Exposome and basal cell carcinoma: a multicenter case-control study.

BACKGROUND: While ultraviolet radiation (UVR) present in sunlight is recognized as the main etiological agent of skin cancer, the most frequent form of which is basal cell carcinoma (BCC), other exposome factors like pollution, diet, and lifestyle may also contribute. This study aimed to investigate the association of BCC and exposome-related factors in the Spanish population. METHODS: BCC cases (n = 119) and controls (n = 127) with no history of skin cancer were recruited between April 2020 and August 2022 by 13 dermatologists throughout Spain in this prospective multicenter case-control study. RESULTS: The BCC group had a higher proportion of outdoor workers, more years of UVR exposure, and a greater consumption of drugs (statins, ASA, hydrochlorothiazide, ACE inhibitors and omeprazole), P < 0.05. Avoidance of sun exposure was the most used photoprotection measure in both groups. The use of hats or caps was higher in the BCC group (P = 0.01). The solar protection factor (SPF) used 15 years previously was higher in the control group (P = 0.04). The control group had a higher daily screen time (P < 0.001), and practiced more relaxation activities (P = 0.03). Higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with BCC (P < 0.05). Statistical significance for all the aforementioned variables was maintained in the multivariate analysis (P < 0.05). CONCLUSIONS: The study found a significant association between BCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers, promoting sun-safe behaviors and stress-reducing activities, and also adequate skin photoprotection in patients on certain medications associated with increased BCC risk.

The Influence of the Exposome in the Cutaneous Squamous Cell Carcinoma, a Multicenter Case-Control Study.

INTRODUCTION: The concept of exposome refers to the total of harmful and beneficial environmental exposures that can help predict the organism's biological responses over time. Ultraviolet radiation (UVR) from sun exposure has been recognized as the main etiological agent of skin cancer, and squamous cell carcinoma (SCC) is one most commonly associated with chronic exposure. However, in recent years, evidence suggests that lifestyle, environmental pollution, and contaminants in water and food can have an influence. OBJECTIVES: To study the relationship between SCC and sun exposure, pollution, stress, and lifestyle in a Spanish cohort. MATERIALS AND METHOD: A multicenter case-control study was carried out in which 13 dermatologists from different regions of Spain recruited cases and controls between April 2020 and August 2022. The group of cases were patients diagnosed with SCC and, as a control group, people who attended Dermatology consultations as companions with no history of skin cancer. RESULTS: A total of 62 patients with SCC and 126 controls were included (62.9% males, median age 76.46 (10.1) and 33.3%, median age 55.7 (15), respectively). The SCC group had experienced more outside work than the controls (75% vs. 22.4%, p < 0.001), less recreational exposure (sunbathing, p = 0.05, and outdoor sports, p = 0.01), and a lower annual income (p = 0.01), with an increase in tobacco exposure (p < 0.001), without differences in other carcinogens, such as ionizing radiation or chemical exposure. The control group had a higher daily screentime use (p < 0.001) and practiced more relaxation activities (p = 0.03). A higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with SCC (p < 0.05). Some chronic medications (anxiolytics, antidepressants, beta-blockers, statins, hydrochlorothiazide, ACE inhibitors, metformin, and omeprazole) were also statistically associated with SCC. Statistical significance for all aforementioned variables was maintained in the multivariate analysis (p < 0.05). CONCLUSIONS: The study found a significant association between SCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers promoting sun-safe behaviors and stress-reducing activities, in addition to adequate skin photoprotection in patients under certain medications associated with SCC.

A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer.

BACKGROUND: While skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. OBJECTIVE: To compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. METHODS: Multicentre case-control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. RESULTS: Of the 254 cases (56.2% female; mean age, 62.67 ± 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p < .05), whereas those with BCC and SCC reported greater use of head coverings (p = .01). BCC and SCC groups reported greater sun exposure 15 years prior, whereas controls reported greater use of sunscreen. However, at the time of this study all groups reported using SPF ≥ 21, and the majority SPF > 50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. CONCLUSIONS: We describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation.

The Effect of Sunscreens on the Skin Barrier.

