No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Cosmetic hair treatments improve quality of life in women with female pattern hair loss
Abstract
Hair is a significant component of physical attractiveness and body image. Therefore, losing hair often affects an individual's self-image, self-esteem, and overall quality of life. A study was designed to determine whether cosmetic hair appearance improvements produced any quality of life changes for women, even though no reversal of their female pattern hair loss (FPHL) would necessarily occur. A study to assess quality of life changes during the period that patients attended a trichology center was conducted over a 24 month period. Each participant attended the trichology center every 4-12 weeks. The participants were advised of lifestyle changes to help their overall hair condition and given topical products and other treatments to help improve the cosmetic look of their hair loss problems. All participants were given the Kingsley Alopecia Profile (KAP) to complete at the initial consultation (month 0). The questionnaire was also given after six months of cosmetic treatments. The KAP is a valid and reliable 38 statement questionnaire which measures the effects of genetic alopecia on quality of life. The results demonstrated significant overall and subcategory (i.e., anxiety and depression, self- esteem, and psychosocial) improvements in quality of life after 6 months of treatment (p < 0.0001 ). This improvement in quality of life is indicated by a lower KAP and/or KAP subcategory score. The importance of hair loss on an individual's general quality of life should not be underestimated. This study has confirmed the results of many previous studies that FPHL has a major effect on the psychosocial and emotional well-being of women. With the lack of a reliable medical cure, chronic concerns of hair loss can lead to long term psychological problems. Therefore, the importance of a measurement which can quantify this impact for practitioners, thereby enabling them to treat the patient effectively, cannot be underrated. Topical trichology stimulants as well as a product1 based on a proprietary marine ingredient2 from Pharma Medico Group1, as used in this study, for treatment of FPHL have been shown to be of great value with respect to hair growth as well as the global improvement of the quality of life.
... This unique method is referred to as 'Proteoglycan Replacement Therapy (PRT)' in clinical literature. Numerous clinical trials and papers have confirmed and demonstrated the clinical efficacy and safety of PRT with Nourkrin ® in patients with diffuse hair loss [6][7][8][9]. ...
... Subjective assessments also indicated a high rate of treatment satisfaction in Nourkrin ® users [6,7]. A later trial reported considerable improvements in overall quality of life and all of its sub-scores after adding Nourkrin ® to the treatment regimen of women with hair loss [9]. ...
... Long-term administration of Nourkrin ® Woman in our study did not induce any side effects. This finding signifies the safety of Nourkrin ® in treating women with diffuse hair loss and confirms the former observational and interventional clinical reports [6][7][8][9]. ...
... Subsequent to this finding, good effort had been made in research centres in Denmark, Norway, and Sweden to formulate a specific enzymatic-extracted mixture of proteoglycans aimed to treat hair loss problems. e resulting product (Nourkrin ® with Marilex ® ,Pharma Medico Aps, Aarhus, Denmark) has been found to produce promising results in different clinical settings [99][100][101], reviewed by om and colleagues [102]. As yet, this line of research has admittedly had limited effects on global standard therapeutic guidelines for hair loss management; however, it appears to be the time for reconsideration. ...
... 85 volunteers received treatment with Nourkrin ® added to a number of topical cosmetic products. After six months of treatment, overall quality of life and its subcategories were significantly improved as measured by Kingsley Alopecia Profile [99]. ...
... Further exploration revealed that close to half of the proteoglycan absorption in the jejunum and the ileum is via clathrin-mediated endocytosis [116]. Furthermore, since bioactivity depends on sufficient bioavailability and bioaccessibility, positive outcomes produced by oral PRT with Nourkrin ® in clinical trials in a variety of health conditions [95,[99][100][101]117] may be taken as indirect evidence for oral bioavailability of specific proteoglycans. However, making reliable conclusions would require direct in vivo pharmacokinetic studies. ...
Follicular proteoglycans are key players with structural, functional, and regulatory roles in the growth and cycling behaviour of the hair follicles. The expression pattern of specific proteoglycans is strongly correlated with follicular phase transitions, which further affirms their functional involvement. Research shows that bioactive proteoglycans, e.g., versican and decorin, can actively trigger follicular phase shift by their anagen-inducing, anagen-maintaining, and immunoregulatory properties. This emerging insight has led to the recognition of “dysregulated proteoglycan metabolism” as a plausible causal or mediating pathology in hair growth disorders in both men and women. In support of this, declined expression of proteoglycans has been reported in cases of anagen shortening and follicular miniaturisation. To facilitate scientific communication, we propose designating this pathology “follicular hypoglycania (FHG),” which results from an impaired ability of follicular cells to replenish and maintain a minimum relative concentration of key proteoglycans during anagen. Lasting FHG may advance to structural decay, called proteoglycan follicular atrophy (PFA). This process is suggested to be an integral pathogenetic factor in pattern hair loss (PHL) and telogen effluvium (TE). To address FHG and PFA, a proteoglycan replacement therapy (PRT) program using oral administration of a marine-derived extract (Nourkrin® with Marilex®, produced by Pharma Medico Aps, Aarhus, Denmark) containing specific proteoglycans has been developed. In clinical studies, this treatment significantly reduced hair fall, promoted hair growth, and improved quality of life in patients with male- and female-pattern hair loss. Accordingly, PRT (using Nourkrin® with Marilex®) can be recommended as an add-on treatment or monotherapy in patients with PHL and TE.
... This degenerative pathological phenomenon, known as Proteoglycan Follicular Atrophy (PFA), is understood to be an important pathology in common types of diffuse hair loss. Mitigating PFA by PRT with a specific, proprietary combination of proteoglycans (Marilex ® ), marketed as Nourkrin ® , has shown efficacy in improving hair growth, hair density and reducing miniaturisation in several clinical trials [17][18][19]. However, the subjective impression of patients about these clinical improvements in different populations has not been sufficiently investigated. ...
