Etiological Analysis Of Female Pattern Hair Loss And Observation On The Efficacy Of Red Light Combined With Blue Light In The Treatment Of Type I Female Pattern Hair Loss

Objective:(1)By analyzing the relevant data of female pattern hair loss(FPHL)patients in dermatology clinics,explore the clinical manifestations and disease related factors of FPHL,and provide assistance for more effective diagnosis,differentiation,and treatment of the disease in the future.(2)Screening out androgenic alopecia(AGA)differentially expressed genes(DEGs)and pathways that may be related to the pathogenesis of androgenic alopecia through bioinformatics methods provides new ideas for studying the pathogenesis and treatment of androgenic alopecia.(3)To compare the efficacy and safety of four methods for treating type I FPHL:Yu fa solution combined with 5%minoxidil tincture,red and blue light combined with Yu fa solution,red and blue light combined with 5%minoxidil tincture,red and blue light combined with Yu fa solution,and 5%minoxidil tincture,and to analyze the efficacy of applying red and blue light in the treatment of FPHL.Methods:(1)The clinical data of 376 patients with FPHL in the dermatology department from October 1,2020 to December 30,2022 were collected.The inclusion criteria were:2 hair specialists clearly diagnosed as FPHL.Diagnostic criteria:Symptomatic diagnosis can be performed when the patient meets the following conditions:a patient has one of the following three types of alopecia(① Sparse hair at the midline of the scalp,widened midline,and gaps in the hairline,presenting a Christmas tree like appearance.②Diffuse sparse hair at the coronal region of the scalp,with normal forehead hairline.③Upward movement of the hairline at both frontal corners,presenting a type of male pattern alopecia,which is relatively rare),the hair pulling test is negative,proportion of vellus hair increases,the difference in hair diameter is greater than 20%,yellow spot sign,white spot sign,white peritrichosis sign,brown peritrichosis sign,and honeycomb pigmentation can be seen under dermoscopy.A patient with a family history of androgenic alopecia can also provide a basis for diagnosis.Through a questionnaire survey,understand the patient’s gender,age,occupation,education level,scalp and hair conditions(itching,dandruff,greasy hair,folliculitis,etc.),life and diet conditions(dietary taste preferences,regular work and rest),sleep disorders(staying up late,insomnia,dreaminess,easy to wake up,etc.),mental and psychological conditions(stress,anxiety,depression,etc.),family history,etc,Analyze the factors that may be related to FPHL.To analyze the correlation between dietary taste preferences,sleep duration,and the severity of FPHL.Check the blood biochemical indicators of 50 patients,and compare the results with those of normal women of similar age who visited the clinic during the same period.Compare the differences in age and course of disease between patients with and without a family history.(2)Download the gene chip expression profile related to androgenic alopecia from the GEO database(Gene Expression Omnibus);Screening and enrichment analysis of DEGs;Build a protein protein interaction network(PPI)based on a String database,and screen key genes through Cytascape software.(3)Outpatients with type Ⅰ FPHL were collected and classified according to Ludwig’s classification criteria:Type Ⅰ:diffuse thinning of hair on the top of the head,thinning of hair,and slight scalp exposure.Type Ⅱ:Hair on the top and front of the head is sparse,hair becomes thinner,and scalp exposure is more obvious;Type Ⅲ:Hair on the top and front of the head is almost completely shed,and the scalp is almost completely exposed,but the hairline of the forehead remains.Inclusion criteria:age 18-45 years;Conforming to the clinical manifestation of type I FPHL;Auxiliary examination:hair pulling test is negative,and hair microscopic examination supports FPHL.The final screening of 160 subjects was randomly divided into 4 groups:Group A(Yu fa solution combined with 5%minoxidil tincture group);Group B(red and blue light combined with Yu fa solution group);Group C(red blue light combined with 5%minoxidil tincture group);Group D(red and blue light combined with Yu fa solution and 5%minoxidil tincture group),with 40 patients in each group.All patients in each group were treated with oral compound glycyrrhizin tablets and Shancun compound vitamin tablets.Treatment parameters related to red and blue light:the wavelength of red light is 633 ± 10 nm,the treatment dose is 24 J/cm2,and the duration of each treatment is 7 minutes;The blue light has a wavelength of 415 ± 5 nm,a therapeutic dose of 25 J/cm2,and a duration of 3 minutes each time.Apply topically to affected scalp areas,2 mL twice daily.Apply 5%minoxidil tincture externally to affected scalp areas,once a day,1 mL each time.Compound glycyrrhizin tablets are taken orally,twice daily,two tablets each time,on a full stomach.Take Shancun compound vitamin tablets orally,one tablet per day.The treatment period is 3 months.Evaluation indicators:①Dermoscopy:20x magnification,and the therapeutic indicators include:hair density,thicker and thinner hair diameters,number of multiple hair follicle unit,and local signs under dermoscopy(hair diameter difference>20%,honeycomb pigmentation,brown perifollicular sign,white perifollicular sign,yellow spot sign,and white spot sign).For each patient,take two points 12 cm upward from the center of the eyebrow(frontal point)and 15 cm upward from the center of the eyebrow(top point),and conduct hair density testing on the scalp within a range of 4 square centimeters around each point.Measure the diameter of 10 thicker hairs and 10 thinner hairs under the hair microscope for each patient,take the average value,and measure the unit number of hair follicles containing multiple hairs at the top point of the patient.Detect the local signs of each patient under the hair microscope and statistically analyze the results.