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Pattern hair loss
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Pattern hair loss
Synonyms
Androgenic alopecia, androgenetic alopecia, male pattern baldness, female androgenic alopecia, female pattern baldness
Male-pattern hair loss
Specialty
Dermatology, plastic surgery
Pattern hair loss, known as male-pattern hair loss (MPHL) when it affects males and female-pattern hair loss (FPHL) when it affects females, is hair loss that primarily affects the top and front of the scalp.[1] In males the hair loss often presents as a receding hairline while in females it typically presents as a thinning of the hair.[1]
Male pattern hair loss is believed to be due to a combination of genetics and the male hormone dihydrotestosterone.[1] The cause in female pattern hair loss remains unclear.[1]
Management may include simply accepting the condition.[1] Otherwise, treatments may include minoxidil, finasteride, or hair transplant surgery.[1] Evidence for finasteride in women, however, is poor and it may result in birth defects if taken during pregnancy.[1]
Pattern hair loss by the age of 50 affects about half of males and a quarter of females.[1] It is the most common cause of hair loss.
Contents
[hide]
1 Signs and symptoms
2 Causes
2.1 Hormones
3 Diagnosis
4 Treatment
4.1 Medication
4.1.1 Androgen-dependent
4.1.2 Androgen-independent
4.2 Procedures
4.3 Alternative therapies
5 Prognosis
5.1 Psychological
6 Epidemiology
7 Society and culture
7.1 Myths
7.2 Names
8 Other animals
9 References
10 External links
Signs and symptoms[edit]
Classic male-pattern hair loss begins above the temples and vertex (calvaria) of the scalp. As it progresses, a rim of hair at the sides and rear of the head remains. This has been referred to as a 'Hippocratic wreath', and rarely progresses to complete baldness.[2] The Hamilton–Norwood scale has been developed to grade androgenic alopecia in males.
Female-pattern hair loss more often causes diffuse thinning without hairline recession; similar to its male counterpart, female androgenic alopecia rarely leads to total hair loss.[3] The Ludwig scale grades severity of female-pattern hair loss.
Causes[edit]
Hormones[edit]
Androgens can interact with the Wnt signalling pathway to cause hair loss.
Research indicates that the initial programming of pilosebaceous units of hair follicles begins in utero.[4] The physiology is primarily androgenic, with dihydrotestosterone (DHT) being the major contributor at the dermal papillae. Men with premature androgenic alopecia tend to have lower than normal values of sex hormone-binding globulin (SHBG), follicle stimulating hormone (FSH), testosterone, and epitestosterone when compared to men without pattern hair loss[citation needed]. Although hair follicles were previously thought to be permanently gone in areas of complete hair loss, they are more likely dormant, as recent studies have shown the scalp contains the stem cell progenitor cells from which the follicles arose.[5]
Transgenic studies have shown that growth and dormancy of hair follicles are related to the activity of insulin-like growth factor (IGF) at the dermal papillae, which is affected by DHT. Androgens are important in male sexual development around birth and at puberty. They regulate sebaceous glands, apocrine hair growth, and libido. With increasing age, androgens stimulate hair growth on the face, but can suppress it at the temples and scalp vertex, a condition that has been referred to as the 'androgen paradox'.[6]
Men with androgenic alopecia typically have higher 5-alpha-reductase, lower total testosterone, higher unbound/free testosterone, and higher free androgens, including DHT[citation needed]. 5-alpha-reductase converts free testosterone into DHT, and is highest in the scalp and prostate gland. DHT is most commonly formed at the tissue level by 5α-reduction of testosterone.[7] The genetic corollary that codes for this enzyme has been discovered.[8] Prolactin has also been suggested to have different effects on the hair follicle across gender.[9]
Also, crosstalk occurs between androgens and the Wnt-beta-catenin signaling pathway that leads to hair loss. At the level of the somatic stem cell, androgens promote differentiation of facial hair dermal papillae, but inhibit it at the scalp.[6] Other research suggests the enzyme prostaglandin D2 synthase and its product prostaglandin D2 (PGD2) in hair follicles as contributive.[10]
These observations have led to study at the level of the mesenchymal dermal papillae.[11][12] Types 1 and 2 5α reductase enzymes are present at pilosebaceous units in papillae of individual hair follicles.[13] They catalyze formation of the androgens testosterone and DHT, which in turn regulate hair growth.[6] Androgens have different effects at different follicles: they stimulate IGF-1 at facial hair, leading to growth, but can also stimulate TGF β1, TGF β2, dickkopf1, and IL-6 at the scalp, leading to catagenic miniaturization.[6] Hair follicles in anaphase express four different caspases.