... No 54 This hypothesis has been corroborated by a clinical study designed to examine the subjective effects of therapy with Nourkrin ® [17]. A 6-month course of PRT significantly improved the feelings of anxiety and depression, self-confidence, social and sexual activities and work performance in female volunteers with hair loss as measured by the Kingsley Alopecia Profile (KAP). ...
... A 6-month course of PRT significantly improved the feelings of anxiety and depression, self-confidence, social and sexual activities and work performance in female volunteers with hair loss as measured by the Kingsley Alopecia Profile (KAP). Moreover, authors reported a substantial 39% increase in the overall KAP score for self-perceived quality of life at the end of the study [17], which is comparable with a 50% improvement in the quality of life of female participants after 12 months of treatment with the first-line medication, topical minoxidil, measured by dermatology life quality index [26]. ...
... Indeed, several reports have highlighted the evolution of the distribution of HSPGs according to the hair growth cycle phases [1][2][3][4]. Others have shown the benefits of the treatment based on proteoglycans (PG) on the hair shaft growth [5][6][7][8]. Many cells constituting the HF (keratinocytes of outer root sheath (ORS), fibroblasts of dermal papilla, transit-amplifying (TA) cells of the matrix and hair stem cells) express glypicans (GPCs). ...
The expression of glypicans in different hair follicle (HF) compartments is still poorly understood. Heparan sulfate proteoglycans (HSPGs) distribution in HF is classically investigated by conventional histology, biochemical analysis, and immunohistochemistry. Our previous study proposed a novel approach to assess hair histology and glypican-1 (GPC1) distribution changes in the HF at different phases of the hair growth cycle using infrared spectral imaging (IRSI). We show in the present manuscript for the first time complementary data on the distribution of glypican-4 (GPC4) and glypican-6 (GPC6) in HF at different phases of the hair growth cycle using IR imaging. Findings were supported by Western blot assays focusing on the GPC4 and GPC6 expression in HFs. Like all proteoglycan features, the glypicans are characterized by a core protein to which sulfated and/or unsulfated glycosaminoglycan (GAG) chains are covalently linked. Our study demonstrates the capacity of IRSI to identify the different HF tissue structures and to highlight protein, proteoglycan (PG), GAG, and sulfated GAG distribution in these structures. The comparison between anagen, catagen, and telogen phases shows the qualitative and/or quantitative evolution of GAGs, as supported by Western blot. Thus, in one analysis, IRSI can simultaneously reveal the location of proteins, PGs, GAGs and sulfated GAGs in HFs in a chemical and label-free manner. From a dermatological point of view, IRSI may constitute a promising technique to study alopecia.
... A specific cocktail of proteoglycans (Nourkrin), rich in lectican and decorin, was formulated. Clinical studies, conducted on patient with hair loss, have proven its efficacy on hair growth in monotherapy 242,243 or in add-on treatment 244 by increasing the hair count and reducing hair loss. Nourkrin is developed as oral treatment. ...
Heparan sulfate proteoglycans (HSPGs) are part of proteoglycan family. They are composed of heparan sulfate (HS)-type glycosaminoglycan (GAG) chains covalently linked to a core protein. By interacting with growth factors and/or receptors, they regulate numerous pathways including Wnt, hedgehog (Hh), bone morphogenic protein (BMP) and fibroblast growth factor (FGF) pathways. They act as inhibitor or activator of these pathways to modulate embryonic and adult stem cell fate during organ morphogenesis, regeneration and homeostasis. This review summarizes the knowledge on HSPG structure and classification and explores several signaling pathways regulated by HSPGs in stem cell fate. A specific focus on hair follicle stem cell fate and the possibility to target HSPGs in order to tackle hair loss are discussed in more dermatological and cosmeceutical perspectives.
... A speci ic natural supplementation, classi ied as a proteoglycan replacement therapy, Nourkrin ® with Marilex ® , has been demonstrated to be effective for anagen induction and prolongation. An increase of up to 35.7% in hair count over a 6-month period in a double-blind placebo-controlled trial have been demonstrated and reported [35][36][37][38][39]. Studies have also shown a decrease in the number of vellus hairs and an overall increase in number of hairs. ...
To evaluate the treatment with cyproterone acetate and ethinyl oestradiol of diffuse androgen-dependent alopecia in women.
Twenty women were treated for a period of 12 months in a reverse sequential regimen employing cyproterone acetate (CPA, 50 mg once daily from Day 5 to Day 15) and ethinyl oestradiol (EE2, 30 micrograms once daily from Day 5 to Day 24 of the menstrual cycle), and 20 were left untreated and acted as controls. Half of each group had serum ferritin concentrations above or below 40 micrograms/l.
Forty Caucasian premenopausal women aged between 18 and 47 years, presenting with diffuse androgen-dependent alopecia, were enrolled into this study.
Hair variables were assessed initially by the unit area trichogram and again in the same sites 12 months later. Biochemical investigations were performed before treatment and after 3, 6, and 12 months.
In the treated group, a significant (P less than 0.01) mean increase in total hair density (hair/cm2) and meaningful hair density (non-vellus hair/cm2) was found in patients in whom the serum ferritin was above, but not below 40 micrograms/l. However, in the control group a significant (P less than 0.05) mean decrease in total hair density and meaningful hair density was observed after 12 months. No correlation between serum ferritin levels and the degree of hair loss within this group could be established.
Patients treated with the anti-androgen cyproterone acetate and ethinyl oestradiol respond best when serum ferritin is above 40 micrograms/l.
