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ANDROGENIC ALOPECIA

The most common type of non scarring alopecia is androgenic alopecia, whose main feature is the progressive miniaturization of hair that become thinner, shorter and less pigmented.
It is possible to differentiate between male and female androgenic alopecia.
By miniaturized hair we mean a hair whose diameter is smaller than 30 µm. It can’t offer coverage to the scalp and it is destined to fall out or shed.

The reasons of these phenomenon are partly genetic and partly linked to the action of androgenic hormones, especially that of DIHYDROTESTOSTERONE, an altered form of TESTOSTERONE.
DIHYDROTESTOSTERONE is produced starting from testosterone by the action of 5α-reductase type 2 enzyme.

Androgenic Alopecia affects:

  • 30% of men under 30.
  • 70% of men under 50.
  • Approximately 80% of Caucasian men and 60% of Caucasian women over 70 are affected by hair loss at different stages.

MALE ANDROGENIC ALOPECIA/MALE-PATTERN HAIR LOSS

 

This type of hair loss affects the fronto-temporal area and the vertex, following a pattern classified by the Norwood-Hamilton scale.

 

Hair loss progression according to Norwood-Hamilton.

FEMALE ANDROGENIC ALOPECIA/FEMALE-PATTERN HAIR LOSS

 

It affects more than 50% of women during their life. It is characterized by a diffuse hair thinning that can reach different stages and is described by the Ludwig scale.
The frontal area is usually not affected.

 

Female hair loss progression according to Ludwig.
Causes

The main cause of female-pattern hair loss is the excessive sensitivity of the hair follicle towards androgens, which leads to a progressive hair thinning. This sensitivity depends on genetic factors. This is the reason why the causes are not to be looked for in systemic hormonal alterations.
Only one third of women affected by female-pattern hair loss are affected by pathologies that cause an excessive amount of androgens, such as the Polycystic ovary syndrome.

Treatment

Following are all the options to treat this pathology:

  • Surgical therapy
  • Medical therapy
  • Regenerative therapy

Once a clear diagnosis is obtained hair transplantation can definitely represent a solution to female-pattern hair loss.
We have to make sure the pathology is stable and exclude other pathologies, such as autoimmune conditions or deficiencies.
Medical therapy is fundamental, both by itself and in combination with surgery.
Medical therapy consists of galenical lotions and Finasteride (only for patients over childbearing age!).
Regenerative therapy has been one of the most innovative and investigated fields over the last few years.
It involves the use of PRP (platelet-rich plasma) and of bulb stem cells.
Both therapies give a huge stimulus to the bulb and the bulge stem cells, thus reactivating the hair follicle and stimulating the anagen phase of the follicle’s life cycle.

Diagnosis

Both male- and female- pattern hair loss arises through a progressive hair thinning. There are several tests that can lead to a precise diagnosis:

  • Dermoscopy: non-invasive in vivo technique that, thanks to a camera with high magnification, allows us to recognize the main features of androgenic alopecia and make a differential diagnosis distinguishing it from other scalp pathologies;
  • Pull test: easy semiological test. A small amount of hair is gently pulled by the hair specialist and according to the number of hairs that will come out and to their characteristics it is possible to make a diagnosis.
  • Wash test: patients can do this at home. They simply count the number of hairs that is lost during the cleansing process. It is normal to lose up to 100-150 hair strands per day.
  • Hair mass index: calculated considering the amount of hair and their thickness. It is calculated thanks to a next generation test known as “Hair Check”. In a quick and non-invasive way it offers a parameter about the mass of the analysed area of the scalp.
  • Trichogram: semi-invasive method, not very popular anymore. Hair is pulled and analysed through an optical microscope. It is possible to calculate the percentage of hair in the anagen phase (growing phase) and telogen phase (resting phase).
  • Trichoscan: a computerized trichogram. The hair specialist chooses a small target area that is analysed by the computer. We are given several parameters and a picture of the progression over time.
  • Global photographs: it offers an overview, which is fundamental to evaluate the response to various therapies.
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