Transepidermal water-loss (TEWL), stratum-corneum hydration (SCH), erythema, elasticity, pH and melanin, are parameters of the epidermal barrier function and skin homeostasis that objectively indicate the integrity of the skin barrier. Sunscreens are necessary to protect people from skin cancer, but could modify the skin barrier function. Nevertheless, there are not many studies on their impact on skin homeostasis. The aim of this study is to evaluate the impact of sunscreens on the epidermal-barrier function and skin homeostasis of healthy individuals. A prospective observational study was designed. TEWL, SCH, erythema, elasticity, pH and melanin were measured on the cheek and volar region of the forearm, using non-invasive methods before and after applying sunscreen. Four different sunscreens were tested, one full-body sunscreen and three facial sunscreens. The study included 51 healthy volunteers, 72.5% (37/51) women, with a mean age of 41.63 years. After full-body sunscreen application, temperature increased by 0.68 °C (p < 0.001), pH by 0.16 units (p < 0.001), and elasticity by 0.22% (p = 0.039), while melanin decreased by 10.95 AU (p < 0.001), erythema by 28.79 AU (p < 0.001) and TEWL by 0.66 g·m−2·h−1 (p = 0.019). On the cheek, facial sunscreen 1 increased temperature by 0.51 °C, TEWL 0.7 g·m−2·h−1 (p < 0.05), pH by 0.12 units (p < 0.001) and elasticity by 0.059% (p < 0.001), but decreased erythema by 19.87 AU (p < 0.05) and SCH by 5.63 AU (p < 0.001). Facial sunscreen 2 increased temperature by 0.67 °C, TEWL by 1.93 g·m−2·h−1 (p < 0.001), pH by 0.42 units (p < 0.001) and elasticity by 0.12% (p < 0.01), but decreased melanin by 15.2 AU (p = 0.000), erythema by 38.61 AU (p < 0.05) and SCH by 10.80 AU (p < 0.01). Facial sunscreen 3 increased temperature by 1.15 °C, TEWL by 2.29 g·m−2·h−1 (p < 0.001), pH by 0.46 units (p < 0.001) and elasticity by 0.15% (p < 0.01), but decreased erythema by 35.7 (p < 0.05) and SCH by 10.80 AU (p < 0.01). In conclusion, sunscreen could slightly modify the skin-barrier function. All of them decreased erythema, likely in relation to anti-inflammatory power.

Knowledge, Behaviour and Attitudes Related to Sun Exposure in Sportspeople: A Systematic Review.

People who practice outdoor sports have an increased risk of skin cancer as they are exposed to high doses of ultraviolet (UV) radiation. Recent studies have shown that in many athletes, sun protection behaviours are inadequate, with the risk that this entails. The aim of this review is to collect the information published to date about the knowledge, attitudes and habits of athletes in relation to sun exposure and its risks. A systematic review was conducted using PubMed and Embase with the search algorithm "(skin cancer OR melanoma) AND (exercise OR sport OR athletes)". All studies analysing the knowledge, attitudes and habits of photoprotection in athletes were included. A total of 2,365 publications were found, of which 23 were selected, including a total of 10,445 sportspeople. The majority of participants declared their voluntary intention to tan and stated that the sun made them feel better, although they also showed concern about possible damage associated with UV radiation. In most studies, less than half of the participants made adequate use of photoprotective measures. In general, most athletes had a high level of knowledge regarding the risk of skin cancer associated with sun exposure. In conclusion, most athletes are aware of the risks associated with UV radiation but do not make adequate use of photoprotective cream. New training programs on photoprotection could help improve athletes' photoprotective behaviour, reducing the incidence of skin cancer and precancerous lesions in this population.

Impact of the COVID-19 Pandemic on the Diagnosis and Prognosis of Melanoma.

Background: Early detection of melanoma is one of the main diagnostic goals of dermatologists worldwide, due to the increasing incidence of the disease in our environment. However, the irruption of the SARS-CoV-2 pandemic has posed a challenge to global healthcare, forcing systems to focus their resources on the fight against COVID-19. Methods: Retrospective cohort study. The exposed cohort were patients diagnosed with melanoma in the year after the general confinement in Spain (15 March 2020) and the unexposed cohort were patients with melanoma diagnosed in the previous year. Results: 130 patients were included. No differences were observed between demographic characteristics in both cohorts. The mean Breslow of melanoma before the onset of the pandemic was 1.08, increasing to 2.65 in the year after the onset of the pandemic (p < 0.001). On the other hand, the percentage of melanomas in situ decreased from 38.96% to 16.98% in the year after the declaration of the state of alarm in Spain. Conclusions: The SARS-CoV-2 outbreak has led to a reduction in the early diagnosis of melanoma, with an increase in invasive melanomas with poor prognosis histological factors. This could lead to an increase in melanoma-related mortality in the coming years in our environment.