Endocrine profiles were established in nineteen women, aged 18–43 years, with common baldness. Reduced plasma levels were found in SHBG (68%), luteal phase progesterone (52%) indicating sub-fertility, LH (42%), oestradiol (37%) and FSH (21%), while plasma total testosterone was raised in only one patient.
Three women with a history of diffuse loss of scalp hair of 2, 13 and 23 years duration and a familial history of premature balding in two, were treated with cyclical antiandrogen therapy (CAT) for 52 weeks. All showed an increase in hair density (hairs/cm2), and in the number of hairs greater than 40 um diameter/cm2 (meaningful density) after 24–28 weeks. The percentage of hairs in the anagen growth phase increased during therapy. Three control patients, left untreated for 26 weeks, showed no significant improvement in hair density, meaningful density or the percentage of hair in the anagen growth phase.
During CAT, each patient showed an increase in plasma SHBG and a fall in plasma testosterone levels. One patient with severe depressive symptom related to hair loss prior to therapy, returned to a normal way of life without the need for psychotropic drugs.
The unit area trichogram was defined in the frontal and occipital areas of ten normal men and ten normal women and the results compared with the findings in ten male and fifteen female patients with androgenic alopecia. The epilation technique provided accurate data of normal hair density (higher than previously reported) and the phases of hair growth. The measurement of hair diameter showed that of 7603 hairs, 1241 were less than 40 microns in diameter, of which only 21 were more than 80 mm in length. Variation in the diameter of individual hair fibres was recorded. The number of hairs less than 40 microns diameter per cm2 of scalp was increased in both men and women with androgenic alopecia. It was concluded that the number of hairs greater than 40 microns in diameter per cm2 (meaningful density) reflected most closely the amount of hair usefully contributing to an individual's clinical appearance.
While the precise incidence of androgenetic alopecia is unknown, it is universally acknowledged to be the most common hair problem in men. Balding is generally associated with ageing; consequently, the desire to prolong a youthful appearance inevitably leads to demands for effective treatments. Further, changing attitudes in modern society have resulted in people becoming concerned about their appearance and less tolerant about conditions that might be alleviated by medical intervention. The importance of hair loss upon quality of life has been underestimated by the medical profession. Clinicians failing to accept hair loss as an important medical problem ignore the real distress suffered by a significant proportion of those affected. New options for treatment that selectively target the metabolic pathways involved in the balding process are showing promise. The first generation of such drugs, Propecia, is now available in some countries and other molecules are currently under development.
Despite the high prevalence and the accepted psychological aspects of male pattern hair loss, few have characterized the effects of hair loss in representative samples of men in different countries. A representative sample of households in 4 European countries (France, Germany, Italy and the United Kingdom) was contacted by an interviewer and resident males 18-40 years of age (n = 1,717) completed a questionnaire designed specifically to evaluate attitudes to hair loss. The questionnaire was comprised of 78 questions translated and pilot-tested using standard methodology into each local language. Questionnaires queried about self-rated hair loss, satisfaction with hair appearance, noticeability of hair loss to others, and bother, concerns and perceptions about hair loss, as well as general physical health (the SF-12 questionnaire) plus three additional questions about mental health. The self-reported degree of hair loss in men was statistically significantly associated (p < 0.001) with all hair-loss specific effects measured, except "limiting job opportunities". The impact of hair loss was generally consistent in the four countries surveyed, although less pronounced in the United Kingdom. Age was significantly correlated with hair loss (rs = 0.34, p < 0.001). Men with greater hair loss were more bothered, more concerned about looking older due to their hair loss, and less satisfied with their hair appearance. Male pattern hair loss has significant negative effects on hair-loss specific measures in men 18 to 40 years of age in France, Italy, Germany and the UK. The degree that hair loss is perceived as noticeable to others appears to be a significant contributor to these negative effects.
This randomized, double-blind, placebo-controlled study was designed to investigate the efficacy and tolerability of Nourkrin, a new natural agent for the treatment of hair loss based on marine proteins, and minerals and vitamins. Fifty-five subjects with hair loss of different aetiologies participated in the 6-month blinded phase of the study. Objective assessments showed a significant positive effect of treatment on hair growth. Intake of the active preparation for a further 6 months in an open phase indicated a subjective further improvement in hair growth. Exposure of the patients previously treated with placebo to the active preparation for 12 months gave similar results. Tolerability was good and no side-effects were reported. Nourkrin may provide an alternative to pharmacotherapy for the treatment of hair-loss problems in individuals with androgenetic alopecia.
Female pattern alopecia is a common dermatologic condition that manifests after puberty. The only approved drug treatment for this condition is 2% minoxidil for topical application.
This pilot study examined the effect of topical application of two niacin derivatives, octyl nicotinate and tetradecyl nicotinate, on hair fullness in female alopecia.
Sixty female subjects with Ludwig types I-III female pattern hair loss were evaluated in a double-blinded, placebo-controlled (40 active, 20 placebo) design using standardized 35-mm photographic analyses for assessment of efficacy after 6 months of application.
The niacin derivatives demonstrated a statistically significant increase in hair fullness (P = 0.04 compared to the placebo).
Whereas evaluation of hair growth in women is challenging, this 6-month pilot study demonstrated statistically significant increase in hair fullness on blinded 35-mm photographic analysis. Long-term topical application of nicotinic acid derivatives offers promise for providing benefit in female alopecia and warrants further study.
Personality and attitude measurements were carried out on 204 adult males suffering from hair loss. Three groups were tested: those in the first group had had a hair weave fitted and were retaining the weave as a viable solution to their hair problem; the second had worn the weave for a trial period but had decided against its continued use; the third had had no form of treatment and seemed little concerned about their hair loss. Results showed that all three groups possessed N and P scores which were significantly higher than those shown by a normative group of males in the same age range, but that the weave-retaining group scored significantly lower on E than the normative group: other personality differences were non-significant. The group who had rejected the hair-weave treatment as a viable solution to their hair-loss problem was significantly more neurotic and possessed a significantly lower self-esteem than the group that retained the weave: this latter group had scores on these and all other variables tested which were very similar to those of the group that had had no treatment.
