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ORIGINAL ARTICLE
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 25-28

Association of early-onset androgenetic alopecia with metabolic syndrome: A case–control study on 46 patients in a tertiary care hospital in South India


Department of Dermatology, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Date of Web Publication14-Dec-2018

Correspondence Address:
Dr. Yadalla Hari Kishan Kumar
70, Padma Nivasa, Skin Care Clinic, 3rd Cross MG Extension, HV Halli, Raja Rajeswari Nagar, Bengaluru - 560 098, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_127_17

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  Abstract 


Background: Androgenetic alopecia (AGA) has a significant psychosocial impact on the patient, especially early-onset AGA patients. The severity and prevalence increase with age in all races worldwide. “Metabolic syndrome” (MetS) is a combination of risk factors of cardiovascular and diabetes-related parameters. Aim of the Study: The aim of the study is to study the association of early-onset AGA with MetS. Materials and Methods: A case–control study was done in a tertiary care hospital, Bengaluru, from December 2015 to November 2016 with 46 cases and controls in the age group of 20–30 years. The Norwood–Hamilton classification was used to grade the AGA patients. Diagnosis of MetS was done based on the national cholesterol education program adult treatment Panel III. Independent t-test will be used as a test of significance. Categorical data were assessed using Chi-square test of significance. Value of P < 0.05 was considered to be statistically significant. Results: MetS was seen in 39.13% of cases and 4.35% of controls (P < 0.001) which was statistically significant. The mean systolic blood pressure (P = 0.017 and P < 0.05) was statistically significant when compared to healthy controls. However, no statistically significant values were seen in the mean values of other parameters. Conclusion: A higher prevalence of MetS was seen in early-onset AGA. Early screening for MetS is important in patients with early-onset AGA to minimize the complications in the future.

Keywords: Androgenetic alopecia, metabolic syndrome, prevention


How to cite this article:
Kumar K C, Kumar YH, Neladimmanahally V. Association of early-onset androgenetic alopecia with metabolic syndrome: A case–control study on 46 patients in a tertiary care hospital in South India. Indian J Paediatr Dermatol 2019;20:25-8

How to cite this URL:
Kumar K C, Kumar YH, Neladimmanahally V. Association of early-onset androgenetic alopecia with metabolic syndrome: A case–control study on 46 patients in a tertiary care hospital in South India. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Oct 17];20:25-8. Available from: http://www.ijpd.in/text.asp?2019/20/1/25/247544




  Introduction Top


Androgenetic alopecia (AGA) has a significant psychosocial impact on the patient, especially early-onset AGA patients. AGA is a progressive process that causes a conversion from a terminal hair into a miniaturized hair which is a hereditary androgen-dependent disorder. The severity and prevalence increase with age in all races worldwide.

In many studies, it is shown that AGA is associated with several diseases, such as insulin resistance,[1] hypertension,[2] coronary heart disease,[3],[4] abnormal serum lipid profiles,[5] prostate cancer,[6] benign prostatic hyperplasia,[7] obesity,[8] and some environmental factors, such as smoking.[8],[9] However, not all studies show similar results regarding the association of those diseases with AGA.[10],[11],[12],[13],[14]

“Metabolic syndrome” (MetS) is a combination of risk factors of cardiovascular and diabetes-related parameters which are gaining more and more importance. Early detection and evaluation are important to minimize the untoward complication, and few of the studies[15],[16],[17],[18],[19],[20],[21],[22] have reported the association between AGA, MetS, and coronary artery disease.

Our aim was to evaluate the association of MetS with early-onset AGA (age group from 20 years to 30 years). We selected this early-onset age group as the risk factors or the parameters of MetS are not usually seen in this age group.

Hence, the early-onset AGA can give a clue to the presence of MetS, and early lifestyle modifications can help the individual reduce the risk of developing untoward complications in the future.


  Materials and Methods Top


A case–control study was conducted for 1 year on patients attending as outpatients and inpatients to the Department of Dermatology of Raja Rajeswari Medical College, Mysore road, Bangalore. Ethical clearance for the study was taken from the Institutional Ethics Committee. A total of 46 patients with AGA between the age group of 20 and 30 years and both sexes were included, and the control group consists of age- and sex-matched individuals without any history of AGA. A written informed consent was taken from all the study patients.

A detailed history was taken, and a thorough cutaneous and systemic examination was done.