Study of the Exposome Ageing-related Factors in the Spanish Population.

To characterize the exposome of the Spanish population and its association with skin ageing a cross-sectional epidemiological study was conducted in men and women (18-60 years old). A total of 1,474 participants were included. Mean age (± standard deviation) was 40.84 ± 10.26 years. Most participants had Fitzpatrick skin phototype II (44.1%) and skin ageing in accordance with their current age (69.0%). In the logistic model, age, smoking habit, use of sunscreen and use of cosmetics were all significant independent predictors of skin ageing. Thus, tobacco consumption increased the score of the model towards presenting skin ageing above that expected for age, while the opposite occurred with the use of sunscreen and a complete skin care routine. The exposome therefore has an impact on skin ageing, with age, smoking habit, use of sunscreen and the use of cosmetics identified as predictors of skin ageing. Skin care routines and sunscreen use may help to prevent this process.

Skin Cancer Prevalence in Outdoor Workers of Ski Resorts.

BACKGROUND: Snow reflectivity and altitude increase the exposure of ski resort workers to solar ultraviolet radiation. The aim was to assess the presence of skin cancer in ski resorts workers and compare it with other groups of outdoor workers reviewing published studies. METHODS: An observational cross-sectional prospective study was conducted in the three largest ski resorts in Spain: Baqueira Beret, Lleida; Formigal, Huesca and Sierra Nevada, Granada. All outdoor workers including ski instructors were invited to participate in the study. The participants completed a validated questionnaire about sun exposure and underwent a skin examination. RESULTS: 219 workers were included in the study (80% male; mean age 43.8 (SD 11.31) years). Actinic keratosis (AK) but no other skin cancers were detected in 32 participants (14.62%). Those with AK worked in the Southernmost ski resort, were more likely to have light colour hair, and were older and with higher photoaging grade than those without them. CONCLUSION: Compared to other studies, outdoor workers on ski resorts show a higher prevalence of AK than general population but a lower prevalence than other groups of outdoor workers.

Comparative Study of Shrinkage in Human Skin, Artificial Human Skin, and Mouse Skin.

INTRODUCTION: The shrinkage of surgical specimens (SS) is known in human skin (HS) but has not been studied in an artificial skin (AS) or mouse skin (MS). OBJECTIVES: To quantify the degree of shrinkage of SS and establish its timing in HS and an in vitro and animal model to explore the possible causes of this phenomenon. METHODOLOGY: We collected 100 SS of HS, 50 SS of AS synthesized with fibrin-agarose biomaterials and 21 SS of MS. The width and length of specimens were measured before the surgical excision (pre-SE), at 5 minutes postsurgery (ex vivo), and after 24 hours of fixation in formalin (postfixation). Histological staining was performed to analyze the differences between HS, AS, and MS that may explain the differences in shrinkage. RESULTS: Between pre-SE and postfixation, the width and length shrank by 16.1% and 17.1% in HS, 14.5% and 8.5% in AS, and 26.5% and 23.1% in MS (P < 0.01), respectively. Shrinkage largely occurred between pre-SE and ex vivo. Cells and interstitial fibers were scant in AS and abundant in MS. CONCLUSIONS: Almost all of the shrinkage occurred during the first 5 minutes postsurgery. According to the AS model findings, 53.6% of SS shrinkage would be explained by the action of dermal fibers and other cellular components of the dermis.

Sun Exposure Habits and Sun Protection Practices of Skaters.