Background: Preoccupation with hair loss and fear of getting bald is a frequent finding among patients referred to dermatological clinics. Objective: Identification of depression and anxieties that may be the underlying psychopathology of a patient with this preoccupation. Patients and Methods: 50 patients with the preoccupation of pathological hair loss who were referred to our clinic within a period of 2 months. The Beck, Taylor and Maudsley inventories were performed on all patients to determine the presence and level of depression, anxiety, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Results: 45 out of 50 patients, i.e. 90%, were found to have affective disorder such as depression, anxiety, OCD, OCPD or a combination of these. Different levels of depression could be identified in 33 cases, OCD in 32, OCPD in 19, and anxiety in 29 patients. Most patients suffered from more than one psychological disorder: 21 patients suffered from 3, and 14 patients from 2 disorders. 10 patients suffered from only one co-existing disorder: 4 from mild depression, 4 from OCD, and 2 from OCPD. The remaining 5 patients showed no psychological problem according to the inventories used. Conclusion: Many patients with normal looking hair but the preoccupation of losing too much hair and the fear of getting bald may actually suffer from hair loss dysmorphic disorder. These people may have one or more psychopathologies, which should be identified and treated properly.
The authors wished to confirm the efficacy of low level laser therapy (LLLT) using a Hair- Max LaserComb for the stimulation of hair growth and also to determine what effect LLLT with this device had on the tensile strength of hair. Thirty-five patients, 28 males and 7 fe- males, with androgenetic alopecia (AGA) underwent treatment for a six-month period. Both the hair counts and tensile strength of the hair were affected very beneficially in both sexes in the temporal and vertex regions, with the males and vertex areas showing the most im- provement.
provides an overview of the psychology of physical appearance—the scientific study of how our physical aesthetics and our bodily attributes, including our somatic self-perceptions, affect our lives / this review examines some of our knowledge (and our ignorance) concerning physical appearance / the chapter focuses largely upon physical attributes that fall within the normal range of appearance
overall appearance: social images [appearance-cued stereotyping, social consequences of appearance stereotyping] / developmental consequences of appearance for psychosocial adjustment / body-self relations: "the inside view"
bodily attributes: social images and self-images [body weight: obesity, social stigma, and self-stigma, male pattern hair loss] / aesthetic self-management of physical appearance (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Hair follicle stem cells and dermal papilla cells play essential roles in the cyclical hair regeneration process. However, compared with the recent progress of follicular stem cell research, detailed analysis of dermal papilla cells is virtually unknown. We have focused on a large chondroitin sulfate proteoglycan molecule, versican, and prove its pivotal role in hair follicle induction both in vitro and in vivo. First, we examined versican expression with hair cycling by in situ hybridization (mRNA) and immunohistochemistry (protein). Results clearly showed specific versican expression in anagen onset of dermal papilla cells implying a function role of versican in hair induction. We then generated transgenic lines with LacZ or green fluorescent protein reporter genes under a versican regulatory element (promoter) control, and confirmed dermal papilla-specific activation of the reporter. These transgenic lines were utilized to isolate the dermal papilla cell population by means of a fluorescent activated cell sorter.
Psychological characteristics were studied in 85 healthy men with early-stage alopecia androgenetica who participated in a double-blind clinical trial on the effect of minoxidil. No evidence of psychosocial malfunctioning was found in the group suffering from hair loss as indicated by personality traits, general psychological adjustment and social functioning. These subjects were less rigid and more self-confident than comparable norm groups. However, specific problems attributed to hair loss were present in more than 30%. More psychological improvement, with regard to hair problems, social discomfort, and self-esteem occurred in the minoxidil group than in the placebo group. The findings are exploratory, because the pretest data were obtained in retrospect.
This study probes one particular component of the well documented linkage between personal appearance and impression formation by investigating the extent to which and the mechanisms through which bald and balding men are underrepresented in high elective office. Study 1 compares the prevalence of hair loss among governors and members of Congress, on the one hand, and the general public, on the other, and concludes that officeholders are much more likely to have a full head of hair than would be expected of men of their age. Study 2 poses an experimental test of voter bias against bald and balding candidates by presenting voters in a simulated congressional race with materials depicting otherwise identical candidates in either their natural bald or balding condition or wearing a professionally fitted hairpiece. No voter bias against bald or balding candidates is apparent, a finding that suggests that the causal mechanism underlying underrepresentation of bald and balding men is not voter bias.
Background and objective: The use of low levels of visible or near infrared light for reducing pain, inflammation and oedema, promoting healing of wounds, deeper tissue and nerves, and preventing tissue damage has been known for almost 40 years since the invention of lasers. The HairMax LaserComb® is a hand-held Class 3R lower level laser therapy device that contains a single laser module that emulates 9 beams at a wavelength of 655 nm (±5%). The device uses a technique of parting the user’s hair by combs that are attached to the device. This improves delivery of distributed laser light to the scalp. The combs are designed so that each of the teeth on the combs aligns with a laser beam. By aligning the teeth with the laser beams, the hair can be parted and the laser energy delivered to the scalp of the user without obstruction by the individual hairs on the scalp. The primary aim of the study was to assess the safety and effectiveness of the HairMax LaserComb® laser phototherapy device in the promotion of hair growth and in the cessation of hair loss in males diagnosed with androgenetic alopecia (AGA).
