Metabolic Syndrome in Androgenetic Alopecia in a Tertiary Care Centre in Goa: A Case Control Study During COVID-19 Pandemic

Background Androgenetic alopecia (AGA) is a hereditary condition that results in the transformation of terminal hair on the scalp into smaller vellus hair in a distinct pattern. This condition affects nearly 80% of Caucasian men and 40% of Caucasian women. Although it can start during puberty, its prevalence increases with age. Circulating androgens, such as dihydrotestosterone (DHT), penetrate the follicle via the capillaries of the dermal papilla (DP), attach to the androgen receptor within the DP cells, and subsequently activate or inhibit molecular signalling pathways that lead to follicular miniaturization and an early shift from anagen to catagen. Symptoms of metabolic syndrome (MetS) include increased waist circumference, elevated triglycerides (TG), reduced high-density lipoprotein-C (HDL-C), heightened fasting blood glucose, and increased blood pressure. Despite the high prevalence of AGA and MetS in India, there is a lack of accurate data on the issue. The medical literature contains only a few studies, and there is no precise information regarding this association within the Indian population. Aims & Objectives The objective of this study was to investigate the relationship between androgenetic alopecia and metabolic syndrome, as well as to compare it with a healthy control group. Methods This was a prospective case control study done over a period of 3 months from patients visiting the Outpatient Department of Dermatology, Venereology and Leprosy of a tertiary care centre in western India during COVID-19 pandemic with 54 cases of AGA and 54 age and sex-matched controls. The criteria updated according to the joint consensus of 2009 were employed for the diagnosis of MetS. We categorized the patients of androgenetic alopecia into two categories in our study as normal to mild AGA and moderate to severe AGA. Results Out of 54 cases, 16.7% (n=9) were females & remainder were males. The most commonly affected age group was less than 30 years. Family history was positive in 88.9% of the patients out of which 38.9% (n=21) of the patients had only positive paternal history of AGA. Sedentary behaviour (physical activity less than 30 minutes daily) was present in 24.1% (n=13) of the patients. Norwood Hamilton grade V was the most common grade of AGA among male patients. Prevalence of metabolic syndrome in patients with AGA i.e., the cases group was 40.7% & that in the control group was 14.8%. Comparison of prevalence of metabolic syndrome between two groups showed higher prevalence in the cases group which was statistically significant with a p value of 0.003 (p<0.05). Conclusion We believe that by finding positive association of metabolic syndrome with androgenetic alopecia we can emphasize the patients with androgenetic alopecia to screen themselves for components of metabolic syndrome as well as metabolic syndrome in order to prevent or delay the adverse future outcomes occurring as a consequence of metabolic syndrome or its components by undertaking in necessary lifestyle modifications & treatment wherever necessary.