Male Androgenetic Alopecia May be Associated with Nail Fold Changes

More Evidence of Microcirculation Issues in Male Balding:

A variety of studies had focused on the risk of cardiovascular disease and metabolic syndrome in androgenetic alopecia. it is clear that males and females with androgenetic alopecia are at increase risk for heart disease and metabolic syndrome. How exactly AGA affects the microcirculation is not clear.

I have reviewed before the AGA is associated with an early disappearance of blood vessels in the dermal papillae of hair follicles.

A 2022 study by Deng and colleagues showed that early balding is associated with a disappearance of the tiny blood vessels in the dermal papilla. Photo: Donovan Hair Clinic 2022. Study Referenced: Deng et al. Androgen receptor-mediated paracrine signaling induces regression of blood vessels in the dermal papilla in androgenetic alopecia. J Invest Dermatol. 2022

One of the ways to examine the microcirculation of blood vessels is to examine nail fold capillaroscopy changes.

Cao et al, 2022

Authors from China set out to investigate whether there are alterations in nailfold capillaries in androgenetic alopecia patients compared to control patients. In addition to examining the type of abnormality a semi-quantitative rating scale was adopted to score the observed capillary abnormalities (0, no changes; 1, <33% capillary alteration or reduction; 2, 33–66% capillary alteration or reduction and 3, >66% capillary alteration or reduction).

A total of 78 men diagnosed with androgenetic alopecia and 78 age- and sex-matched controls were included in the study. The AGA group had a mean age of 29.91 years and the control group had a mean age of 32.76 years. Differences in the ages of these two groups were not significantly different. The numbers of patients with Grades 2, 3, 4, 5 and 6 AGA according to the Norwood-Hamilton classification scale were 11 (14.1%), 45 (57.7%), 8 (10.3%), 13 (16.7%) and 1 (1.3%), respectively.

Avascular, Bushy, Bizarre and Disorganized and Dilated Capillaries more Common in AGA

Some capillary changes were more common in AGA than controls and some occurred with similar frequency. Specifically, the frequencies of avascular areas, dilated, bushy and bizarre capillaries and capillary disorganization were statistically higher in the androgenetic alopecia group than in healthy controls. Other abnormalities were similarly common in AGA and controls.

Examples of Capillaries Abnormalities More Commonly Seen In Androgenetic Alopecia

Normal capillaries. this image is a helpful reference. Source: Cao L et al. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2022 Feb 28;1-7. Image shown with creative commons license.

BUSHY CAPILLARIES

Bushy capillaries are More Common in Nail Capillaries from Patients with Androgenetic Alopecia Compared to Controls. Source: Cao L et al. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2022 Feb 28;1-7. Image shown with creative commons license.

BIZARRE CAPILLARIES

Bizarre capillaries are More Common in Nail Capillaries from Patients with Androgenetic Alopecia Compared to Controls. Source: Cao L et al. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2022 Feb 28;1-7. Image shown with creative commons license.

DILATED CAPILLARIES

Dilated capillary areas are More Common in Nail Capillaries from Patients with Androgenetic Alopecia Compared to Controls. Source: Cao L et al. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2022 Feb 28;1-7. Image shown with creative commons license.

DISORGANIZED CAPILLARIES

Disorganized capillary areas are More Common in Nail Capillaries from Patients with Androgenetic Alopecia Compared to Controls. Source: Cao L et al. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2022 Feb 28;1-7. Image shown with creative commons license.

AVASCULAR CAPILLARY AREAS

Avascular areas are More Common in Nail Capillaries from Patients with Androgenetic Alopecia Compared to Controls. Source: Cao L et al. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2022 Feb 28;1-7. Image shown with creative commons license.

The androgenetic alopecia group also had significantly higher frequencies of nailfold capillaroscopy scores of 2 or 2 and 3 as compared to the control group. This reflects that a larger proportion of the capillary network was likely affected in some manner in AGA than controls

The authors did not find that capillary abnormalities differed according to severity of AGA in any clear way. The one difference was that capillary density was lower in early AGA than controls but there were no other clear differences.

Conclusion

All in all, the authors propose that the frequency of capillary anomalies is higher in AGA than controls. This includes anomalies such as bushy, bizarre, dilated capillaries, capillary disorganization and avascular areas.

The researchers propose that there may be widespread microcirculation injury in androgenetic alopecia. More research is needed to understand the significance of these changes and whether any of the changes predict metabolic and cardiovascular sequelae.

REFERENCE

Cao L et al. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol. 2022 Feb 28;1-7. doi: 10.25259/IJDVL_714_2021. Online ahead of print.