Scalp Microbiome Alterations in Androgenetic Alopecia: Patterns and Emerging Mechanistic Insights

Emerging evidence suggests that alterations in the scalp microbiome, particularly an increase in Cutibacterium acnes and Malassezia, may contribute to androgenetic alopecia (AGA) by affecting scalp sebum composition and activating immune pathways that lead to inflammation and hair follicle miniaturization. These microbial changes, alongside elevated triglycerides and palmitic acid, may promote the growth of lipophilic microbes and trigger pro-inflammatory cytokine production, potentially causing follicular stem cell apoptosis. Although findings are varied, these insights highlight the potential for treatments targeting microbial-lipid-immune interactions, such as ketoconazole or lipid-modulating interventions, in managing AGA.