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Androgenetic alopecia

Definition
Androgenetic alopecia, also known as male or female pattern baldness, is a common form of hair loss in both genders.
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Pathophysiology
The pathophysiology of androgenetic alopecia involves both genetic and hormonal factors. The condition is known to depend on the presence of the androgen dihydrotestosterone and a genetic predisposition, with the androgen receptor gene playing a significant role.
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Epidemiology
Androgenetic alopecia is estimated to affect about 0.2-2% of the population worldwide.
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Disease course
Clinically, it is characterized by a progressive loss of hair, with a specific pattern of baldness. In men, it often presents as hairline recession at the temples and balding at the top of the head. In women, it typically manifests as a general thinning of hair across the entire scalp, with preservation of the frontal hairline.
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Prognosis and risk of recurrence
The prognosis of androgenetic alopecia is chronic and progressive. While treatments can slow the progression and improve hair density, there is currently no known cure. The hair loss typically continues over time.
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Key sources
The following summarized guidelines for the evaluation and management of androgenetic alopecia are prepared by our editorial team based on guidelines from the Japanese Dermatological Association (JDA 2018), the European Dermatology Forum (EDF 2018), and the American Academy of Family Physicians (AAFP 2009).
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Guidelines

1.Diagnostic investigations

Laboratory evaluation: obtain targeted endocrine evaluation (testosterone, DHEAS, and prolactin levels) in female patients presenting with hair loss associated with abnormal menses, history of infertility, hirsutism, unresponsive cystic acne, virilization, or galactorrhea.
B
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2.Medical management

Topical minoxidil, male-pattern hair loss, EDF: offer topical minoxidil 2-5% solution 1 mL or half a cap of 5% foam BID to improve or to prevent the progression of androgenetic alopecia in > 18 years old male patients with mild-to-moderate disease, Hamilton-Norwood IIv-V.
A
consider offering topical minoxidil 5% solution or half a cap of 5% foam for greater efficacy.
B
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More topics in this section

  • Topical minoxidil (female-pattern hair loss)

  • Other topical therapies

  • Oral minoxidil

  • 5-alpha-reductase inhibitors (male-pattern hair loss)

  • 5-alpha-reductase inhibitors (female-pattern hair loss)

  • Hormonal therapy (male-pattern hair loss)

  • Hormonal therapy (female-pattern hair loss)

  • Therapies with no evidence for benefit

3.Nonpharmacologic interventions

Use of wigs: consider advising the use of wigs as an option for hair loss.
C

4.Therapeutic procedures

Laser therapy
As per EDF 2018 guidelines:
Consider offering low-level laser therapy (with devices using energy levels shown to be effective in randomized-controlled clinical trials) as an ancillary therapy in patients with androgenetic alopecia.
C
Insufficient evidence to recommend for or against treatment for > 6 months with low-level laser therapy.
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5.Surgical interventions

Self-hair transplantation, male-pattern hair loss, EDF
Consider offering follicular unit transplantation in male patients with androgenetic alopecia with sufficient donor hair.
C
Consider combining follicular unit transplantation with finasteride 1 mg/day to achieve a better clinical outcome.
C

More topics in this section

  • Self-hair transplantation (female-pattern hair loss)

  • Prosthetic hair transplantation