Clinical assessment of AGA was done based on the Hamilton–Norwood classification,[23] a standard classification scheme with the good test-retest reliability in male patients and for women, the Ludwig classification (Grade I–III) was used.[24]

We further divided the AGA cases into two categories, normal to mild AGA as severity 1 group which includes – Hamilton–Norwood Types I–III and Ludwig classification Type I and moderate or severe AGA as severity 2 group which includes – Hamilton–Norwood Types IV–VII and Ludwig classification Grade II–III, respectively, to assess its association with other potential risk factors.

Diagnosis of MetS was based on the national cholesterol education program adult treatment Panel III[25] by the presence of three or more of the following criteria.

TGs value ≥150 mg/dl and high-density lipoprotein (HDL) ≤40 mg/dl in males and HDL ≤50 mg/dl in females were the cut-off points of dyslipidemia.

Fetal bovine serum ≥110 mg/dl was the cutoff point of impaired fasting glycemia.

Waist circumference of ≥102 cm in males and 88 cm in females and blood pressure (BP) ≥130/85 were the cutoff points. Relevant investigations were done in all patients, and reports were recorded.

Data were entered into Excel and analyzed using the statistical package for the social sciences (SPSS Inc., Chicago, IL) SPSS version 17. Quantitative data were presented as a mean ± standard deviation, median, and range. Qualitative data were expressed in terms of frequency and percentage. Independent t-test was used as a test of significance. Categorical data were assessed using the Chi-square test of significance. P < 0.05 was considered to be statistically significant.


  Results Top


In the study, males outnumbered the females. About 73.91% of the cases and the controls studied were males and 26.09% were females. The male: female ratio in cases and controls was 2.84:1. The mean value of the age of onset was 29.750 ± 7.736.

About 84.78% of the cases studied belonged to severity 1 (normal-to-mild AGA), and 15.22% of the cases studied belonged to severity 2 (moderate or severe AGA). Among males 79.41% had severity 1 and 20.59% had severity 2 AGA. In females all the cases had severity 1 AGA.

The value of systolic BP was statistically significant between cases and controls. The mean value was 125.826 ± 9.332 in cases and 121.478 ± 7.687 in controls, P = 0.017 and P < 0.05. The value of diastolic BP was not statistically significantly higher when cases were compared with that of controls. The mean value of diastolic BP was 79.783 ± 6.1424 in cases and 80.231 ± 6.4331 in controls, P = 0.771 and P > 0.05.

The value of triglycerides in cases was not statistically significant when compared to the controls. The mean value in cases was 141.70 ± 67.871 and 128.39 ± 21.875 in controls, P = 0.687 and P > 0.05. The value of fasting blood sugar levels in cases was not statistically significant when compared to the controls. The mean value was 92.63 ± 13.833 in cases and 95.76 ± 10.183 in controls, P = 0.065 and P > 0.05.

In males, the value of HDL in cases was not statistically significant when compared to the controls. The mean value was 43.44 ± 9.611 in cases and 46.00 ± 6.329 in controls, P = 0.077 and P > 0.05. In females, the value of HDL in cases was not statistically significant when compared to the controls. The mean value was 47.75 ± 10.350 in cases and 43.83 ± 7.359 in controls, P = 0.354 and P > 0.05.

In males, the value of waist circumference in cases was statistically significantly higher when compared to the controls. The mean value was 94.59 ± 11.325 in cases and 91.09 ± 8.558 in controls, P = 0.116 and P > 0.05. In females as well the value of waist circumference in cases was not statistically significantly higher when compared to the controls. The mean value was 75.58 ± 6.022 in cases and 79.42 ± 5.728 in controls, P = 0.085 and P > 0.05.

The prevalence of MetS in cases (39.13%) was statistically very highly significant when compared to the controls (4.35%) (P < 0.001). [Table 1] shows mean ± standard deviation and P value of MetS parameters in cases and controls.
Table 1: The mean±standard deviation of systolic and diastolic blood pressure, triglycerides, fasting blood glucose, high-density lipoproteins, and waist circumference values between the cases and controls

Click here to view


The value of systolic BP in severity 2 cases was not statistically significant when compared to severity 1 cases. The mean value was 128.571 ± 10.690 in severity 2 cases and 125.333 ± 9.134 in severity 1 cases, P = 0.404 and P > 0.05. The value of diastolic BP in severity 2 cases was not statistically significant when compared to severity 1 cases. The mean value in severity 2 cases was 82.857 ± 4.879 and 79.231 ± 6.340 in severity 1 cases, P = 0.152 and P > 0.05.