Beach activities and outdoor sports are risk factors for developing skin cancer. Skateboarding is among the most popular sports among adolescents. The aim was to analyse the sun exposure habits and sun protection practices of skaters, in comparison with corresponding sun exposure and protection practices on the beach. This cross-sectional study is based on health surveys carried out into sun exposure and protection practices among young skateboarders. The study population was composed of 102 skaters, of whom 84 (82.4 %) were male. Fifty-eight (56.8 %) of the participants reported having suffered at least one sunburn event the previous summer. Eighty-seven (91.6 %) said they practiced outdoor sports more than 90 days per year, while only six (6.1 %) spent this long at the beach. Forty-nine (52.1 %) practiced outdoor sports for 5 or more hours a day compared to 42 (43.3 %) who spent comparable periods at the beach. A long-sleeved shirt was worn more frequently during sports than at the beach. Keen skaters are a risk group for the development of skin cancer due to excessive sun exposure, high rates of sunburn and scant use of sun protection measures. Specific educational and behavioural interventions should be aimed at this risk group.

Adolescents' Attitudes to Sun Exposure and Sun Protection.

Adolescents are considered a risk group for the development of skin cancer in later life due to their high rates of sunburn. The aim of this study is to evaluate the association between attitudes to sun exposure and the sociodemographic characteristics of adolescents, their habits, practices and knowledge. As a secondary goal, we describe the magnitude and sign of the correlations between these attitudes. Cross-sectional study of adolescent students from 12 secondary schools in southern Spain, the subjects were asked to complete the 'Beach Questionnaire'. This instrument examines four dimensions of attitudes, with standardised scores of 0-100, related to the sun, sun tanning, sun protection and sun cream. The higher the score, the more positive the attitude. The study population was composed of 270 adolescents. The highest scores were obtained for attitudes towards sun protection practices (mean 66.2; SD 18.6) and towards sun tanning (mean 64.2; SD 21.1). The lowest scores were obtained for attitudes towards using sun cream (mean 50.1; SD 24.6). Significant differences were found for all four attitudes, with a positive sign for the relationship between the number of days of sun exposure and a higher score for attitudes towards sunbathing (27.3 points difference between response extremes) and for attitudes towards suntanning (20 points difference). Favourable attitudes towards sunbathing and sun tanning have most influence on inadequate habits of sun exposure and deficient measures of sun protection. Adolescents should be considered a priority group for targeted interventions to improve sun protection behaviour.

Sensitivity to change of the Beach Questionnaire to behaviour, attitudes and knowledge related to sun exposure: quasi-experimental before-after study.

BACKGROUND: Health questionnaires must present accredited measurement properties such as validity, reliability and sensitivity to change, the latter being essential for interventions to be planned and for evaluating their effectiveness. The aim of this study was to evaluate the sensitivity to change of a Beach Questionnaire. METHODS: Quasi-experimental before-after study carried out in 2011, for a study population of adolescents attending schools in the Costa del Sol. First, the questionnaire was administered to the adolescents, after which a multicomponent educational intervention was carried out; finally, three months later, the same questionnaire was re-administered to the same adolescents. Changes were assessed in the categories of each item, using the McNemar test, and the changes in the scores, standardised to a range of 0-100, using the Student t test for paired samples, and including the mean of the differences and the 95% confidence interval. The level of statistical significance was set at p < 0.05. RESULTS: 228 adolescents, aged 14-17 years, and 55.3% were girls. Statistically significant changes were observed in sunburn experiences, exposure to the sun at mid-day and attitudes to sun exposure and suncreams. For the seven items related to knowledge about sun exposure, a higher rate of correct answers was observed. The analysis of changes, within the standardised range, revealed a significant improvement in the scores for sun exposure habits (MD 4.33; CI 95% 2.2-6.5), attitudes to sun exposure (MD 2.22; CI 95% 1.2-3.2) and knowledge (MD 9.10; CI 95% 7.1-11.1), but not in those for sun-protection practices (MD 0.23; CI 95% -1.2-1.7). CONCLUSIONS: The Beach Questionnaire on behaviour, attitudes and knowledge related to sun exposure is the first such instrument in Spanish language to provide sufficient sensitivity to change. It constitutes a useful tool for epidemiologic research into photoprotection and for skin cancer prevention programmes.

Prevalence of common and atypical melanocytic nevi in young adults and its relationship with sun protection and exposure habits.

