Role of prostaglandins in androgenetic alopecia

Androgenetic alopecia (AGA) is the most prevalent progressive hair loss disorder worldwide, and its pathogenesis is closely linked to dysregulated androgen metabolism. Conventional therapies for AGA have limited efficacy and adverse reactions. Prostaglandins (PGs), a class of lipid signaling molecules, have recently been implicated in AGA development. This review systematically examines the association of PGs with key pathogenic mechanisms of AGA, including androgen pathway dysregulation, immune response, inflammation, vascular microenvironment disturbances, and lipid metabolism disorders. Accumulating evidence indicates that the homeostatic imbalance of PGs may represent a core common pathological mechanism in AGA. In alopecic scalp tissues of AGA patients, prostaglandin D₂ (PGD₂) and prostaglandin I₂ (PGI₂) levels are significantly elevated, whereas prostaglandin E₂ (PGE₂) and prostaglandin F₂α (PGF₂α) levels are markedly reduced. Moreover, PG expression levels strongly correlated with the clinical stage and disease duration of AGA. Therefore, PG-related parameters can serve as novel non-invasive biomarkers for early and differential diagnosis of AGA. Additionally, the PG pathway is a promising therapeutic target for AGA. Several novel agents, including PG analogs, receptor modulators, and 15-hydroxyprostaglandin dehydrogenase inhibitors, have shown potential applications in AGA treatment. This review systematically summarizes the roles of PGs in the pathogenesis of AGA and research advances in PG-based diagnosis and therapy, aiming to provide a valuable reference for clinicians and researchers.