Changes of Hair Diameter after Treatment of Androgenic Alopecia; the First Case-control Study
Mahsa Jamshidi Asl,
Elham Razzagh Karimi,
Daniel F. Fouladi
Diminished hair diameter has been suggested as an early indicator of androgenic
alopecia. The objective of the present work is to examine hair diameter changes
after appropriate treatments in patients with androgenic alopecia, considering
other possible interfering factors such as sex, natural hair color and location
of hair sampling on the scalp. In a cross-sectional, case-control setting, 41
patients with androgenic alopecia (the case group) and 41 age and sex-matched
healthy individuals (the control groups) were recruited from a referral dermatological
center in Tabriz from September 2008 to December 2011. Patients received standard
treatments for six months. Hair diameter was measured using a standard digital
micrometer (Mitutoyo 0.001 mm, Japan) at baseline and six months later in both
groups. In the case group, the mean hair diameter increased significantly from
0.052±0.008 to 0.055±0.008 m, 6 months later (p = 0.03). In the control group,
the change of the mean hair diameter was not statistically significant in the
controls. Frontal hairs were the While the mean hair diameter in female patients
was higher, the mean change of hair diameter after treatment was significantly
more in male patients. The mean hair diameter was significantly higher in light-brown
than in dark-brown hairs of the patients thinnest samples, in this study. In
conclusion, although hair diameter increased significantly after treatment,
other factors such as gender, hair color and location on the scalp may also
play significant roles in this regard.
to cite this article:
Effat Khodaeiani, Shahla Babaeinejad, Mahsa Jamshidi Asl, Elham Razzagh Karimi, Daniel F. Fouladi and Morteza Ghojazadeh, 2014. Changes of Hair Diameter after Treatment of Androgenic Alopecia; the First Case-control Study. Journal of Medical Sciences, 14: 97-100.
Received: October 15, 2013;
Accepted: November 09, 2013;
Published: January 16, 2014
Hair has been always important for human in terms of beauty, attractiveness
and even social prestige. Thus, hair loss and disorders may significantly affect
mental and physical well-being of patients. In females, hair loss has been interpreted
as marred feminine characteristics (Helms et al.,
2008; Erol et al., 2012). Hair problems
are very common all over the world. Many etiologies underlie hair disorders,
among them androgenic alopecia is a widespread subtype in both males and females
(Gordon and Tosti, 2011; Firooz
and Fouladi, 2012). In normal individuals, hair diameter varies between
40 and 120 micrometer. Accordingly, hairs can be categorized as fine
(thickness >60 μm), medium (thickness: 60-80 μm) and
thick (thickness >80 μm) (Kang et
al., 2009). Along with hair loss, diminished hair thickness has been
also suggested as a major sign of androgenic alopecia, even in early stages
when the problem is not apparent yet. This is because hair diameter is an accurate
index of hair mass (Paus and Cotsarelis, 1999). As a
result, hair diameter changes can be used as an indicator of treatment efficacy
in such patients. Despite the importance of hair diameter in this regard, there
is lack of related studies in the literature (Ishino et
al., 1997; Sagsoz et al., 2004). The
present study, for the first time, aimed to examine hair diameter changes after
appropriate treatments in androgenic alopecia in a well-designed, case-control
study. In addition, possible effect of other factors such as gender, hair color
and hair location on the scalp was also investigated in this regard.
MATERIALS AND METHODS
In this case-control study, 41 patients with androgenic alopecia were recruited
from a referral clinic of dermatology in Tabriz from September 2008 to December
2011. Androgenic alopecia was present in at least one first-degree relative
of the enrolled patients. Forty-one age and sex-matched healthy individuals
served as the controls. First-degree relatives of the controls were negative
for androgenic alopecia. The ethics committee of Tabriz University of Medical
Sciences approved this study. Written informed contests were obtained from the
participants. All the patients in the case group received similar appropriate
treatments for androgenic alopecia by an experience dermatologist for 6 months.
A standard hair pull test (Gordon and Tosti, 2011)
was performed on the scalps of both cases and controls at the baseline. This
test included gentle traction on a group of hairs (approximately 40-60) on three
separate areas of the scalp. The test was repeated 6 months later in the case
group and at the same time in the control group. A digital micrometer (Mitutoyo
0.001 mm, Japan) was used to measure diameter of the pulled hairs near their
base (Dhurat and Saraogi, 2009). The operator was blind
to the group of the studied hairs. In addition to hair diameter, age, sex and
natural hair color were also documented.