UNLABELLED: Background: The incidence of melanoma in young adults is rising. The design of appropriate preventive measures requires the analysis of risk factors, including the prevalence of common and atypical melanocytic nevi (MN) and sun protection and exposure habits. OBJECTIVES: To establish the prevalence and density of common and atypical MN in young adults (18-25 yrs) and their relationship with sun exposure and protection habits. METHODS: Cross-sectional descriptive study was undertaken in 535 university students from southern Spain to gather data on: the number, density, body localization, and characteristics of common and atypical nevi; phototype; sunburn history; sun protection and exposure habits; and family history of skin cancer. RESULTS: Means of 94.28 common MN and 0.06 atypical MN were detected; most MN were ≤2 mm in diameter; MN were more frequently detected on upper (p<0.01) and lower (p<0.0001 limbs in females versus males and on the trunk (p = 0.08) in males versus females. Nevus density was higher in females in all body areas. Sunburns (in the previous summer) were reported by 88.2% of participants, while cream with SPF ≥15 was not used by 75.8%. Mean number of atypical MN was higher in those with low phototypes and a family history of skin cancer. CONCLUSIONS: Mean number of common MN was elevated and atypical MN were associated with a low phototype and a family history of skin cancer. Sunburn history was significantly associated with younger age and with sun exposure between mid-day and 6 pm.

Behaviour, attitudes and awareness concerning sun exposure in adolescents on the Costa del Sol.

BACKGROUND: A history of sunburn and cumulative sun exposure during adolescence are the most important risk factors for the development of skin cancer. Skin cancer can be prevented by reducing sun exposure, particularly during adolescence, which is precisely the age group that could best benefit from primary prevention campaigns. OBJECTIVE: To determine the behaviour, attitudes and understanding of adolescents concerning sun exposure. METHODS: This cross-sectional descriptive study undertaken during 2011 included secondary school adolescents from randomly selected schools on the Costa del Sol, southern Spain. A validated beachside questionnaire was used to record data on demographics, skin colour, phototype, sun exposure habits, sunburns, practices, attitudes and knowledge about the sun. RESULTS: The study involved 270 students, aged 14-17 years, from 11 schools; 50.4% were female, 43.7% were aged 14 years, and 85.9% were Spanish. Most had a light skin colour (49.3%) and phototypes III (42.2%) or IV (34.8%). Most (71%) went to the beach on more than 16 days and 74.4% had had sunburn the previous summer. Sun cream was used by 47.8% and 1.1% wore long sleeves or trousers. Concerning attitudes, 60.7% stated they felt better when they were tanned, and concerning understanding, most were aware of the harmful effects of the sun on the skin. CONCLUSION: Adolescents comprise a special risk group with a positive attitude towards tanning. Further studies are required to assess educational stategies in order to reduce the desire to have a suntan, and improve sun protection practices and habits targeted at this age group.

Association of 25-hydroxyvitamin D serum levels and metabolic parameters in psoriatic patients with and without arthritis.

BACKGROUND: Psoriasis has been related to a higher prevalence of cardiovascular risk factors. Vitamin-D deficiency has been associated with metabolic syndrome, cardiovascular disease, and psoriasis. However, there has been no comparative study on the effects of vitamin-D status between patients with and without psoriatic arthritis. OBJECTIVE: The objective was to assess the relationship of 25-hydroxyvitamin D [25-(OH)D] levels with lipid and glucose metabolism parameters in psoriatic patients with and without arthritis. METHODS: We studied 122 patients with psoriasis (61 without arthritis and 61 with arthritis) from the psoriasis unit (dermatology department) and rheumatology department of our hospital, analyzing lipid and glucose metabolism variables and serum 25-(OH)D concentrations. Measurements were conducted within a 2-month period to minimize seasonal bias in 25-(OH)D levels. RESULTS: In the psoriatic patients without arthritis, serum 25-(OH)D levels were inversely correlated with fasting glucose (r = -0.285; P = .026), total cholesterol (r = -0.440; P = .000), low-density lipoprotein (r = -0.415; P = .001), total cholesterol/high-density lipoprotein (r = -0.303; P = .01), and triglyceride (r = -0.280; P = .029) values. This association remained statistically significant for glucose, total cholesterol, and low-density lipoprotein after controlling for confounding factors in multivariate analysis. No association was found between serum 25-(OH)D levels and any metabolic parameter in the patients with psoriatic arthritis. LIMITATIONS: This is a cross-sectional study that supports the hypothesis of an association between vitamin D and metabolic parameters but does not establish a causal relationship. CONCLUSIONS: Serum 25-(OH)D was inversely related to lipid and glucose metabolism parameters in psoriatic patients without arthritis, whereas no such association was observed in psoriatic patients with arthritis. Interventional studies are warranted to assess the effects of vitamin-D supplements on the metabolic profile of psoriatic patients without arthritis.

