дем’яненко, Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the MoH of Ukraine, Kyiv

PhD, senior researcher at the Department of reproductive medicine and surgery

References

  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. 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
  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

Downloads

Published

2020-05-13

How to Cite

Сідорова, І. В., Тутченко, Т. М., Бурка, О. А., Семенюк, Л. М., Ноговська I. Г., & Дем’яненко, Л. В. (2020). Androgen-associated and androgen-independent causes of alopecia and acne in women. Literature review. REPRODUCTIVE ENDOCRINOLOGY, (52), 39–48. https://doi.org/10.18370/2309-4117.2020.52.39-48

Issue

No. 52 (2020)

Section

Interdisciplinary consilium

License

Copyright (c) 2020 І. В. Сідорова, Т. М. Тутченко, О. А. Бурка, Л. М. Семенюк, I. Г. Ноговська, Л. В. Дем’яненко

Creative Commons License

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

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.