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Androgenetic alopecia areata
Last reviewed: 08.07.2025
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[ Pathogenesis
The role of androgens in the development of common baldness is generally recognized. The second factor of pathogenesis is genetic predisposition (androgen-sensitive follicles). The third is a change in the balance of enzymes involved in androgen metabolism. The enzyme 5-alpha reductase catalyzes the conversion of testosterone into dihydrotestosterone. As a result of contact of dihydrotestosterone with follicle receptors, the process of gradual miniaturization of hair is activated. The enzyme aromatase converts androgens into estrogens, which have an antiandrogenic effect. The role of living conditions, nutritional status and other factors that accelerate the aging process of the entire organism cannot be ruled out.
Pathomorphology
In the bald area, most follicles are short and reduced in size.
Symptoms of Androgenetic Alopecia
The main clinical sign is the replacement of terminal hairs by thinner, shorter and less pigmented ones. The process is accompanied by a shortening of the anagen phase and, accordingly, an increase in the number of hairs in the telogen phase. Some follicles are late in entering the anagen phase, their mouths look empty.
In men, baldness begins with a change in the hairline, the forehead becomes higher. Bitemporal bald spots gradually deepen, hair thinning appears, and then a bald spot in the parietal region. In the lateral and posterior areas of the scalp, hair is retained (androgen-resistant follicles)
In women, the frontal hairline usually does not change, there is a diffuse thinning of hair in the frontal-parietal region, with a widening of the central parting. The rate of these changes increases with the use of progesterone-dominant contraceptives and after menopause. Women with rapid progression of baldness, as well as with a gradual onset of alopecia, combined with dysmenorrhea, hirsutism and acne, need examination to identify the cause of hyperandrogenism.
The connection between common baldness and seborrhea has long been noted, which is reflected in the use of the term "seborrheic alopecia" as a synonym for common baldness. It is known that the amount of excreted sebum is also controlled by dihydrotestosterone.
Diagnostics
An objective method for diagnosing common baldness is a trichogram - a microscopic examination of removed hair. In the frontal-parietal region, an increased number of hairs in the telogen phase is detected and, accordingly, a decrease in the anagen/telogen index (normally 9:1); dystrophic hair is also encountered.
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Treatment of androgenetic alopecia
Treatment of androgenetic alopecia must be carried out over a long period of time; discontinuation of therapy leads to resumption of hair loss. The treatment uses substances that suppress the effect of androgens either by inhibiting the activity of 5-alpha reductase, or by blocking androgen receptors in target tissues, or by increasing the production of sex hormone-binding globulin.
Among the effective means of external treatment, lotions containing herbal extracts with antiandrogenic action (Chronostim, Tricostim, 101G) should be noted. In 30% of patients, a significant clinical improvement is caused by a 2% (5%) solution of a powerful vasodilator - minoxidil (Regaine, etc.).
For general treatment of common male pattern baldness, finasteride, a 5-alpha reductase inhibitor, is prescribed at a dose of 1 mg per day (Propecia). Cyproterone acetate is effective for general treatment of female pattern baldness. Since the drug has an antiestrogenic effect, it is necessary to prescribe estrogens simultaneously. In this regard, combined oral contraceptives, such as Diane-35 and Silest, deserve attention. It should be remembered that systemic antiandrogens have serious side effects, so their use in order to prevent, in fact, a cosmetic defect should be carefully weighed.
In cases of severe baldness, surgical correction is the treatment of choice, which involves transplanting androgen-resistant follicles from the area of thinning or baldness; the patient must continue to take medications to prevent the loss of the remaining androgen-sensitive hair. Physiotherapeutic treatments are used as adjuvant treatments.