Clinical and metabolic characteristics of males with early-onset androgenetic alopecia.

Background Men with early-onset androgenetic alopecia (AGA) often have an abnormal hormonal milieu. Objective To ascertain the clinico-phenotypic characteristics and the prevalence of hormonal and metabolic changes in men with early-onset AGA. Methods Consecutive male patients less than 30 years of age with a Norwood-Hamilton grade ≥3 AGA were recruited in this comparative cross-sectional study. After endocrine evaluation they were classified into two groups, that is, Group A consisting of subjects with an altered hormonal profile and Group B with normal hormonal profiles. The groups were assessed for differences in disease phenotype and severity (Norwood-Hamilton grade), insulin resistance and parameters of metabolic syndrome (ATP III guidelines). Results Altered hormonal profiles were seen in 34 of the 100 subjects with AGA, while insulin resistance and metabolic syndrome were noted in 44 and 26 respectively. Altered hormonal profiles were significantly associated with insulin resistance and severe alopecia (grade 4 and above Hamilton-Norwood Scale). Insulin resistant Group A patients had a significantly higher prevalence of severe alopecia (>grade 4) (P = 0.0036). The prevalence of metabolic syndrome was similar in both groups. Limitation The cross sectional study design was a drawback of this study. Further, a control arm without AGA was not included and the sample size of 100 was selected arbitrarily. Conclusion An altered hormonal profile and insulin resistance was noted in a third of the males with early-onset AGA. Subjects with altered hormonal profiles had a higher prevalence of insulin resistance and were likely to have severe grades of AGA.

Facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome: A cross-sectional study.

BACKGROUND: Face was often thought to be spared in psoriasis possibly due to the protective effect of sebum and low-dose ambient ultraviolet radiation exposure. Some have suggested that facial involvement is common and indicates disease severity. There is a paucity of data on this, particularly from India. Psoriatics have a higher prevalence of metabolic syndrome, and patients with severe disease are at greater risk. OBJECTIVE: A study of the frequency and type of facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome. METHODS: A total of 250 consecutive psoriatic patients were screened and these yielded 188 patients with facial involvement. Facial psoriatics were divided into peripherofacial, centrofacial and mixed facial types. Disease severity was assessed using whole body, scalp, facial psoriasis area severity index scores and nail area psoriasis severity index scores. Patients were evaluated for the presence of metabolic syndrome using NCEP-III criteria. All parameters were compared both between facial and nonfacial psoriatics and between cases with different types of face involvement. RESULTS: The mean age (P = 0.04) and age of onset of disease (P = 0.02) was lower and median whole-body psoriasis area severity index score was higher in psoriatics with facial involvement (P < 0.001) than those without. No significant association was found between facial involvement and metabolic syndrome. Mixed facial was the commonest type of facial involvement and there was a significant association of mixed facial involvement with increased total body psoriasis area severity index scores (P < 0.001). LIMITATIONS: Dietary habits, physical activity level, family history of diabetes and obesity were not enquired for in our patients. Centrofacial cases were too few in number, hence statistical comparisons are not relevant. CONCLUSION: Facial involvement in psoriatics is associated with severe disease but not metabolic syndrome. Mixed facial type might be considered a marker of overall psoriasis disease severity in the Indian population.

Metabolic syndrome and female gender, but not methotrexate, are the important associations of significant liver fibrosis in patients with moderate-to-severe psoriasis as detected by transient elastography.

BACKGROUND: Many international guidelines on psoriasis management have emphasized upon the need to identify risk factors for liver fibrosis and that the risk may be increased after a certain total cumulative dose of methotrexate. METHODS: Consecutive patients with moderate-to-severe psoriasis were assessed for liver fibrosis using transient elastography and noninvasive scores. Based on the presence of significant liver fibrosis, the Odds ratio associated with various factors was calculated using logistic regression analysis. Receiver operating characteristic curves were calculated to find maximal cutoff values of noninvasive tests to detect fibrosis. RESULTS: In this cross-sectional study, 134 patients completed the study. Significant fibrosis (liver stiffness measurement ≥7, corresponding to F2 fibrosis or higher) was seen in 33 (24.6%) patients. Neither methotrexate exposure nor total cumulative dose of ≥1.5 was associated with significant fibrosis. Female sex (P = 0.024) and the presence of metabolic syndrome (P = 0.034) were the two variables associated with significant liver fibrosis. On logistic regression analysis, the odds ratio for the female gender and metabolic syndrome was estimated to be 2.51 (95% confidence interval - 1.09-5.81) and 2.33 (95% confidence interval - 1.03-5.27), respectively. Aspartate transaminase to platelet ratio index, nonalcoholic fatty liver disease score and the fibrosis-4 index had low sensitivity in comparison to transient elastography. LIMITATIONS: These included small sample size, small number of patients with a total cumulative methotrexate dose of >3-4.5 g, and lack of control group consisting of healthy persons. Another is the absence of liver biopsies considered as the gold standard in the diagnosis of liver fibrosis. CONCLUSIONS: Metabolic syndrome and female sex are associated with the development of significant liver fibrosis in patients with psoriasis. Methotrexate exposure does not seem to be significantly associated with significant liver fibrosis.