"Buen Rayito Study": awareness, attitudes and behavior of teenagers to sunlight through a web based system in Spain.

BACKGROUND: The exponential rise in cutaneous cancers underscores the need to promote primary prevention, emphasising exposure to ultraviolet radiation as the main modifiable risk factor. Children and adolescents are especially vulnerable to radiation. OBJECTIVES: Our objectives were to determine the knowledge and behavior of a Spanish adolescent population in relation to sun exposure thorough a web-based system. METHODS: This cross-sectional study included 1525 school students aged 12-15 yrs. Students completed the survey via the website, with 23 questions and three information blocks on: physical characteristics and general state of health; sun exposure habits and effects; and knowledge of the sun and its effects. RESULTS: Adolescents displayed a good level of knowledge on the risks of sun exposure, but this did not correlate with healthy sun protection habits. 63.1% of students reported suffering from sunburn in the previous summer and 15.8% reported sunburn with blisters.Sunburn risk increased with the frequency of sun exposure between 12 and 6 pm "always or almost always" (OR of 1.29; p = 0.001), the use of sun protection cream (OR of 1.38; p = 0.034) and decreased with physical sun protection measures (shade) with an OR of 0.85 (p = 0.032) in a multivariate study. LIMITATION: The retrospective gathering of sunburn data is a study limitation because of the possibility of a recall bias and potential inter-individual variation in the concept of burn. CONCLUSION: The high percentage of sunburns suffered by adolescents in the previous summer underscores the need for skin cancer preventive programs.

Androgenetic alopecia as an early marker of benign prostatic hyperplasia.

BACKGROUND: Androgenetic alopecia (AGA) and benign prostatic hyperplasia are both androgen-dependent entities that respond to the blocking of 5-alpha-reductase. OBJECTIVES: The objective of this study was to determine whether prostatic volumes and urinary flow changes were higher in patients with early-onset AGA than in healthy control subjects. METHODS: This was an observational case-control study of 87 men: 45 with early-onset AGA diagnosed in the dermatology department and 42 control subjects. End-point variables were prostatic volume, measured by transrectal ultrasound, and urinary flow, measured by urinary flowmetry. A hormone study was performed on all participants, and the International Prostate Symptom Score and International Index of Erectile Function score were determined. RESULTS: The groups did not significantly differ in mean age (cases, 52.7 years vs control subjects, 49.8 years; P = .12). Patients with AGA had significantly higher mean prostate volume (29.65 vs 20.24 mL, P < .0001), International Prostate Symptom Score (4.93 vs 1.23, P < .0001), and prostate-specific antigen value (1.53 vs 0.94 ng/mL, P < .0001) and significantly lower maximum urinary flow (14.5 vs 22.45 mL/s, P < .0001) versus control subjects. Binary logistic regression analysis showed a strong association between the presence of AGA and benign prostatic hyperplasia after adjusting for age, urinary volume, urination time, International Prostate Symptom Score, abdominal obesity, glucose levels, systolic blood pressure, insulin levels, fibrinogen, and C-reactive protein (odds ratio = 5.14, 95% confidence interval 1.23-47.36, P = .041). LIMITATIONS: The study of larger sample sizes would facilitate stratified analyses according to the Ebling type of androgenetic alopecia. CONCLUSION: There is a relationship between the presence of AGA and prostate growth-associated urinary symptoms, likely attributable to their pathophysiological similarity. This study suggests that early-onset AGA may be an early marker of urinary/prostatic symptomatology. Future studies may clarify whether treatment of patients with AGA may benefit the concomitant benign prostatic hypertrophy, which would be present at an earlier stage in its natural evolution.