الفهرس 
Female Pattern Hair LossOnly 14 pages are availabe for public view
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Abstract
H
air loss in women is an increasingly frequent problem. The clinical aspects of FPHL differ according to the origin. The severity and clinical evaluation of the pattern of FPHL has traditionally relied on the Ludwig (three-point) classification in which there is diffuse central thinning over the mid-frontal scalp with preservation of the frontal hairline. Ludwig described increasing stages І to ІІІ that correspond to increase width of the midline and progressive frontal accentuation.
Metabolic syndrome is a group of abnormalities probably caused by IR with systemic hyperinsulinism. It consists of glucose intolerance or type 2 diabetes, arterial HTN, atherosclerosis, obesity and dyslipidemia.
The most important risk factors for the development of MetS are weight, genetics, endocrine disorders and aging. Most patients are older, obese, sedentary and have a degree of IR, stress can also be a contributing factor. As MetS is highly associated with CVD and type 2 diabetes, corroborating the association between MetS and FPHL may provide another clue to the clinical signs and symptoms related to both diseases, but unfortunately there is little data on population based studies on this association.
The current study aimed at assessing the frequency of MetSamong women with FPHL compared to age matched control group.
The present study is a case control study that included 90 female subjects, 45 patients with different stages of FPHL that were classified according to Ludwig classification with the age ranging from 19 - 45 years and 45 healthy volunteers who served as controls that were age, and socioeconomic status matched with the patients.
Females not within this age range, or having telogen effluvium, dermatological or non-dermatological conditions known to cause diffuse hair loss, having autoimmune diseases, malignancy or receiving chemotherapy or hormonal therapy or corticosteroid therapy were excluded from this study.
Diagnosis of FPHL was based on the clinical findings as the pattern of hair loss, reduction in hair density over the crown and widening of the central part. Patients were graded as stage I, II, or III according to Ludwig’s classification. A photograph was taken for all patients to document the condition using a digital camera.
Waist circumference & HC were measured for all subjects & also arterial BP was measured twice with 5 minutes apart. Five ml of venous blood were withdrawn from every subject after a 12 hour fasting period to assess FBS, TG, TC, LDL-C and HDL-C.
The diagnosis of MetS was based on the criteria defined by the NCEP ATP III criteria. All 45 patients were submitted to pelvic ultrasonography to detect the presence of PCO.
The current study noted a statistically significant difference between patients and controls as regards TC and LDL-C being higher in patients, while there was no statistically significant difference noted as regards the FBS, TG, and HDL-C.
Also there was a highly significant difference in the mean SBP and DBP values, mean HC and mean WC in patients versus controls being higher in patients.
Comparing the MetS parameters with the different stages of FPHL revealed that severity of FPHL showed a tendency to increase with age.
Meanwhile, a highly significant difference was observed when comparing stage I with each of stage II and stage III as regards the waist and hip circumference being greater in stages II and III.
Using the logistic regression, the odds ratio for MetS was 8.85 for patients with FPHL versus controls. MetS was significantly more frequent in patients than controls.
The presence of MetS among the different degrees of FPHL tended to increase with severity being greater in stage III > stage II > stage I.
When each component of MetS was considered individually with the control group, patients with FPHL did not significantly differ in the presence of any MetS variable with the exception of central obesity and HTN which were considered significantly higher in patients as an ORs of 5.6 and 3.5 were recorded respectively.
There was a highly significant positive correlation between the different Ludwig stages and each of WC, HC, and W/H ratio.
A highly significant positive correlation was recorded between increasing age and both waist and hip circumferences in patients, while this was not significant among the control group.
Interestingly, in the present study, only 5 (11.1%) of the patients had PCO diagnosed by pelvi-abdominal ultrasound, and 4 out of these 5 (80%) had MetS.
We believe that one of the limitations in this study is that the study should have been performed on a wider sample of patients with FPHL to confirm our findings and to allow a detailed analysis of the above factors as a function of the degree of alopecia or between menopausal and premenopausal women.
In conclusion, we have found a higher prevalence of MetS in women with FPHL, which could have expose them to cardiovascular consequences. We recommend that patients with FPHL, especially if associated with an increased WC, should be screened for components of MetS for early identification and management.