The combination of overweight and smoking increases the severity of androgenetic alopecia.

Introduction: Even though androgenetic alopecia (AGA) is the most common type of alopecia, factors associated with AGA severity have been poorly investigated.

Objectives: The objective of our study was to investigate risk factors for AGA severity among a Caucasian population.

Methods: A cross-sectional study was conducted among AGA subjects in the outpatient clinic of a reference hospital for skin diseases in Rome, Italy. A total of 351 Caucasian subjects with AGA, mean age 35.6 years, were enrolled in the study. Information on educational level, family history of AGA, diet, alcohol consumption, the presence of chronic diseases, the use of pills including dietary supplements, BMI, and smoking was collected by a face-to-face interview using standardized questionnaires. Norwood and Ludwig classifications were used to assess the degree of AGA.

Results: Subjects with a BMI of 25 or more and current smokers had circa six times an increased risk of having moderate or severe AGA (OR: 6.72; 95% CI: 2.57-17.6). In the multivariate model, after controlling for gender, age, education, dyslipidemia, dietary supplements, and wine consumption, the effect of high BMI and smoking (OR: 5.96; 95% CI: 1.65-21.5) on AGA severity remained. Only age and gender, besides the effect of BMI and smoking, remained statistically significant in the multivariate model while education, the presence of dyslipidemia, dietary supplements, and wine consumption did not remain statistically significant.

Conclusions: Our study shows that the combination of overweight and smoking is associated with an increased severity of androgenetic alopecia.