Methods: This double-blind, sham device-controlled, multicentre, 26-week trial randomized male patients with Norwood-Hamilton classes IIa-V AGA to treatment with the HairMax LaserComb® or the sham device (2: 1). The sham device used in the study was identical to the active device except that the laser light was replaced by a non-active incandescent light source.
Results: Of the 110 patients who completed the study, subjects in the HairMax LaserComb® treatment group exhibited a significantly greater increase in mean terminal hair density than subjects in the sham device group (p
Androgenetic alopecia in the female occurs much more frequently than is generally believed. The condition is still considered infrequent, for it differs, in its clinical picture and in the sequence of events leading to it, from common baldness in men. To facilitate an early diagnosis (desirable in view of the therapeutic possibilities by means of antiandrogens) a classification of the stages of the common form (female type) of androgenetic alopecia in women is presented. The exceptionally observed male type of androgenetic alopecia can be classified according to Hamilton or to the modification of this classification proposed by Ebling & Rook.
Thirty-two women complaining of diffuse alopecia were examined by a psychiatrist. Seven of them were found to have severe, usually long-standing marital and sexual problems and two of them were overtly depressed. In a previous investigation the results of tests to assess the degree of hair loss of these seven women showed no significant difference from the values obtained in a control series of women. The psychopathology underlying this complaint is discussed and it is suggested that those women whose anxiety seems disproportionate to their degree of hair loss should be carefully questioned regarding depression and marital difficulties as these may cause them to be unusually sensitive to a hair loss which normally might not worry them sufficiently to seek further advice. They may then use their hair in a symbolic way to obtain help with their underlying problems.
Despite the prevalence of androgenetic alopecia among men, little is known about its psychological effects.
This investigation examined the psychosocial sequelae that balding men attribute to hair loss and compared balding and nonbalding men in personality functioning.
Subjects included 63 men with modest balding, 40 men with more extensive balding, and 42 nonbalding controls. All anonymously completed a battery of standardized psychological measures.
Reported effects of balding reflected considerable preoccupation, moderate stress or distress, and copious coping efforts. These effects were especially salient among men with more extensive balding and among younger men, single men, and those with an earlier hair-loss onset. Relative to controls, balding men had less body-image satisfaction yet were comparable on other personality indexes. Personality correlates of the psychological responses to hair loss were identified.
Although most men regard hair loss to be an unwanted, distressing experience that diminishes their body image, balding men actively cope and generally retain the integrity of their personality functioning.
The psychological characteristics and the hair problems of 58 females with androgenetic alopecia were compared with a group of women with non-apparent dermatological diseases, and with a group of men with androgenetic alopecia. The women with androgenetic alopecia had higher scores for self-sufficiency and social inadequacy compared to women with non-visible dermatological complaints, and they scored higher for inadequacy, rigidity and general psychological maladjustment than the men and had lower scores for injuredness self-evaluation and self-esteem. The women with androgenetic alopecia had more psychosocial problems, which they attributed to the hair loss, than the other groups.
Psychologic characteristics were studied in a sample of 168 men with alopecia androgenetica who participated in a clinical trial on the efficacy of minoxidil gel. In general, no evidence of psychologic malfunctioning was found. Instead, a slightly more adequate psychologic state was indicated. However, specific problems associated with hair loss were reported by a substantial number of men. Responders with cosmetic improvement in the group over 35 years of age improved more regarding general psychologic maladjustment, inadequacy, and self-evaluation than those who did not respond. A reverse trend was, however, found in the group younger than 35 years of age, where the nonresponders improved more. An explanation for these findings is derived from the theory of cognitive dissonance.
Scalp hair loss problems and the policies of general practitioners were studied by sending questionnaires to 374 physicians, of whom 21% responded. About 50% of the patients, according to their physicians, had psychological problems which predominantly comprised low self-esteem in the male patients and fear and anxiety in the female patients. The general practitioners followed the same policy for patients with psychological problems and for those without. The findings suggest that many alopecia patients need more psychological support from their physicians.
Data obtained from 91 American male respondents, ranging in age from 23 to 66 years of age, indicated that a personality trait, public self-consciousness, pertaining to habitual attention to and concern for public self-aspects, was related to both perceptions of men with thinning hair and reactions to one's own thinning hair. Men with high public self-consciousness were not only more likely to believe that balding men were less attractive, but were also more likely to believe that balding men were less desirable romantic partners for women. Furthermore, faced with their own hair loss, they expressed greater concern and were more willing to try prescription hair remedies to grow thicker hair than were their low self-consciousness counterparts. Despite the concern that hair loss appears to cause many men, there was no evidence that the onset of hair loss caused changes in level of public self-consciousness.
Consultations, motives, experience, and attitudes were explored in 201 men with alopecia androgenetica who had two years before shown interest in hair treatment using minoxidil. During the past two years, one-third consulted a professional on account of hair loss. General practitioners were consulted by 60% and other professionals by about 75%. The main motive for the consultation was hair treatment, which was offered to half of the consulting subjects. Medical professionals were generally considered to be more suitable than other professionals for consultation on minoxidil treatment. The perceived chance of the treatment being successful and the amount of hair problems experienced seemed more important factors for consulting than the views on the suitability of a professional or the extent of baldness. There were indications that subjects who consulted both general practitioners and other professionals had also more general problems.
