Pattern hair loss

Pattern hair loss
Synonyms	Androgenic alopecia, androgenetic alopecia, male pattern baldness, female androgenic alopecia, female pattern baldness
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Field	Dermatology, plastic surgery
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Androgens may interact with the Wnt signalling pathway leading to hair loss

Pattern hair loss is a type of hair loss predominantly impacting the top and front of the scalp. This condition presents differently in men and women: male-pattern hair loss (MPHL) is often characterized by a receding hairline, loss of hair on the scalp's crown, or both, whereas female-pattern hair loss (FPHL) typically results in general hair thinning.

Etiology

The causality behind pattern hair loss is multifaceted. In men, the condition is generally attributed to a blend of genetic factors and the male hormone dihydrotestosterone. The specific causes of female pattern hair loss, however, remain ambiguous.

Treatment Options

Management of pattern hair loss can range from acceptance of the condition to active treatment. Common treatment modalities include the use of minoxidil, finasteride, and hair transplant surgery. The efficacy of finasteride in women is currently understudied, and it poses a risk of birth defects if consumed during pregnancy.

Epidemiology

Pattern hair loss is a widespread phenomenon, affecting approximately half of all males and a quarter of all females by the age of 50. It is the most prevalent cause of hair loss.

Clinical Manifestations

The hallmarks of classic male-pattern hair loss include hairline receding above the temples and vertex (calvaria) of the scalp. As the condition progresses, a rim of hair often remains around the sides and back of the head, known as a 'Hippocratic wreath', and rarely evolves into total baldness. Pattern hair loss falls under the classification of non-scarring hair loss.

Unlike its male counterpart, female-pattern hair loss typically leads to diffuse thinning without a receding hairline and seldom results in total hair loss. The severity of female-pattern hair loss is graded using the Ludwig scale, ranging from Grades 1 to 3, based on visible scalp exposure due to hair thinning.

Underlying Mechanisms

Hormonal Influence

Androgens, specifically dihydrotestosterone, have been linked to pattern hair loss through their interaction with the Wnt signalling pathway, a group of signal transduction pathways made of proteins that pass signals into a cell through cell surface receptors.

References

Pattern hair loss Resources
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