Hair follicle and mesenchymal dermal papilla, labelled at top
Diagnosis[edit]
The diagnosis of androgenic alopecia can be usually established based on clinical presentation in men. In women, the diagnosis usually requires more complex diagnostic evaluation. Further evaluation of the differential requires exclusion of other causes of hair loss, and assessing for the typical progressive hair loss pattern of androgenic alopecia.[14] Trichoscopy can be used for further evaluation.[15] Biopsy may be needed to exclude other causes of hair loss,[16] and histology would demonstrate perifollicular fibrosis.[17][18]
Treatment[edit]
Main article: Management of hair loss
Medication[edit]
Hair loss can be slowed or reversed in its early stages with medication. Medications approved by the United States' Food and Drug Administration (FDA) to treat male-pattern hair loss include minoxidil and finasteride.[19]
Androgen-dependent[edit]
Finasteride is a medication of the 5α-reductase inhibitors (5-ARIs) class.[20] By inhibiting type II 5-ARI, finasteride prevents the conversion of testosterone to dihydrotestosterone in various tissues including the scalp.[20][21] Increased hair on the scalp can be seen within three months of starting finasteride treatment and longer-term studies have demonstrated increased hair on the scalp at 24 and 48 months with continued use.[21] Treatment with finasteride more effectively treats male-pattern hair loss at the vertex than male-pattern hair loss at the front of the head and temples.[21]
Dutasteride is a medication in the same class as finasteride but inhibits both type I and type II 5-alpha reductase.[21] Dutasteride is approved for the treatment of male-pattern hair loss in Korea and Japan, but not in the United States.[21] However, it is commonly used off-label to treat male-pattern hair loss.[21]
Androgen-independent[edit]
Minoxidil dilates small blood vessels; it is not clear how this causes hair to grow.[22] Other treatments include tretinoin combined with minoxidil, ketoconazole shampoo, spironolactone,[23] alfatradiol, and topilutamide (fluridil).[24]
Procedures[edit]
More advanced cases may be resistant or unresponsive to medical therapy and require hair transplantation. Naturally occurring units of one to four hairs, called follicular units, are excised and moved to areas of hair restoration.[23] These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either follicular unit transplantation (FUT) or follicular unit extraction (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites.[25][26] Cosmetic scalp tattoos can also mimic the appearance of a short, buzzed haircut.
Alternative therapies[edit]
Many people use unproven treatments.[27] There is no evidence for vitamins, minerals, or other dietary supplements.[28] As of 2008, there is little evidence to support the use of lasers to treat male-pattern hair loss.[29] The same applies to special lights.[28] Dietary supplements are not typically recommended.[29] A 2015 review found a growing number of papers in which plant extracts were studied but only one randomized controlled clinical trial, namely a study in 10 people of saw palmetto extract.[30][31]
Prognosis[edit]
Psychological[edit]
Androgenic alopecia is typically experienced as a "moderately stressful condition that diminishes body image satisfaction".[32] However, although most men regard baldness as an unwanted and distressing experience, they usually are able to cope and retain integrity of personality.[33]
Although baldness is not as common in women as in men, the psychological effects of hair loss tend to be much greater. Typically, the frontal hairline is preserved, but the density of hair is decreased on all areas of the scalp. Previously, it was believed to be caused by testosterone just as in male baldness, but most women who lose hair have normal testosterone levels.[34]
Epidemiology[edit]
Female androgenic alopecia has become a growing problem that, according to the American Academy of Dermatology, affects around 30 million women in the United States. Although hair loss in females normally occurs after the age of 50 or even later when it does not follow events like pregnancy, chronic illness, crash diets, and stress among others, it is now occurring at earlier ages with reported cases in women as young as 15 or 16.[35]
Society and culture[edit]
Certain studies have suggested androgenic alopecia conveys survival advantage.
