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PostPosted: 18 Jun 2014 03:47 
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'Androgenetic alopecia' describes a type of hair loss which occurs in a distinctive pattern in genetically predisposed individuals and is thought to be androgen dependent.
In men, hair loss usually initially involves the front and sides of the scalp and progresses towards the back. In women, on the other hand, hair loss is usually more diffuse, affecting the top of the scalp.

Male androgenetic alopecia is thought to be a polygenic disorder. It is thought that in genetically predisposed hair follicles there are increased numbers of androgen receptors and/or increased activity of 5-alpha reductase.

Family history is the strongest risk factor.

The prevalence and the severity of androgenetic alopecia is highest in white men and tends to occur later and slower in Asians.

By 30 years of age, it affects about a third of white men. This increases to around 80% in men older than 70 years of age.

The diagnosis of androgenetic alopecia in men is usually made from the history and clinical findings alone.
Typically there is recession of the hairline and thinning of the hair of the crown and frontal/parietal areas. Normal hair may be replaced by short, thin vellus hairs.

Options for management include:
Doing nothing. This is likely to be the best option for most men.

Using a drug treatment — topical minoxidil (available over the counter or on private prescription) or oral finasteride 1 mg daily (available on private prescription only).

Use of aesthetic options (hair pieces and wigs; hair styling; hair camouflage products — which provide scalp cover; hair extensions — which provide fullness but may result in further pulling and traction on existing follicles; and surgical hair transplantation .

Referral to a specialist is not usually necessary. Referral may be considered in men with:
Atypical presentation or uncertain diagnosis.
A possible underlying condition requiring treatment in secondary care.
Requirement for further psychological support.

Differential diagnosis
What else might it be?
Alternative diagnoses include other diseases affecting hair growth, diseases of the scalp, and associated underlying factors.
Telogen effluvium is the most common alternative diagnosis.

Sudden and severe shedding may occur when a higher percentage of hairs are in the resting phase.

Shedding may be precipitated by significant events, such as a severe infection, crash diets, or major surgery, or by some medications.
Usually, scalp coverage is good because more than half the hair must be lost before it is objectively apparent.

In the active phase, the pull test may be positive. Later, regrowth of shorter hairs with tapered ends may be seen.

Underlying causes of hair loss (particularly in effluvium), but less common in men than women, include:
Thyroid disease (hypo- and hyperthyroidism) and other endocrine disorders.

Drugs, such as those implicated in telogen effluvium (for example antidepressants, anticoagulants, cancer treatments, and hormonal treatments).
Iron deficiency and poor nutritional status.
Severe pyrexial infection.
Systemic disease, such as systemic lupus erythematosus.

Less common causes of hair loss include:
Alopecia areata — this can occasionally present as diffuse hair loss (see the CKS topic onAlopecia areata).
Trichotillomania — a psychiatric condition in which people pull their hair out. It may be associated with obsessive-compulsive disorder and is less common in males than females. Hair loss is asymmetrical and has an unusual shape. Single or multiple areas can be affected, including eyebrows and eyelashes.
Traction alopecia — such as from styling that involves hair being pulled back.
Hair fragility from chemical application — such as bleaching.

G Mohan.

A dermatlogist's view would be most valuable .

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