Hair is more than meets the eye. Despite arguments that the study of its psychologic and sociologic implications is frivolous, hair is important. Another person's hair is one of the first characteristics we notice upon meeting. Our own hair is one of the first and last characteristics we attend to before a meeting or a social engagement.Observations of contemporary culture suggest that hair has significance to society as a whole and in the lives of individuals. Existing social science research on hair is not voluminous but recently has noted that “the psychology of hair is a subject of growing interest.”1 At present, social science research addresses hair both directly and indirectly. Direct research focuses on psychologic and sociologic dimensions of hair. While scant, this research investigates color, length/style, and amount (in terms of baldness). Indirect research reflects a greater quantity and involves hair as a determinant of an individual's physical attractiveness. As such, selective social science data about physical attractiveness that is partially determined by hair can be reasonably generalized as social science data that specifically focuses on hair. Given interdependences between hair and physical attractiveness, these relationships reflect a straightforward extrapolation of knowledge. As a result, psychologic and sociologic knowledge of hair exists in a robust body of social science reseach.Accordingly, this article discusses research on “the physical attractiveness phenomena” as well as an overview on the psychologic and sociologic dimensions of an individual's hair.
Significant hair growth occurred in 53% of the 81 patients completing a 1 year trial of topical minoxidil. The average reduction in the diameter of the balding crown was 3.48 cm for all patients. There were no minoxidil related changes in laboratory tests during the study period. Psychosocial studies of our patients indicate that 95% assessed the effectiveness of topical minoxidil as moderate or excellent. The majority of those participating in the study thought that their personal presentation of self was of equal or greater importance than their work performance. It was concluded that topical minoxidil has the potential to improve male pattern baldness significantly without apparent risk and to be a means by which individual presentation of self may be improved.
One-hundred twenty-six healthy men with early male pattern baldness completed a 12-month double-blind, controlled trial of 2% and 3% topical minoxidil. Subjects were initially randomly assigned to use placebo or 2% or 3% topical minoxidil. After 4 months of study, the placebo group was crossed over to 3% topical minoxidil. Both objective measurement of hair growth by counting of vellus, terminal, and total hairs in a vertex target balding area and subjective assessment by subject and investigator were done. Treatment of subjects with topical minoxidil for 4 months resulted in a statistically significant increase in terminal hair growth in comparison with placebo therapy. In addition, subjects initially treated with placebo, when crossed over to topical minoxidil, showed a significant increase in the number of terminal hairs. No subject had a net hair loss in the target area during the study. These results indicate that topical minoxidil can increase terminal hair growth in early male pattern baldness.
Alopecia, or loss of hair, is felt by many cancer patients to be the most traumatic side effect of chemotherapy. The presence of hair contributes substantially to each person's overall appearance or body image. If a person's hair is suddenly taken away as a result of chemotherapeutic damage done to the hair follicles, then the resulting alopecia should alter the patient's body image. In order to assess perceptions of alteration in body image, a body image scale was administered to 40 cancer patients receiving chemotherapy. Patients with alopecia were expected to score higher, thus indicating lowered body image than patients without alopecia. The findings of this study showed a statistically significant difference in the scores on the body image scale between patients with alopecia and patients without alopecia.
This article has no abstract; the first 100 words appear below.
Testosterone, the principal circulating androgen, acts directly in many tissues. To be active in the prostate and skin, testosterone must be converted to dihydrotestosterone by the enzyme 5α-reductase (Figure 1). Most dihydrotestosterone in the prostate arises from testicular precursors, although some arises from adrenal precursors¹. In women, although the relative ovarian and adrenal contributions to intracellular dihydrotestosterone are unknown, the two organs contribute equally to testosterone production². Finasteride is one of several inhibitors of 5α-reductase that have recently been developed. These drugs selectively block dihydrotestosterone production and androgen action in the prostate and skin. Finasteride (Proscar) has been . . .
Source Information
From the Department of Medicine, Dalhousie University, Rm. 809, Gerard Hall, 5303 Morris St., Halifax, NS B3J 1B6, Canada, where reprint requests should be addressed to Dr. Rittmaster.
In order to investigate the relationship between male hair loss and psychological distress, 182 men were recruited who had a wide range of ages and hair loss varying from none to severe. Care was taken to ensure that hair loss and age were uncorrelated in the sample. Multiple regression was used to predict possible consequences of baldness, controlling for age, and examining the interaction between baldness and age to see if consequences were especially severe in cases of premature baldness. Increasing degrees of hair loss were associated with loss of self-esteem, depression, introversion, neuroticism and feeling unattractive. These effects were more marked for young men in the case of self-esteem, introversion and feeling unattractive.
Versican is a member of the group of aggregating proteoglycans involved in matrix assembly and structure and in cell adhesion. We examined changes in the distribution of versican in mammalian skin, with emphasis on hair follicle development and cycling. In adult human skin, immunostaining for versican appeared predominantly in the dermis, with intense staining of the reticular dermis. Weak staining was observed at the dermoepidermal junction and the connective tissue sheath of hair follicles. Versican expression was also noted in the reticular dermis of rat skin, within dermal papillae, and possibly associated with follicle basement membranes. During mouse hair follicle development, versican was not expressed until the hair follicles were beginning to produce fibers. With follicle maturation, versican expression intensified in the dermal papillae, reaching a maximum at the height of the growth phase (anagen), after which it diminished as the end of this phase approached. Versican immunoreactivity in the papillae decreased further during catagen and was absent from these structures during telogen. However, intense staining for versican was then observed in the neck regions of telogen follicles. As the follicles entered the next hair cycle, versican disappeared from the necks and was again seen in the dermal papillae when follicles began producing fibers. This type of expression continued throughout subsequent hair cycles and is unlike any other dermal papilla component. The results of this study are consistent with a distinct supportive role for versican in the follicle matrices during hair follicle morphogenesis and cycling.
The few articles published on the interactions between psychological factors and alopecia seem to yield contrasting results. To assess the relationships between alopecia, gender, Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorders, and psychopathologic symptoms reactive to alopecia, we administered the Personality Disorders Questionnaire-Revised and the Symptoms Checklist-90 to a randomly selected sample of 116 outpatients with androgenetic alopecia.
