P6.62 FEMALE PATTERN HAIR LOSS AND SKIN ANDROGEN RESPONSE

MP Birch, S Agarwal, H Lashen*, AG Messenger

Department of Dermatology, Royal Hallamshire Hospital, and Department of Obstetrics & Gynaecology, Jessop Wing*, Sheffield S10 2JF

Male androgenetic alopecia (AGA) is an androgen-dependent condition. The evidence that androgens are involved in causing female AGA is less conclusive. Our aim was to explore the role of androgens in female AGA by relating objective and subjective measures of scalp hair status to circulating androgen levels and to markers of androgen responses.

We studied 95 women aged 18-50 years, 41 with clinical female AGA (without hirsutism), 25 with hirsutism (with and without scalp hair loss) and 29 control subjects without hair problems. We measured hair density on the frontal scalp using a macrophotographic method, forehead sebum excretion rate (SER) using Sebutape, serum free androgen index (FAI), and body mass index (BMI). Women with clinical female AGA had lower hair density than the control and the hirsute groups (p<0.001). Mean scalp hair density in hirsute women was also lower than in control subjects but the difference was not significant. However, of the 19 women referred with hirsutism (mean age 29.8) 7 also had clinical evidence of scalp hair loss, a much higher frequency (37%) than expected in this age group (<5%). The mean SER (measured as arbitrary units of area on Sebutape) was higher in the hirsute group than in the AGA group, which was itself higher than in the control group, but these differences were not statistically significant. Hirsute women had significantly higher FAI (p<0.001) and BMI (p<0.001) levels than either of the other groups. There was no significant difference in these measurements between the control and female AGA groups although the mean FAI was slightly higher in the AGA group than in controls.

We were unable to demonstrate correlations between scalp hair density and FAI levels, BMI levels or sebum excretion rates.

Our results are consistent with the androgen-dependent nature of hirsutism. The high frequency of scalp hair loss in hirsute women also indicates that female hair loss may be androgen-dependent. There was no significant difference between the control and AGA groups in terms of circulating androgen levels and other markers of peripheral androgen response, suggesting scalp hair loss in most women is androgen-independent. However, the slightly higher mean FAI and SER levels in the AGA group suggest that androgens play a role in mediating hair loss in some of these women.