Studies have been inconsistent and not stable across cultures how balding men rate on the attraction scale. While a study from South Korea showed most people rated balding men as less attractive,[36] a more recent survey of 1,000 Welsh women rated bald and gray haired men quite desirable.[37]
Proposed social theories for male-pattern hair loss include that baldness signaled dominance, social status, or longevity.[38] Biologists have hypothesized the larger sunlight exposed area would allow more vitamin D to be synthesized, which might have been a "finely tuned mechanism to prevent prostate cancer", as the malignancy itself is also associated with higher levels of DHT.[39][40]
Myths[edit]
An ancient phenomenon:
Greek philosophers with and without much hair (from left to right: Socrates, Antisthenes, Chrysippus, and Epicurus, fifth to third centuries BC)
Many myths are given regarding the possible causes of baldness and its relationship with one's virility, intelligence, ethnicity, job, social class, wealth, etc. While skepticism may be warranted in many cases due to a lack of scientific validation, some claims may have a degree of underlying truth and are supported by research.
“ You inherit baldness from your mother's father. ”
A 50% chance exists for a person to share the same X chromosome as his maternal grandfather. Because women have two X chromosomes, they have two copies of the androgen receptor gene, while men only have one.
“ Weight training and other types of physical activity cause baldness. ”
Because it increases testosterone levels, many Internet forums[which?] have put forward the idea that weight training and other forms of exercise increase hair loss in predisposed individuals. Although scientific studies do support a correlation between exercise and testosterone, no direct study has found a link between exercise and baldness. However, a few have found a relationship between a sedentary life and baldness, suggesting some exercise is beneficial. The type or quantity of exercise may influence hair loss.[41][42] Testosterone levels are not a good marker of baldness, and many studies actually show paradoxical low testosterone in balding persons, although research on the implications is limited.
“ Baldness can be caused by emotional stress, sleep deprivation, etc. ”
Emotional stress has been shown to accelerate baldness in genetically susceptible individuals.[43] Stress due to sleep deprivation in military recruits lowered testosterone levels, but is not noted to have affected SHBG.[44] Thus, stress due to sleep deprivation in fit males is unlikely to elevate DHT, which is one cause of male pattern baldness. Whether sleep deprivation can cause hair loss by some other mechanism is not clear.
“ Bald men are more 'virile' or sexually active than others. ”
Levels of free testosterone are strongly linked to libido and DHT levels, but unless free testosterone is virtually nonexistent, levels have not been shown to affect virility. Men with androgenic alopecia are more likely to have a higher baseline of free androgens. However, sexual activity is multifactoral, and androgenic profile is not the only determining factor in baldness. Additionally, because hair loss is progressive and free testosterone declines with age, a male's hairline may be more indicative of his past than his present disposition.[45][46]
“ Frequent ejaculation causes baldness. ”
Many misconceptions exist about what can help prevent hair loss, one of these being that lack of sexual activity will automatically prevent hair loss. While a proven direct correlation exists between increased frequency of ejaculation and increased levels of DHT, as shown in a recent study by Harvard Medical School, the study suggests that ejaculation frequency may be a sign, rather than a cause, of higher DHT levels.[47] Another study shows that although sexual arousal and masturbation-induced orgasm increase testosterone concentration around orgasm, they reduce testosterone concentration on average (especially before abstinence) and because about 5% of testosterone is converted to DHT, ejaculation does not elevate DHT levels.[48]
The only published study to test correlation between ejaculation frequency and baldness was probably large enough to detect an association (1390 subjects) and found no correlation, although persons with only vertex androgenetic alopecia had had fewer female sexual partners than those of other androgenetic alopecia categories (such as frontal or both frontal and vertex). One study may not be enough, especially in baldness, where there is a complex with age.[49] Marital status has been shown in some studies to influence hair loss in cross-sectional studies (NHANES1).[citation needed]
Names[edit]
Male pattern hair loss is also known as androgenic alopecia, androgenetic alopecia (AGA), alopecia androgenetica and male pattern baldness (MPB).
