Understanding Hormonal Therapies: Overview for the Dermatologist Focused on Hair

Desai, Karishma; Almeida, Bianca Alencar Dias; Miteva, Mariya

doi:10.1159/000512888

Cited by 11 publications

(15 citation statements)

References 45 publications

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“…Estrogen therapy increased epidermal and dermal thickness, increased collagen and elastin content, and improved skin moisture, with fewer wrinkles 144 . Although menopause is associated with a decrease in hair density and female pattern hair loss, research on the role of hormone therapy in mitigating these changes is lacking 145 …”

Section: Skin Hair and Special Sensesmentioning

confidence: 99%

The 2022 hormone therapy position statement of The North American Menopause Society

2022

Menopause

327

219

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and identifies future research needs. An Advisory Panel of clinicians and researchers expert in the field of women's health and menopause was recruited by NAMS to review the 2017 Position Statement, evaluate new literature, assess the evidence, and reach consensus on recommendations, using the level of evidence to identify the strength of recommendations and the quality of the evidence. The Advisory Panel's recommendations were reviewed and approved by the NAMS Board of Trustees.Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture. The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing therapy.For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS and prevention of bone loss. For women who initiate hormone therapy more than 10 years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. Longer durations of therapy should be for documented indications such as persistent VMS, with shared decision-making and periodic reevaluation. For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended.

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Section: Skin Hair and Special Sensesmentioning

confidence: 99%

The 2022 hormone therapy position statement of The North American Menopause Society

2022

Menopause

327

219

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“…Moreover, this PLCA has recently seen an unexplained, almost “epidemic” increase in both prevalence and incidence [ 20 , 21 , 22 , 23 ]. To explain this, several hypotheses about environmental causes are considered plausible, including prolonged use of hormonal contraceptives [ 24 , 25 ] as well as the increased or excessive use of leave-on facial skin care/antiaging products and sunscreens [ 26 ] (particularly chemical sunscreens [ 27 ], and personal care products such as cleansers, cosmetics, creams, lotions, hair care products, etc). The association of leave-on cosmetics such as sunscreens with FFA is increasingly being proposed in the field [ 6 , 26 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

A Cell Membrane-Level Approach to Cicatricial Alopecia Management: Is Caveolin-1 a Viable Therapeutic Target in Frontal Fibrosing Alopecia?

et al. 2021

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Irreversible destruction of the hair follicle (HF) in primary cicatricial alopecia and its most common variant, frontal fibrosing alopecia (FFA), results from apoptosis and pathological epithelial-mesenchymal transition (EMT) of epithelial HF stem cells (eHFSCs), in conjunction with the collapse of bulge immune privilege (IP) and interferon-gamma-mediated chronic inflammation. The scaffolding protein caveolin-1 (Cav1) is a key component of specialized cell membrane microdomains (caveolae) that regulates multiple signaling events, and even though Cav1 is most prominently expressed in the bulge area of human scalp HFs, it has not been investigated in any cicatricial alopecia context. Interestingly, in mice, Cav1 is involved in the regulation of (1) key HF IP guardians (TGF-β and α-MSH signaling), (2) IP collapse inducers/markers (IFNγ, substance P and MICA), and (3) EMT. Therefore, we hypothesize that Cav1 may be an unrecognized, important player in the pathobiology of cicatricial alopecias, and particularly, in FFA, which is currently considered as the most common type of primary lymphocytic scarring alopecia in the world. We envision that localized therapeutic inhibition of Cav1 in management of FFA (by cholesterol depleting agents, i.e., cyclodextrins/statins), could inhibit and potentially reverse bulge IP collapse and pathological EMT. Moreover, manipulation of HF Cav1 expression/localization would not only be relevant for management of cicatricial alopecia, but FFA could also serve as a model disease for elucidating the role of Cav1 in other stem cell- and/or IP collapse-related pathologies.