The value of triglycerides levels in severity 2 cases was not statistically significant when compared to the severity 1 cases. The mean value was 154.71 ± 74.471 in severity 2 cases and 139.36 ± 67.398 in severity 1 cases, P = 0.612 and P > 0.05. The value of fasting blood sugar levels in severity 2 cases was not statistically significant when compared to the severity 1 cases. The mean value was 89.29 ± 10.468 in severity 2 cases and 93.23 ± 14.383 in severity 1 cases, P = 0.603 and P > 0.05.

In males, the value of HDL in severity 2 cases was not statistically significant when compared to the severity 1 cases. The mean value was 39.71 ± 7.251 in severity 2 cases and 44.41 ± 10.020 in severity 1 cases, P = 0.256 and P > 0.05. In females, the mean value was 47.75 ± 10.350 in severity 1 cases.

In males, the value of waist circumference in severity 2 cases was not statistically significant when compared to the severity 1 cases. The mean value was 89.43 ± 11.914 in severity 2 cases and 95.93 ± 11.000 in severity 1 cases, P = 0.18 and P > 0.05. In females, the mean value was 75.58 ± 6.022 in severity 1 cases.

The prevalence of MetS in severity 2 cases (28.57%) was not statistically significant when compared to severity 1 cases (41.03%) (P = 0.534 and P > 0.05). [Table 2] shows the mean ± standard deviation and P value of MetS parameters in severity-1 and severity-2 cases.
Table 2: The mean±standard deviation of systolic and diastolic blood pressure, triglycerides, fasting blood glucose, high-density lipoproteins, and waist circumference values between severity 1 cases and severity 2 cases

Click here to view



  Discussion Top


In our study, we had included 46 cases diagnosed with early-onset AGA and 46 controls without AGA. These patients were subjected to blood investigations to measure HDL levels, fasting blood sugar levels, and triglycerides levels. BP was recorded along with the waist circumference both from the cases and controls. In our study, the mean age of onset was around 22.83 ± 2.532.

In our study, systolic BP was statistically significant between cases and controls. The mean value was 125.826 ± 9.332 in cases and 121.478 ± 7.687 in controls, P = 0.017 and P < 0.05. Similar results were reported by Arias-Santiago et al.,[21] Chakrabarty et al.,[26] and Bakry et al.[27] regarding the systolic BP.

Other parameters of MetS such as diastolic BP, triglycerides, fasting blood sugar levels, HDL levels, and waist circumference were not statistically significant when the mean values of cases were compared with that of controls.

In our study, MS was significantly associated with AGA cases. The prevalence of MetS in cases (39.13%) was statistically very highly significant when compared to the controls (4.35%) (P < 0.001). Similar results were seen in studies conducted by Acibucu et al.,[28] Chakrabarty et al.,[26] Arias-Santiago et al.,[21] and Bakry et al.[27] In contrast to our study results reported by Mumcuoglu et al.,[29] there was no statistically significant difference between the cases and controls.

In our study, we had divided the patients further into two severities to evaluate the association of early AGA with the prevalence of MetS, but the mean values of all the parameters of MetS were not statistically significant when severity 1 cases were compared with that of severity 2 cases. The prevalence of MetS in severity 2 cases was not statistically significant when compared to severity 1 cases (P = 0.534 and P > 0.05). [Table 2] shows mean ± standard deviation and P value of MetS parameters in severity-1 and severity-2 cases.

In a similar study conducted by Yi et al.,[30] among men, the difference between the two groups was not statistically significant, but the number of cases were more in severity 2 when compared with severity 1 cases. Among women, the difference was statistically significant when severity 2 cases were compared with that of severity 1.

Based on the observations and results in our study, it is very important as a dermatologist to screen for MetS by evaluating for lipid profile, anthropometric measurements, fasting blood sugar levels, and recording the BP in all the AGA patients as this can be an advantage or a warning sign of more devastating state in the future such as cardiovascular disease or diabetes.

Hence, by screening for MetS based on the obtained results, we can advise the patient for lifestyle modification and thereby preventing the untoward complications. Screening for MetS will be an important aspect in all the patients in the near future due to the present sedentary lifestyle and unhealthy food habits.


  Conclusion Top


A higher prevalence of MetS is seen in early-onset AGA cases when compared with that of controls. A significant association was not seen between the severity of AGA and MetS. This may suggest an association of early-onset AGA with MetS, and hence, early screening for MetS is beneficial to reduce the risk of developing untoward complications in patients with AGA.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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