Other animals[edit]
Animal models of androgenic alopecia occur naturally and have been developed in transgenic mice;[50] chimpanzees (Pan troglodytes); bald uakaris (Cacajao rubicundus); and stump-tailed macaques (Macaca speciosa and M. arctoides). Of these, macaques have demonstrated the greatest incidence and most prominent degrees of hair loss.[51][52]
Baldness is not a trait unique to human beings. One possible case study is the maneless male Tsavo lion. The Tsavo lions' prides are unique in that they frequently have only a single male lion with usually seven or eight adult females, as opposed to four females in other lion prides. Tsavo males may have heightened levels of testosterone, which could explain their reputation for aggression and dominance, indicating that lack of mane may at one time have had an alpha correlation.[53]
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External links[edit]
Wikimedia Commons has media related to Androgenic alopecia.
NLM- Genetics Home Reference
Scow, D. T.; Nolte, R. S.; Shaughnessy, A. F. (1999). "Medical treatments for balding in men". American Family Physician. 59 (8): 2189–2194, 2196. PMID 10221304.
Classification
V · T · D
ICD-10: L64
MeSH: D000505
DiseasesDB: 7773
External resources
MedlinePlus: 001177
eMedicine: derm/21
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Frosted tips
Hair crimping
Harvard clip
High and tight
Hime cut
Historical Christian hairstyles
Hi-top fade
Induction cut
Ivy League
Jewfro
Jheri curl
Kinky hair
Kiss curl
Layered hair
Liberty spikes
Long hair
Lob cut
Marcelling
Mod cut
Mohawk
Mullet
1950s
1980s
Pageboy
Part
Payot
Pigtail
Pixie cut
Pompadour
Ponytail
Punch perm
Princeton
Professional cut
Queue
Quiff
Rattail
Razor cut
Regular haircut
Regular taper cut
Ringlets
Shag (Shaggy hair)
Shape-Up
Shimada
Short back and sides
Short brush cut
Short hair
Spiky hair
Straight hair
Standard haircut
Surfer hair
Taper cut
Tonsure
Updo
Undercut
Waves
Wings
Facial hair
Beard
Chinstrap
Designer stubble
Goatee
Moustache
Fu Manchu
handlebar
horseshoe
pencil
toothbrush
walrus
Shenandoah (Chin curtain)
Sideburns
Soul patch
Van Dyke
Hair loss
Cosmetic
Removal
waxing
threading
plucking
chemical
electric
laser
IPL
Shaving
head
leg
cream
brush
soap
Razor
electric
safety
straight
other
Alopecia
areata
totalis
universalis
Male-pattern hair loss
Glabrousness
Hypertrichosis
Management
Trichophilia
Trichotillomania
Pogonophobia
Haircare Products
Brush
Clay
Clipper
Comb
Conditioner
Dryer
Gel
Hot comb
Iron
Mousse
Pomade
Relaxer
Rollers
Shampoo
Spray
Wax
Haircare Techniques
Backcombing
Crimping
Curly Girl Method
Hair cutting
Perm
Shampoo and set
Straightening
Documentaries
My Nappy Roots: A Journey Through Black Hair-itage (2008)
Good Hair (2009)
Related Topics
Afro-textured hair (Kinky hair)
Bearded lady
Barber (pole)
Eponymous hairstyle
Frizz
Good hair (phrase)
Hairdresser
Hair fetishism (pubic)
Hair follicle
Hair growth
Hypertrichosis
Trichotillomania
[show]
v
t
e
Diseases of the skin and appendages by morphology
Growths
Epidermal
wart
callus
seborrheic keratosis
acrochordon
molluscum contagiosum
actinic keratosis
squamous-cell carcinoma
basal-cell carcinoma
Merkel-cell carcinoma
nevus sebaceous
trichoepithelioma
Pigmented
Freckles
lentigo
melasma
nevus
melanoma
Dermal and
subcutaneous
epidermal inclusion cyst
hemangioma
dermatofibroma (benign fibrous histiocytoma)
keloid
lipoma
neurofibroma
xanthoma
Kaposi's sarcoma
infantile digital fibromatosis
granular cell tumor
leiomyoma
lymphangioma circumscriptum
myxoid cyst
Rashes
With
epidermal
involvement
