Alopecia androgenetica is gene-determined progressive hair loss which occurs due to increased sensitivity of specific follicle to androgenic hormones. It is autosomal dominant inherited tendency to hair loss which is visible at both genders after puberty, when both men and women (women rather less than men) start producing testosterone.

Alopecia androgenetica is manifested by increased conversion of testosterone into active androgen, i.e. dihydrotestosterone (DHT) by means of 5-alpha reductase. DHT inhibits hair growth in genetically predisposed hair follicles (frontal-parietal zone) of forehead and pate region of the scalp. Terminal follicles gradually turn into small follicles with thin and short hair (vellus hair), hair growth cycle is reduced and large number of hairs is in telogen phase which is accompanied by increased hair loss. As the number of cycles for each hair is genetically determined (25-30), the reduction of cycles and frequent phase rotation lead to premature fatigue of follicle activities. Thus, follicles become inactive i.e. turn into atrophic follicles. DTH on the level of sebaceous glands leads to the increase of glands and their activities, so alopecia is often accompanied by seborrhea, as enlarged gland makes additional pressure on the weakened follicle, i.e. hair.

It is important to note that alopecia androgenetica occurs at males even though their laboratory values of androgen are normal. At some female patients, the level of testosterone may be increased and therefore we do not exclude immunology factor at genetically predisposed individuals.

Clinical presentation of alopecia androgenetica is different at male and female population. In both cases, it starts with the changes on frontal (forehead) line of capillitium where normal hairs are replaced by thin and short (vellus) hairs. At male patients the changes further affect the temporal part and vertex (central point of capillitium), which are referred to as stages I and II. These areas of thinning hair get closer together until reaching the last stage which implies only the preservation of occipital-temporal zone in terminal IV stage. At female patients, alopecia androgenetica is localized in frontal-parietal zone in the form of diffuse thinning which almost never reaches IV stage, except in case of excessive hormone disorder.

Diagnosis is set up based on thorough case history, clinical presentation and scannerscopic examination, i.e. state-of-the-art device for detailed analysis of skin and hair which uses numerous lenses, with enlargement up to 650x, and strong luminous flux which makes skin transparent thus enabling observation of vital structures of capillitium.

Treatment of alopecia androgenetica is almost impossible, as the only efficient medication could be antiandrogen, i.e. blocker of male sexual hormone testosterone. Antiandrogen decreases biosynthesis of androgen and connects to androgen receptors, so the effect of changed hormonal balance is unpredictable, while contraindication (reduced libido) limits its use.

Aside from the general treatment, local application of natural biostimulants has shown important results. The effect of local treatment is improved by specific physical procedures, primarily laser and LED biostimulation.

Hair mesotherapy and PRP are contemporary methods for stimulating hair growth and renewal.

Surgical treatment implies transplantation of autograft from the preserved area to areas affected by alopecia, or by means of other macro-technique (scalp reduction). However, the use of “stem” technology is seen as a method which will satisfy patients’’ expectations.

So far, prosthetic solutions in the form of capillary systems for locally limited alopecia and capillary prosthesis for diffused type of alopecia are far more acceptable for patients because we do not transplant hair, but compensate % which is missing. Dermograft method represents the perfection of capillitium prosthetics. Toupees and wigs are outdated hairdressing methods which have done more harm than good and thus made doctors develop new branch of medicine called capillitiology, as well as new prosthetic aids, i.e. procedures which do not affect normal physiological functions of the skin and enable hair regrowth in case the potential of capillitium is vital.

Due to the implementation of capillitology in may medical branches, especially in dermatology and oncology, many patients have regained hope for living a normal life, as human self-confidence largely depends on external look and satisfaction with one’s appearance is immediately accompanied by motivation and creativity in all spheres of life.

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