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The Relative Contribution of Endogenous and Exogenous Factors to Female Alopecia: A Study of Identical Twins
James Gatherwright, MD
Mengyuan T. Liu, BS
Christy Gliniak, MS
Ali Totonchi, MD
Bahman Guyuron, MD, FACS
University Hospitals, Cleveland, OH
2012-02-06
Presenter: James Gatherwright
Affidavit:
The majority of the submitted research above is a direct contribution of the presenting resident as well as the preparation of the abstract, manuscript, and presentations.
Director Name: Arun Gosain
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
How does this presentation meet the established conference educational objectives?
The submitted research addresses a novel approach for measuring and identifying potential factors in female alopecia.
How will your presentation be used by practicing physicians in the audience?
Physicians will be available to advise patients on potential exacerbating factors of female alopecia as well potentially avoid certain factors that may worsen follicular transplant outcomes.
Background: This study investigated the potential contribution of environmental factors and testosterone levels on androgenic alopecia (AGA) in women.
Methods: Ninety-eight identical female twins (49 pairs) were recruited during the Twins Days Festival in Twinsburg, OH from 2009 to 2011. Subjects were asked to complete a comprehensive questionnaire, provide a sputum sample, and pose for standardized digital photography. Testosterone levels were analyzed from the sputum samples, and frontal (FHL), temporal (THL), and vertex (VHL) hair loss were measured from the photographs. Hair loss was then correlated with survey responses and testosterone levels between twin pairs. Two independent, blinded observers also assessed for hair thickness.
Results: Factors associated with increased FHL included multiple marriages (p=0.043), longer sleep duration (p = 0.011), higher severity of stress (p = 0.034), positive smoking history (p=0.021), higher income (p=0.023), absence of hat use (p=0.017), and history of diabetes mellitus (p=0.023), polycystic ovarian syndrome (p=0.002), and hypertension (p=0.001). Factors associated with increased THL included divorce or separation (p = 0.034), multiple marriages (p=0.040), more children (p=0.005), longer sleep duration (p=0.006), and history of diabetes mellitus (p=0.008), and hypertension (p=0.027). Lack of sun protection (p=0.020), consuming less caffeine (p = 0.040), history of skin disease (p=0.048), and lack of exercise (p=0.012) were associated with increased VHL. Higher testosterone levels was associated with increased temporal and vertex hair loss patterns (p<0.039).
Conclusions: This study implicates several environmental risk factors in the patho-physiology of female alopecia.
