Validity of self reported male balding patterns in epidemiological studies

BACKGROUND: Several studies have investigated the association between male pattern baldness and disease such as prostate cancer and cardiovascular disease. Limitations in the lack of standardized instruments to measure male pattern baldness have resulted in researchers measuring balding patterns in a variety of ways. This paper examines the accuracy and reliability of assessment of balding patterns by both trained observers and men themselves, using the Hamilton-Norwood classification system. METHODS: An observational study was carried out in Western Australia with 105 male volunteers aged between 30 and 70 years. Participants completed a short questionnaire and selected a picture that best represented their balding pattern. Two trained data collectors also independently assessed the participant's balding pattern using the same system and the men's self assessment was compared with the trained observer's assessment. In a substudy, observers assessed the balding pattern in a photo of the man aged 35 years while the man independently rated his balding at that age. RESULTS: Observers were very reliable in their assessment of balding pattern (85% exact agreement, κ = 0.83). Compared to trained observers, men were moderately accurate in their self-assessment of their balding status (48–55% exact agreement, κ = 0.39–0.46). For the substudy the exact agreement between the men and the observers was 67% and the agreement within balding groups was 87%. CONCLUSIONS: We recommend that male balding patterns be assessed by trained personnel using the Hamilton-Norwood classification system. Where the use of trained personnel is not feasible, men's self assessment both currently and retrospectively has been shown to be adequate

Skin tensile properties revisited during ageing. Where now, where next?

Skin and its subcutaneous layer represent a complex composite of tissues, whose mechanical characteristics depend upon the mutual interdependence of their constituent parts. The molecular and microanatomical structures of skin allow it to meet normal mechanical demands. They also determine the orientation both of Langer's lines and of relaxed skin tension lines. Ageing, photodamage, hormones, drugs, cosmetic products and dermatological interventions may modify the skin's overall tensile properties. In turn, any variation in mechanical stresses and strains imposed upon the skin's connective tissue influences the metabolic activity and phenotypic expression of fibroblasts and dermal dendrocytes. The viscoelastic functions of ageing skin can be tested by altering the orientation and magnitude of imposed stresses and strains over time. Assessment can be made of various biomechanical properties of skin: tensile, torsional, acoustic shear wave, indentation, impact and elevation. Such objective biomechanical assessments may be applied to dermocosmetic interventions, so providing opportunity for progress in cosmetic dermatological science

Female Pattern Hair Loss

CONTEXT: Female pattern hair loss (FPHL) also known as female androgenetic alopecia is a common condition afflicting millions of women that can be cosmetically disrupting. Prompt diagnosis and treatment are essential for obtaining optimal outcome. This review addresses the clinical presentation of female pattern hair loss, its differential diagnosis and treatment modalities. EVIDENCE ACQUISITION: A) Diffuse thinning of the crown region with preservation of the frontal hairline (Ludwig’s type) B) The “Christmas tree pattern” where the thinning is wider in the frontal scalp giving the alopecic area a triangular shaped figure resembling a christmas tree. C) Thinning associated with bitemporal recession (Hamilton type). Generally, FPHL is not associated with elevated androgens. Less commonly females with FPHL may have other skin or general signs of hyperandrogenism such as hirsutism, acne, irregular menses, infertility, galactorrhea and insulin resistance. The most common endocrinological abnormality associated with FPHL is polycystic ovarian syndrome (PCOS). RESULTS: The most important diseases to consider in the differential diagnosis of FPHL include Chronic Telogen Effluvium (CTE), Permanent Alopecia after Chemotherapy (PAC), Alopecia Areata Incognito (AAI) and Frontal Fibrosing Alopecia (FFA). This review describes criteria for distinguishing these conditions from FPHL. CONCLUSIONS: The only approved treatment for FPHL, which is 2% topical Minoxidil, should be applied at the dosage of 1ml twice day for a minimum period of 12 months. This review will discuss off-label alternative modalities of treatment including 5-alfa reductase inhibitors, antiandrogens, estrogens, prostaglandin analogs, lasers, light treatments and hair transplantation