The prevalence of personality disorders in subjects with androgenetic alopecia proved to be significantly higher than the prevalence of such diagnoses in the general population. Women did not show a higher prevalence of personality disorders or more psychopathologic symptoms than men. The factor analysis demonstrated the existence of three personality profiles (F1, F2, and F3) significantly and specifically associated with the subject's gender and with the psychopathologic reactive symptoms, measured using the Symptoms Checklist-90.
The most important factor in developing a psychopathologic reaction to alopecia seems to be the presence of a Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorder and not the subject's gender.
The mind plays a dual role in the pathology of the hair follicle: the disease has repercussions on the mind, and the mind in turn may trigger off or exacerbate its course. As all skin diseases, those involving the hair follicles have much to do with vision, and they profoundly alter the images the subjects has of himself (self image) and offers to other persons. Repercussions on the mind are particularly intense with these diseases since they usually occur on the face and during adolescence. It results from these findings that a dual, somatic and psychological approach of the patient is indispensable. Moreover, this approach increases the patient's compliance with the treatment prescribed.
Quality of life and maladjustment related to hair loss were studied by means of a standardized interview in a group of 58 women with alopecia androgenetica who applied for treatment at the Department of Dermatology. The hair loss was found to have a negative influence on the quality of life on the majority of them. In 88%, hair loss had negative effects on their daily life; in about 75%, the hair problems were manifested in negative self-esteem and about 50% experienced social problems. General psychosocial maladjustment in relation to hair loss was indicated in almost one-third of the women.
Several studies have examined the psychological impact of androgenetic alopecia on men but scientific evidence is absent regarding its effects on women.
Our purpose was to determine the psychosocial sequelae of androgenetic alopecia in women and, comparatively, in men.
Subjects were newly referred patients with androgenetic alopecia (96 women and 60 men) and 56 female control patients. Subjects completed standardized questionnaires to assess their psychological reactions to their respective conditions and to measure body image, personality, and adjustment.
Androgenetic alopecia clearly was a stressful experience for both sexes, but substantially more distressing for women. Relative to control subjects, women with androgenetic alopecia possessed a more negative body image and a pattern of less adaptive functioning. Specific correlates of the adversity of patients' hair-loss experiences were identified.
The results confirm the psychologically detrimental effects of androgenetic alopecia, especially on women. The implications for patient care are discussed.
Few studies have quantified the psychosocial effects of hair loss using standardized instruments in men not seeking treatment for hair loss.
Examine self-perception of hair loss and its effects on men from the community.
Men 18-50 years of age recruited without regard to hair loss, from households near Dayton, Ohio, completed a questionnaire assessing self-perception of hair loss, satisfaction with hair appearance, hair-loss-specific effects and general health status.
Men with greater hair loss had more bother, concern about getting older, perceived noticeability to others and greater dissatisfaction with their hair appearance than men with less hair loss. These effects decreased with age for men with hair loss, but regardless of age, perceived noticeability of hair loss increased monotonically with degree of hair loss.
Men with greater hair loss report more negative effects due to their hair loss across all age groups, but the effects were more pronounced in younger men.
Despite the prevalence of androgenetic alopecia (AGA) and the acceptance of its associated psychological factors in women, few studies have directly queried women about which specific aspects of their lives are affected by hair thinning and the relative importance of such effects. Perceptions of such negative effects can influence patient satisfaction, health-related quality of life (HRQL) and the impetus to seek medical attention for hair loss. Women (n = 120) aged 22-66 years with at least mild (Ludwig I) AGA were recruited from two dermatology clinics and from a large worksite and asked to complete a questionnaire. The questionnaire solicited information about specific aspects of their lives potentially affected by AGA and the relative importance of those aspects. Inability to style their hair, dissatisfaction with their appearance, concern about hair loss continuing, and concern about others noticing their hair loss were most important to women. Emotional aspects also ranked high, including self-consciousness, jealousy, embarrassment, and feeling powerless to stop their hair loss. In summary, women with AGA report numerous ways in which their hair thinning affects their lives. Knowledge of these effects may be beneficial in counseling such patients and in designing clinical trials or epidemiological studies to evaluate hair loss in women.
Androgenetic alopecia is a common dermatological condition, with potentially adverse psychosocial sequelae. The present review critically examines scientific evidence concerning the effects of androgenetic hair loss on social processes and psychological functioning, as well as the psychosocial outcomes of medical treatments. Research confirms a negative but modest effect of visible hair loss on social perceptions. More importantly, androgenetic alopecia is typically experienced as a moderately stressful condition that diminishes body image satisfaction. Deleterious effects on self-esteem and certain facets of psychological adjustment are more apparent among women than men and among treatment-seeking patients. Various 'risk factors' vis-à-vis the psychological adversity of androgenetic alopecia are identified. Medical treatments, i.e. minoxidil and finasteride, appear to have some psychological efficacy. A conceptual model is delineated to explain the psychological effects of hair loss and its treatment. Directions for needed research are discussed. Strategies are presented for the clinical management of psychological issues among these patients.
Measurements of the quality of life (QoL) have recently become an integral part of dermatological studies. Our hypothesis is that QoL in patients with certain diseases can be affected by strategies of coping behaviour, as well as by personality traits.
The aim of this study was to explore the particular correlation between QoL and strategies of coping in female patients with alopecia.
Fifty female patients, diagnosed with either diffuse or androgenetic alopecia, were evaluated by the use of Hairdex, an instrument developed to measure QoL in patients with hair loss. Most patients also underwent additional psychological assessments.
Findings indicated that patients with highly visible hair loss reported a more negative impact on four Hairdex dimensions (functioning, emotions, self-confidence and stigmatization) than patients whose hair loss was only slightly visible. However, a subgroup of patients, with non-visible symptoms of hair loss, showed striking signs of psychological disturbance. These disturbed patients displayed either dysmorphophobic or affective disorder tendencies.