Eczematous
contact dermatitis
atopic dermatitis
seborrheic dermatitis
stasis dermatitis
lichen simplex chronicus
Darier's disease
glucagonoma syndrome
langerhans cell histiocytosis
lichen sclerosus
pemphigus foliaceus
Wiskott–Aldrich syndrome
Zinc deficiency
Scaling
psoriasis
tinea (corporis
cruris
pedis
manuum
faciei)
pityriasis rosea
secondary syphilis
mycosis fungoides
systemic lupus erythematosus
pityriasis rubra pilaris
parapsoriasis
ichthyosis
Blistering
herpes simplex
herpes zoster
varicella
bullous impetigo
acute contact dermatitis
pemphigus vulgaris
bullous pemphigoid
dermatitis herpetiformis
porphyria cutanea tarda
epidermolysis bullosa simplex
Papular
scabies
insect bite reactions
lichen planus
miliaria
keratosis pilaris
lichen spinulosus
transient acantholytic dermatosis
lichen nitidus
pityriasis lichenoides et varioliformis acuta
Pustular
acne vulgaris
acne rosacea
folliculitis
impetigo
candidiasis
gonococcemia
dermatophyte
coccidioidomycosis
subcorneal pustular dermatosis
Hypopigmented
tinea versicolor
vitiligo
pityriasis alba
postinflammatory hyperpigmentation
tuberous sclerosis
idiopathic guttate hypomelanosis
leprosy
hypopigmented mycosis fungoides
Without
epidermal
involvement
Red
Blanchable
Erythema
Generalized
drug eruptions
viral exanthems
toxic erythema
systemic lupus erythematosus
Localized
cellulitis
abscess
boil
erythema nodosum
carcinoid syndrome
fixed drug eruption
Specialized
urticaria
erythema (multiforme
migrans
gyratum repens
annulare centrifugum
ab igne)
Nonblanchable
Purpura
Macular
thrombocytopenic purpura
actinic/solar purpura
Papular
disseminated intravascular coagulation
vasculitis
Indurated
scleroderma/morphea
granuloma annulare
lichen sclerosis et atrophicus
necrobiosis lipoidica
Miscellaneous
disorders
Ulcers
Hair
telogen effluvium
androgenic alopecia
alopecia areata
systemic lupus erythematosus
tinea capitis
loose anagen syndrome
lichen planopilaris
folliculitis decalvans
acne keloidalis nuchae
Nail
onychomycosis
psoriasis
paronychia
ingrown nail
Mucous
membrane
Aphthous stomatitis
oral candidiasis
lichen planus
leukoplakia
pemphigus vulgaris
mucous membrane pemphigoid
cicatricial pemphigoid
herpesvirus
coxsackievirus
syphilis
systemic histoplasmosis
squamous-cell carcinoma
[show]
v
t
e
Disorders of skin appendages (L60–L75, 703–706)
Nail
thickness: Onychogryphosis
Onychauxis
color: Beau's lines
Yellow nail syndrome
Leukonychia
Azure lunula
shape: Koilonychia
Nail clubbing
behavior: Onychotillomania
Onychophagia
other: Ingrown nail
Anonychia
ungrouped: Paronychia
Acute
Chronic
Chevron nail
Congenital onychodysplasia of the index fingers
Green nails
Half and half nails
Hangnail
Hapalonychia
Hook nail
Ingrown nail
Lichen planus of the nails
Longitudinal erythronychia
Malalignment of the nail plate
Median nail dystrophy
Mees' lines
Melanonychia
Muehrcke's lines
Nail–patella syndrome
Onychoatrophy
Onycholysis
Onychomadesis
Onychomatricoma
Onychomycosis
Onychophosis
Onychoptosis defluvium
Onychorrhexis
Onychoschizia
Platonychia
Pincer nails
Plummer's nail
Psoriatic nails
Pterygium inversum unguis
Pterygium unguis
Purpura of the nail bed
Racquet nail
Red lunulae
Shell nail syndrome
Splinter hemorrhage
Spotted lunulae
Staining of the nail plate
Stippled nails
Subungual hematoma
Terry's nails
Twenty-nail dystrophy
Hair
Hair loss/
Baldness
noncicatricial alopecia: Alopecia
areata
totalis
universalis
Ophiasis
Androgenic alopecia (male-pattern baldness)
Hypotrichosis
Telogen effluvium
Traction alopecia
Lichen planopilaris
Trichorrhexis nodosa
Alopecia neoplastica
Anagen effluvium