②Photos.Results:(1)Of the 376 women with alopecia in this survey,the maximum age was 51 years old,the minimum was 13 years old,and the average age of consultation was 27.97 ±7.30 years old.The longest course of disease is 10 years,the shortest is 1 month,and the average course is 1.29 ± 1.25 years.Ludwig type Ⅰ patients accounted for 61.5%,type Ⅱpatients accounted for 30.1%,and type Ⅲ patients accounted for 8.3%.88.3%of the patients were mental workers in occupations such as students,teachers,and accountants,with a majority of them having a college degree or above.11.7%of patients were manual workers in occupations such as housewives and workers.In addition to hair loss,81.9%of patients also have one or more scalp or hair symptoms,such as itchy scalp,excessive dandruff,greasy hair,folliculitis,and so on.15.4%of patients had irregular menstruation,and 29.3%had a positive family history.70.7%of patients had abnormalities in their daily life and diet,with a moderate correlation between high fat diet and FPHL,with a correlation coefficient of r=0.553(P<0.001).A spicy diet had a low correlation with the severity of FPHL,with a correlation coefficient of r=0.366(P=0.001).50.5%of patients rated themselves as having sleep disorders,and insufficient sleep duration was associated with the severity of hair loss,with a correlation coefficient of 0.419(P<0.05).47.1%of patients rated themselves as having poor mental and psychological conditions.There was no significant difference in liver and renal function and blood lipid analysis between FPHL patients and normal women of similar age(P>0.05).(2)A total of 142 DEGs were selected from 10 scalp samples.GO enrichment analysis showed that these 142 DEGs were mainly enriched in epidermal development,cell structure,supramolecular fibers,and other aspects.KEGG enrichment analysis showed that these DEGs were mainly related to two pathways,staphylococcus aureus infection and estrogen signaling pathway.Through PPI analysis,10 key genes were selected,including LEF1,HOXC13,MMP2,KIT,FOS,BMP2,SERPINA1,MLLT11,KRT33B,and STMN2.(3)① After 3 months of treatment,the hair density at the frontal point and the top point,the diameter of thicker and thinner hair,and the number of multiple hair follicle units at the top point of each of the four groups were improved compared to those before treatment.②The efficacy differences between groups were analyzed:Improvement of hair density:The difference between the four groups was statistically significant(P<0.05).The red and blue light combined with Yu fa solution and 5%minoxidil tincture group for hair density improvement at the frontal point and top point was the most effective.There was no statistically significant difference between the Yu fa solution combined with 5%minoxidil tincture group and the red blue light combined with 5%minoxidil tincture group(frontal point:P=0.802;top point:P=0.503).Improvement of hair diameter:The difference between the four groups was statistically significant(P<0.05).The red and blue light combined with Yu fa solution and 5%minoxidil tincture group had the best effect in improving the diameter of thicker and thinner hair.There was no statistically significant difference between the red and blue light combined with Yu fa solution group and the red blue light combined with 5%minoxidil tincture group(improvement of thicker hair diameter:P=0.883;improvement of thicker hair diameter:P=0.979).Improvement in the number of hair follicles containing multiple hairs at the top point:The difference between the four groups was statistically significant(P<0.05).The red and blue light combined with Yu fa solution and 5%minoxidil tincture group had the best therapeutic effect.There was no statistically significant difference between the Yu fa solution combined with 5%minoxidil tincture group and the red and blue light combined with 5%minoxidil tincture group(P=0.135).The photos show that the hair loss symptoms of each group of patients have improved.Many newly born hair in the patient’s hair can been seen under the dermoscopy.The difference in hair diameter decreases,and the number of hair follicles containing multiple hairs increases.Other signs such as honeycomb pigmentation,brown peritrichal sign,white peritrichal sign,yellow dot sign and white dot sign have also been improved to some extent.No serious adverse events or side effects were reported during treatment.Conclusion:(1)The incidence rate of FPHL is higher among people engaged in mental work and high pressure in work and life.High fat diet,spicy diet and insufficient sleep time are all related factors to the aggravation of FPHL.Genetic factors are also an important cause of the disease.(2)This study used bioinformatics methods to screen out 10 key genes related to the pathogenesis of AGA,including LEF1,HOXC13,MMP2,KIT,FOS,BMP2,SERPINA1,MLLT11,KRT33B,and STMN2.MMP2,KIT,FOS,and STMN2 are upregulated genes,while LEF1,HOXC13,BMP2,SERPINA1,MLLT11,and KRT33B are downregulated genes.It also found that staphylococcus aureus infection and estrogen signaling pathway play a certain role in the pathogenesis of AGA.This provides a theoretical basis for in-depth research on the pathogenesis and treatment methods of androgenic alopecia.(3)Red and blue light therapy is a feasible non operative treatment for FPHL.Red and blue light combined with Yu fa solution and 5%minoxidil tincture treatment is the best effect.