Future studies using QoL as an instrument in research on patients with alopecia should consider that in cases of female alopecia these measurements may be affected by psychological disturbances.
Hair, especially scalp hair, is imbued with greater social and psychological significance than with biological importance. Hair provides some cranial cushioning and shielding from the sun’s rays; however, throughout history and across cultures, hair conveys considerable symbolism.1‐3 It can serve as a social signal of gender, age, status, values, and group membership. From monks to skinheads, prisoners of war to warriors, “bigwig” European aristocrats to moptop Beatles, and hippies to head-shaven celebrity athletes, hair makes a statement, whether chosen or imposed. Beyond its sociological meanings, hair can become an essential part of self-identity or “body image.” Body image is a psychological concept that refers to one’s perceptions, thoughts, feelings, and behaviors related to one’s physical appearance.4 For many people, hair is a physical attribute that expresses individuality and is central to feelings of attractiveness or unattractiveness. Indeed, scalp hair is rather unique as an actual part of the human body that is readily malleable in altering or managing one’s physical appearance. In a relatively short time, one can color, cut, curl, and/or restyle one’s hair to create the visual image one desires. In contrast, other bodily transformations require substantial time and effort (eg, loss of weight or increase in muscle definition), involve artificial adornments (eg, clothing, cosmetics, and jewelry), or entail surgical procedures (eg, a face lift). For many people (and other primates), hair is a focal aspect of a daily grooming ritual. Preparing one’s hair is preparation to face one’s social world. The expression “bad hair day” is testimony to the psychological importance of hair. Hair loss can turn every day into a bad hair day. The purpose of the present article is to provide the practicing dermatologist useful information and insights about the psychological effects of hair loss, particularly androgenetic alopecia (AGA). This clinically oriented presentation draws upon the scientific literature on the psychosocial sequelae of hair loss5,6 and contemporary perspectives concerning the psychology of physical appearance.4,7,8
Versican, a large chondroitin sulfate proteoglycan molecule, is implicated in the induction of hair morphogenesis, the initiation of hair regeneration, and the maintenance of hair growth in mouse species. In contrast, in human hair follicles, the distribution and the roles of versican remains obscure.
To elucidate the implication of versican in normal human hair growth.
Versican expression was examined by in situ hybridization (mRNA) and immunohistochemistry (protein).
The results clearly showed specific versican gene expression in the dermal papilla of anagen, which apparently decreased in the dermal papilla of catagen hair follicles. No specific signal was detectable in telogen hair follicles. Consistent with ISH results, versican immunoreactivity was extended over the dermal papilla of anagen hair follicles, and again, this staining diminished in the catagen phase of human hair follicles. Interestingly, versican proteins were deposited outside K15-positive epithelial cells in the bulge throughout the hair cycle. Versican immunoreactivity in the dermal papilla was almost lost in vellus-like hair follicles affected by male pattern baldness.
Specific expression of versican in the anagen hair follicles suggests its importance to maintain the normal growing phase of human as well as mouse.
Balding men are viewed as less desirable in a physical, personal, and social sense. Given the stereotype, it is not surprising that some men with androgenetic alopecia (AGA) appear to have a lower self-image, depression resulting in increased introversion, and increased feelings of unattractiveness.
Ours is a culture that places a premium on physical appearance. In this context, appearance-altering conditions can be psychosocially insidious, especially conditions such as AGA with an uncertain course and a negative social meaning.
To date, little or no data have been available regarding the psychosocial and quality-of-life aspects of AGA in a representative sample of community men. It is unknown whether AGA is a causal factor in the development of low self-esteem, depression, introversion, and feeling of unattractiveness, or whether there are underlying problems in certain patients prior to hair loss. Longitudinal studies will be important to investigate the temporal relationships between the degree of hair loss and psychosocial variables associated with AGA.
A patient with male pattern baldness will be better treated and consequently more satisfied (better quality of life) if he receives effective anti-alopecia agents and simultaneously is evaluated and treated, if needed, for his psychological disorder.
Why men with hair loss go to the doctor
- J Passchier
- S E Rijpma
- Dutree-Meulenberg
- Ro
- F Verhage
Passchier J, Rijpma SE, Dutree-Meulenberg RO, Verhage F. et al. (1989) Why men with hair
loss go to the doctor. Psychol. Reports, 65: 323-30.
The development and validation of a quality of life measure for the impact of androgen-dependent alopecia. Qual
- D H Kingsley
Kingsley DH. (2000) The development and validation of a quality of life measure for the impact
of androgen-dependent alopecia. Qual. Life Res J., 9: 331.
Androgenetic Alopecia in Women: Diagnosis and Treatment
- M G Mercurio
Mercurio MG. (1997) Androgenetic Alopecia in Women: Diagnosis and Treatment. Hosp. Med.,
33: 30-38.
A quality of life measure for the impact of genetic alopecia
- D H Kingsley
Kingsley DH. (2000) A quality of life measure for the impact of genetic alopecia. Poster at the
7th International Society for Quality of Life Research, Vancouver, Canada, Oct 29-31.
The psychosocial effects of male pattern balding
- T F Cash
Cash TF. (1989) The psychosocial effects of male pattern balding. Patient Care, 1: 18-23.
Antiandrogen activity of progesterone in human skin
- F Wright
- M-O Kirchhoffer
- M Giacomini
Wright F, Kirchhoffer M-O, Giacomini M. (1980) Antiandrogen activity of progesterone in
human skin. In Percutaneous Absorption of Steroids. New York: Academic Press, p. 123-138.
- R S Rittmaster
- N Finasteride
- Eng
Rittmaster RS.( 1994) Finasteride. N. Eng. J. Med., 330: 120-5.