Smokers Are More Likely to Have Androgenetic Alopecia Despite Negative Family History

A man with hair loss
A man with hair loss
The demographic and clinical features of early onset androgenetic alopecia in smokers and nonsmokers was assessed.

People who smoke have a higher prevalence of early onset androgenetic alopecia compared with nonsmokers, but many smokers with this form of pattern hair loss more often report a negative family history for the disorder, according to findings from a study published in the Journal of Cosmetic Dermatology.

Early onset androgenetic alopecia is defined as a progressive pattern of regressing hair lines and balding of the vertex that occurs in men younger than 35 years of age. In a study of early onset androgenetic alopecia, researchers from Egypt enrolled 1000 healthy men between the ages of 20 and 35 years without any local scalp condition. These participants were divided into 2 equal groups: people who smoked (n=500) and people who did not smoke (n=500).

Trichoscopy and the Hamilton baldness scale were used to identify cases of androgenetic alopecia in this population. Questionnaires were administered by a dermatologist to identify the perceived duration of any hair loss, family history of hair loss, and smoking habits.

There was no difference in the group who smoked and the group who did not smoke in terms of the median age at baseline (25.69±2.96 vs 24.95±2.93, respectively; P =.309). A greater number of participants who smoked (n=425) had a form of androgenetic alopecia compared with nonsmokers (n=200) (P <.01). In the group of smokers, approximately 47% had grade 3 androgenetic alopecia, and24% had grade 4. It was noted that 20% and 10% of nonsmokers had grade 3 and grade 4 androgenetic alopecia, respectively.

According to responses to the baseline questionnaire, there was no significant difference in the percentage of smokers and nonsmokers who reported a negative family history of first-degree relatives for androgenetic alopecia (87% vs 80%, respectively; P =.439).

Limitations of this study were the inclusion of only participants between the ages of 20 and 30 years, the reliance on questionnaire data, and the recruitment of participants from a single location.

Although the study did not investigate the mechanism behind “which smoking might precipitate androgenetic alopecia,” the investigators noted that “nicotine and its derivative cotinine might be responsible for accelerating” the progress of the disorder.


Salem AS, Ibrahim HS, Abdelaziz HH, Elsaie ML. Implications of cigarette smoking on early-onset androgenetic alopecia: A cross-sectional study. Published online September 18, 2020. J Cosmet Dermatol. doi:10.1111/jocd.13727