What is and what causes the androgenetic alopecia?
Androgenetic alopecia or baldness is the most common form of alopecia in men and women.
It is the result of the combined effect of genetic predisposition and the action of the androgens at the follicles of the scalp.
However, most patients are endocrine healthy.
What is the clinical picture of the androgenetic alopecia?
The hair progressively becomes thinner and shorter. With time, it becomes downy and eventually it atrophies.
In men, hair loss is located at the frontoparietal region and the top and in women could follow the male model or be more diffuse.
In girls there are often other elements of masculinization eg hirsutism. Seborrhea often coexists on the skin of the scalp.
How is the diagnosis of androgenic alopecia performed?
The diagnosis of androgenetic alopecia is mainly based on the clinical picture.
The trichogram helps us to measure the number of telogen hair (hair in resting phase) and anagen hair (developing hair).
Normally 80-90% of the hair is in anagen phase, but in androgenetic alopecia there is an increase in the percentage of telogen hair.
It is particularly useful for monitoring the therapy response.
In women with a hyperandrogenism suspicion, a testosterone check, a divine dehydroepiandrostenedione (also known as androstenolone) and prolactin check is performed.
It is also necessary to exclude other causes of thinning hair, so a check with fe, ferittin, TSH, T3, T4 and complete blood count is performed.
In some cases, skin biopsy is needed.
What is androgenic alopecia’s treatment?
The treatment of choice is to administer 5% minoxidil topically, applied either alone or in combination with retinoic acid.
The progression of the disease is slow and gradual.
With the topical treatment, appropriate combinations where deemed necessary with toning lotions and grant supplements eg cystine, in one year's time your dermatologist can change the look of your hair completely.
In many cases, oral administration of antiandrogens or finasteride will be provided.
What is the finasteride?
Finasteride is an orally administered drug which blocks the conversion of testosterone to dihydrotestosterone.
Most patients see positive results at 3 months and at 6 months they start to experience hair regrowth.
If the drug administration is stopped, we experience a relapse.
The side effects of finasteride occur in 2% of men and are the reduction of erectile function and libido.
These side effects are reversible upon discontinuation of the drug.
Are there any treatments that enhance the topical therapy?
The mesotherapy of the scalp with vitamins or minoxidil and the RPR autologous mesotherapy with the blood of the patient, which it's rich in platelets and stem cells, are promising new therapies with excellent results.
These techniques are applied to our clinic with very good results, even in very difficult cases who did not want any other topical treatment.
A digital trichogram is done at the clinic, for monitoring patients with androgenetic alopecia.
This process provides a safer assessment of the progress of the patient and a better and more effective treatment of androgenetic alopecia.
What is the trichogram?
The trichogram belongs to the non-invasive methods of diagnosis of alopecia and is a major approach in the workup of non cicatricial forms of alopecia.
It allows the observation of the morphology of the hair root and the hair shaft.
The digital FOTOFINDER system that we use at the clinic is the latest non-invasive method for diagnosing alopecia, which implements digital technology for photography and computer software analysis of the findings of the examination.
This procedure provides a safer assessment of the patient's progress and a better and more effective treatment of the disease.
How is the trichogram performed?
Taking pictures at a specific part of the scalp at certain time intervals is required. After that, processing of the information collected is done by a specialized computer software.
It can be used to monitor the androgenetic and diffuse alopecia. The performance of the test is carried out 3 to 5 days after shampooing the patient's scalp.
What does the trichogram show us?
It shows the percentage of hair that are in growth, in cessation and rest phase, the density and the hair that's dystrophic.
In the growth phase, 80-95% of the hair is found at a normal scalp.
At this stage, the hair follicle's activity is strong and the hair root exhibits an increased diameter.
The rest stage corresponds to the resting phase, in which the follicle is inactive and thus the gradual hair loss.
Normally at this stage, 10-18% of the hair is on the scalp.