Statistical analysis: The SPSS Software for Windows (ver.16.0, SPSS
Inc., IL, USA) was used for analysis. One-way Analysis of Variance (ANOVA) along
with Tukey post hoc test and the Chi-square (χ5) or Fishers exact
tests were used. A p-value ≤0.05 was considered statistically significant.
Demographics and general data of the cases and controls are summarized in Table
1. The two groups were comparable in terms of sex, age, hair color and hair
diameter at baseline. In the case group, the mean hair diameter increased significantly
from 0.052±0.008 to 0.055±0.008 m, 6 months later (p = 0.03).
The change of the mean hair diameter was not statistically significant in the
controls (0.050±0.009 m at baseline, 0.049±0.008 m 6 months later,
p = 0.46). The mean change of hair diameter was significantly higher in the
cases than in the controls (p<0.001). After the treatments, the mean hair
diameter in the case group was significantly higher in females than in males
(0.056±0.010 m vs. 0.053±0.009 m; p = 0.01). The mean change of
hair diameter after treatment, however, was significantly higher in male than
in female patients (p<0.01). Considering the hair color in the patients after
the treatments, the mean hair diameter was significantly higher in light-brown
than in dark-brown hairs (0.056±0.008 m vs. 0.050±0.010 m; p =
|| Demographic and general data of the patients with androgenic
alopecia and normal controls
|Data are shown as Mean±Standard deviation or frequency
(%) p-value <0.05 is significant
There was no significant difference between the other hair-color groups (p<0.05).
Considering the area of hair sampling on the scalps of the patients 6 months
after the treatments, the mean hair diameter was significantly lower when the
pull test was performed in frontal area (0.50±0.008 m; p = 0.03). The mean hair
diameter was 0.053±0.009 m in temporal region; 0.053±0.010 m in parietal region
and 0.055±0.010 m in occipital region.
Androgenic alopecia is a very common finding not only in males, but also in
females. The underlying etiology of this type of alopecia is increased action
of 5-alpha reductase and diminished receptors of dihydrotestosterone (active
metabolite of testosterone) (Odom et al., 2000;
Firooz and Fouladi, 2012). In females, hormonal abnormalities
may also play role in pathogenesis of hair disorders (Navali
et al., 2011), including androgenic alopecia. Hair loss happens when
anagen phase is gradually reduced, growth cycle of the hair becomes shorter
and hair follicles create vellus hair (Burn et al.,
2004). Along with hair loss, decreased hair diameter is a prominent finding
in androgenic alopecia. A variety in hair diameter >20% has been suggested
as an early sign of alopecia areata (Tosti et al.,
2005; Inui et al., 2009). Ishino
et al. (1997) followed hair diameter changes for three years in 56 Japanese
with male pattern alopecia and concluded that the average hair diameter reduced
significantly almost 1.1 micron per year. Sagsoz et
al. (2004) also reported a significant positive correlation between
hair diameter and serum androgen levels. In the present work, the effect of
appropriate treatments on hair diameter was investigated in patients with androgenic
alopecia in a well-designed, case-control setting. Accordingly, the hairs became
thicker significantly after treatments in the patients. To the best of our knowledge,
there is no similar study in the literature. To clarify the effect of gender
in this regard, hair diameter of males and females were compared in the patient
groups after the treatments. Interestingly, while the mean hair diameter in
females was significantly higher after treatment, the mean amount of hair diameter
change before and after treatment was significantly more in the male patients.
It has been previously shown that hair follicle miniaturization plays pivotal
role in the pathogenesis of androgenic alopecia (De Lacharriere
et al., 2001). One of possible mechanisms of this difference observed
between male and female patients in the present work is the difference in rate
and extent of follicle miniaturization between the two genders. This needs to
be examined in future studies. Another interesting finding in the present work
was the effect of hair color on its diameter after treatment. Accordingly, the
mean hair diameter in patients with light-brown hairs was significantly higher
than that in the cases with dark-brown. This is in contrast to a general belief
that darker hairs are thicker, because there was not a significant difference
between blond and brown hairs in terms of their diameter in the current study.
The underlying physiopathology of this finding needs to be investigated in future
Last but not least, the present study showed that hair diameter was the thinnest
in specimens obtained from frontal region comparing with those from other regions
on the scalp. It is known than the frontal area is the first involved region
in androgenic alopecia. This may justify this finding regarding hair diameter
observed in the present work. In addition to previously emphasized areas for
further studies in this regard, larger sample size and considering the role
of age (Sagsoz et al., 2004; Babaeinejad
et al., 2011) are also important in this regard.
This study, for the first time, reported hair diameter changes before and after
treatment in androgenic alopecia. Although hair diameter increased significantly
after treatment, other factors such as gender, hair color and location on the
scalp may also play significant roles in this regard.
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