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“…спостерігав відсутність алопеції у євнухів. Доведено, що випадіння волосся за чоловічим типом є андрогензалежним, оскільки пов'язано зі змінами вмісту андрогенів (тестостерону і дигідротестостерону -ДГТ), експресії їхніх рецепторів та відповідає на антиандрогенну терапію [9].…”

Section: патофізіологіяunclassified

“…У більшості пацієнток з ВВЖТ не виявлено клініколабораторних ознак гіперандрогенізму, лише в однієї третини жінок спостерігається збільшений рівень андрогенів при ендокринних захворюваннях (СПКЯ, гіперпролактинемія, гіперплазія надниркових залоз, пухлини яєчників і надниркових залоз), зниженні вмісту глобуліну, що зв'язує статеві гормони (ГЗСГ), застосуванні контрацептивних препаратів з високим андрогенним потенціалом або інших засобів (тестостерон і його ефіри, местеролон, анаболічні стероїди, циметидин, аргінін, кетоконазол, кортикостероїди) [9,34].…”

Section: патофізіологіяunclassified

“…Згідно із статистичними даними, понад 70% жінок з віком стикаються з проблемою дифузної втрати волосся [4,8], яка у більшості випадків відбувається при телогенному облисінні (телоген ефлювіум) та при випадінні волосся за жіночим типом (ВВЖТ). ВВЖТ є однією з поширених форм захворювань волосся у дорослих жінок, яке спостерігають не тільки дерматологи, а й лікарі іншого профілю, у тому числі гінекологи [2,9]. З приводу алопеції, особливо у поєднанні з гірсутизмом, акне, порушеннями менструального циклу, дерматологи часто скеровують пацієнток до гінеколога з метою виключення синдрому полікістозних яєчників (СПКЯ) та інших розладів ендокринної системи.…”

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Women’s hair loss: pathophysiological, diagnostic and therapeutic aspects

Возіанова

Bolotna

Sarian

2022

RHW

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The article presents a review of modern ukrainian and foreign publications on the pathogenesis, clinical manifestations and diagnostics of female pattern hair loss (FPHL), which is a common type of hair loss and its frequency increases with age. The questions of terminology, disease prevalence, and risk factors of hair loss are considered. It is emphasized that FPHL is a clinical problem and that it is advisable to clarify the comorbid profile of female patients and to screen for metabolic disorders. There is still no complete understanding of the pathophysiology of FPHL. There is evidence that hormonal, genetic, and environmental factors are involved in the process of hair loss in women. Current data concerning systemic hormonal disturbances in ovarian and adrenal gland diseases in women as well as the importance of disorders of androgen-dependent mechanisms of regulation of the hair follicle growth cycle are presented.The attention is drawn to genetic abnormalities in the case of FPHL. The role of growth factors, cytokines, microinflammation, iron deficiency, perifollicular fibrosis, oxidative stress in regression of the hair follicle is considered. FPHL is characterized as non-scarring alopecia, which develops due to progressive miniaturization of hair follicles and further hair reduction, especially in the central (frontal and parietal) scalp, gradual replacement of long terminal hair by short pubic (vellus) hair. Three models of female hair loss, modern classification according to the stages of progression used in practice, possible causes of clinical differences in alopecia in men and women are presented. The main directions of diagnostics (history, clinical and laboratory examination, special dermatological tests) are outlined, the possibilities of modern noninvasive diagnostic method of dermoscopy are emphasized. Pharmacotherapy, recommended on the basis of evidence-based medicine, is limited to two drugs – topical minoxidil and systemic finasteride. The necessity of interdisciplinary approach to the management of patients with FPHL has been proved.

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Understanding Hormonal Therapies: Overview for the Dermatologist Focused on Hair

Cited by 11 publications

References 45 publications

The 2022 hormone therapy position statement of The North American Menopause Society

The 2022 hormone therapy position statement of The North American Menopause Society

A Cell Membrane-Level Approach to Cicatricial Alopecia Management: Is Caveolin-1 a Viable Therapeutic Target in Frontal Fibrosing Alopecia?

Women’s hair loss: pathophysiological, diagnostic and therapeutic aspects

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