Study links oral contraceptive use to female hair loss

The study, which was funded by the British Skin Foundation through its Young Investigator Award and published in the JAMA Dermatology journal, has examined the potential link between taking the oral contraceptive pill and a type of hair loss called frontal fibrosing alopecia (FFA).

FFA is a skin disorder that causes inflammation, scarring and irreversible hair loss, often resulting in a ‘receding hair line.’

It mainly affects women and cases of the condition have been growing since it was first medically described in 1994.

The condition is thought to result from a combination of genetic and environmental factors, yet the exact disease mechanism is still unknown, which makes it hard to prevent and treat.

Hormone metabolism influenced by oral contraceptives​

The research found that women with a specific version of the CYP1B1 gene (which encodes an enzyme that’s important in the metabolism of exogenous hormones including oral contraception) who took oral contraceptives were more likely to develop FFA.

This supports the hypothesis that FFA results from a combination of genetic susceptibility and environmental factors – such as hormone metabolism influenced by oral contraceptives.

This study team, which included Dr Christos Tziotzios, a consultant dermatologist and senior lecturer at St. John’s Institute of Dermatology, King’s College London; Prof Michael Simpson from the Department of Medical and Molecular Genetics; Prof John McGrath from St. John’s Institute of Dermatology; and Dr Tuntas Rayinda, a recent PhD graduate, had previously discovered that the gene CYP1B1 is causally linked with FFA. .

This further study focused on understanding whether taking the oral contraceptive pill could be linked to the development of FFA – particularly in women with specific genetic mutations in the responsible gene. 

The hypothesis was further supported by a prior study they had undertaken on identical twins. Between July 2015 and September 2017, data was collected from women with FFA across the UK and compared against women without FFA from the UK Biobank.

Dr Christos Tziotzios explained more: “Our study is the first ever gene-environment interaction study into frontal fibrosing alopecia (FFA), a lichenoid inflammatory and scarring condition affecting almost exclusively women.”

“We have previously identified causal variation in a hormone-metabolism related gene, conferring susceptibility to this increasingly common and highly distressing disease,” he continued.

“We have now demonstrated contribution of the oral contraceptive to disease manifestation via gene-environment interaction. We are very grateful to all our referring clinicians in the UK, all clinical and research staff, our patients, and the British Skin Foundation, for financially supporting our work,” he concluded.

This study was the first to explore the interaction between genetic factors and environmental factors (like oral contraceptive use) in the development of the hair loss condition.

According to British Skin Foundation, the findings “support existing models that FFA results from a combination of genetic predisposition and environmental triggers.” 

The researchers now hope their findings will lead to the development of genetic tests to minimise the risk of FFA and are currently working on making these tests more widely available.