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AT-A-GLANCE

AT-A-GLANCE

  • Androgenetic alopecia (AGA) is a nonscarring progressive miniaturization of the hair follicle in genetically predisposed men and women, usually in a specific pattern distribution.

  • AGA onset may be at any age following puberty, showing an increasing frequency with age.

  • The etiology of AGA is multifactorial and polygenic with, as of this writing, 12 genetic regions recognized to associate with AGA in men. In men, AGA is an androgen-dependent trait. Even though the role of androgens in female AGA is less certain than in men, there is a subset of women with AGA and associated hormonal dysregulation.

  • Generally, diagnosis of AGA is based on history and clinical examination. Depending on patient history and clinical evaluation, however, additional diagnostics may become necessary to exclude differential diagnoses; for example, ferritin level or thyroid-stimulating hormone in diffuse effluvium or endocrinologic workup in women with signs of hyperandrogenism.

  • Biopsy is very rarely indicated in AGA. Biopsy is indicated only if, for example, the differential diagnoses cicatricial alopecia or diffuse alopecia areata are suspected.

  • AGA has a naturally progressive course, meaning that the main therapeutic aim is the prevention of disease progression or enhancement of hair growth during the early, mild to moderate stages of the disease.

  • The best clinical evidence according to current study data exists for topical application of minoxidil in both genders and for the oral intake of finasteride in men. Alternatively, cosmetically satisfactory results can be achieved using hair transplantation in nonprogressive stable AGA with sufficient available donor area.

DEFINITION

Androgenetic alopecia (AGA) is the most common type of hair loss, a nonscarring progressive miniaturization of the hair follicle with shortening of the anagen phase in genetically predisposed men and women, usually in a specific pattern distribution.1 Life quality may be significantly impaired in affected individuals, independent of severity, age, or gender.

EPIDEMIOLOGY

Although AGA onset may be at any age following puberty, there is an increasing frequency with age. Reportedly, approximately 50% to 60% of men are affected by the age of 50 years increasing to approximately 80% by the age of 70 years and beyond.2,3 The prevalence of AGA is reportedly lower and its severity less among Asians, Native Americans, and African Americans compared to the European population.4,5 Approximately 10% to 20% of Chinese men are affected by the age of 40 to 49 years, rising to 40% to 60% by the age of 70 years and beyond.6,7

The frequency and severity of AGA is lower in women than in men, but it still affects a sizeable proportion of the population. Reported prevalence rates in white women in the United Kingdom and United States range between 3% and 6% in women younger than 30 years of age, increasing to 29% to 42% in women 70 years of age and older.8,9 AGA ...

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