Alopecia mucinosa
cicatricial alopecia: Pseudopelade of Brocq
Central centrifugal cicatricial alopecia
Pressure alopecia
Traumatic alopecia
Tumor alopecia
Hot comb alopecia
Perifolliculitis capitis abscedens et suffodiens
Graham-Little syndrome
Folliculitis decalvans
ungrouped: Triangular alopecia
Frontal fibrosing alopecia
Marie Unna hereditary hypotrichosis
Hypertrichosis
Hirsutism
Acquired
localised
generalised
patterned
Congenital
generalised
localised
X-linked
Prepubertal
Acneiform
eruption
Acne
Acne vulgaris
Acne conglobata
Acne miliaris necrotica
Tropical acne
Infantile acne/Neonatal acne
Excoriated acne
Acne fulminans
Acne medicamentosa (e.g., steroid acne)
Halogen acne
Iododerma
Bromoderma
Chloracne
Oil acne
Tar acne
Acne cosmetica
Occupational acne
Acne aestivalis
Acne keloidalis nuchae
Acne mechanica
Acne with facial edema
Pomade acne
Acne necrotica
Blackhead
Lupus miliaris disseminatus faciei
Rosacea
Perioral dermatitis
Granulomatous perioral dermatitis
Phymatous rosacea
Rhinophyma
Blepharophyma
Gnathophyma
Metophyma
Otophyma
Papulopustular rosacea
Lupoid rosacea
Erythrotelangiectatic rosacea
Glandular rosacea
Gram-negative rosacea
Steroid rosacea
Ocular rosacea
Persistent edema of rosacea
Rosacea conglobata
variants
Periorificial dermatitis
Pyoderma faciale
Ungrouped
Granulomatous facial dermatitis
Idiopathic facial aseptic granuloma
Periorbital dermatitis
SAPHO syndrome
Follicular cysts
"Sebaceous cyst"
Epidermoid cyst
Trichilemmal cyst
Steatocystoma
simplex
multiplex
Milia
Inflammation
Folliculitis
Folliculitis nares perforans
Tufted folliculitis
Pseudofolliculitis barbae
Hidradenitis
Hidradenitis suppurativa
Recurrent palmoplantar hidradenitis
Neutrophilic eccrine hidradenitis
Ungrouped
Acrokeratosis paraneoplastica of Bazex
Acroosteolysis
Bubble hair deformity
Disseminate and recurrent infundibulofolliculitis
Erosive pustular dermatitis of the scalp
Erythromelanosis follicularis faciei et colli
Hair casts
Hair follicle nevus
Intermittent hair–follicle dystrophy
Keratosis pilaris atropicans
Kinking hair
Koenen's tumor
Lichen planopilaris
Lichen spinulosus
Loose anagen syndrome
Menkes kinky hair syndrome
Monilethrix
Parakeratosis pustulosa
Pili (Pili annulati
Pili bifurcati
Pili multigemini
Pili pseudoannulati
Pili torti)
Pityriasis amiantacea
Plica neuropathica
Poliosis
Rubinstein–Taybi syndrome
Setleis syndrome
Traumatic anserine folliculosis
Trichomegaly
Trichomycosis axillaris
Trichorrhexis (Trichorrhexis invaginata
Trichorrhexis nodosa)
Trichostasis spinulosa
Uncombable hair syndrome
Wooly hair
Wooly hair nevus
Sweat
glands
Eccrine
Miliaria
Colloid milium
Miliaria crystalline
Miliaria profunda
Miliaria pustulosa
Miliaria rubra
Occlusion miliaria
Postmiliarial hypohidrosis
Granulosis rubra nasi
Ross’ syndrome
Anhidrosis
Hyperhidrosis
Generalized
Gustatory
Palmoplantar
Apocrine
Body odor
Chromhidrosis
Fox–Fordyce disease
Sebaceous
Sebaceous hyperplasia
Retrieved from "https://en.wikipedia.org/w/index.php?title=Pattern_hair_loss&oldid=834189177"
Categories:
Genetic disorders with no OMIM
Conditions of the skin appendages
Human hair
Hair diseases
Testosterone
Hidden categories:
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Androgenic alopecia

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Mucous membrane pemphigoid

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Acute paronychia

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Chronic paronychia

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Lichen planus of the nails

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