Hair loss (alopecia) in men

Even though anyone can lose hair from their scalp, men are more likely to do so. Baldness often refers to a significant loss of scalp hair. The most common cause of baldness is hereditary hair loss as people age. In men, the cause is often genetic, with androgenetic alopecia being dominantly inherited from one parent.

It can start as early as the second decade of life, but more commonly starts to be visible around the age of 40.

When there is significant hair loss or when hair loss occurs early, alopecia can cause significant psychosocial and aesthetic problems.

Androgenetic alopecia occurs through androgen-dependent mechanisms leading to a reduction in the terminal hair/velocus ratio, with specific disposition, most often with fronto-parietal and vertex onset and progressive accentuation.

However, there may be other causes of hair loss in men, such as telogen effluvium, a condition often linked to physical or emotional stress, restrictive diets, vitamin and other trace element deficiencies or even hormonal conditions such as thyroid disease. In this case it is extremely important to have a definitive diagnosis and correction of the factors, in combination with hair loss treatment, to achieve optimal results.

At the same time, some forms of autoimmune alopecia - alopecia aerata - can affect men on both the scalp and the chin, with sudden onset as small, round, well-defined, hairless areas that can progress to confluence if left untreated. Alopecia areatosum is often associated with other autoimmune conditions such as vitiligo or thyroid disease, so a full clinical and biological assessment of patients is indicated.

Seborrheic dermatitis is an extremely common condition of the scalp, but can also affect seborrhoeic areas such as the eyebrows, nasal bridge or ear flap. It progresses in flares, with periods of calm and periods of aggravation, and frequent relapses, often linked to periods of physical or emotional stress. Severe seborrhoeic dermatitis, left untreated, can exacerbate hair loss, but this is reversible with treatment.

In addition to the described forms of hair loss, there are also clinical forms of scarring alopecia, associated with conditions such as lupus, lichen planus or even infectious processes (folliculitis decalvans), the treatment of which is complex and often requires additional investigations such as skin biopsy of the scalp.

Non-catalytic alopecia generally involves temporary and reversible hair loss if the causative factor is identified and removed or if the patient undergoes appropriate treatment. Alopecia may be diffuse, focal or in a particular pattern of distribution. This includes the most common alopecias encountered in medical practice such as androgenetic alopecia in both women and men, telogen effluvium, alopecia areata. Also in this category are alopecia due to syphilis, traction alopecia and trichotillomania.

In children, one of the most common causes of alopecia capitis is tinea capitis, caused by fungi such as Mycrosporum or Trichophyton.

Scarring alopecia is an inflammatory condition leading to irreversible hair loss, caused by discoid cutaneous lupus erythematosus, lichen plano-pilaris, pseudopelada Brocq, folliculitis decalvans, dissecting cellulitis of the scalp.

In order to start treatment, it is necessary to correctly diagnose the causes of alopecia.

Androgenetic alopecia is the most common cause of hair loss for men. It is a hereditary condition that affects hair follicles, leading to hair loss or baldness in men.

Male pattern alopecia is caused by a combination of genetic and hormonal factors. Male hormones (androgens) are thought to play a key role in its development. Over the course of a lifetime, one in two men will experience alopecia - severe hair loss - by the age of 50. After this age, the percentage rises to 70%, and 21% of them may notice the first signs of hair loss even before the age of 21. It is estimated that there are around 50 million men in the United States alone who experience this problem, with the percentage now extremely high in Europe and Asia.

While stress may not directly cause male pattern baldness, it can contribute to hair loss by triggering a condition called telogen effluvium, which results in temporary hair loss.

Male pattern baldness can occur at any age, although it most commonly starts in men in their 30s and 40s.

Currently, there is no known way to prevent male alopecia, as it is usually the result of genetic and hormonal factors. However, early intervention with hair loss treatments can help slow or stop the progression of hair loss.

Hair transplantation is considered a safe and effective procedure with few risks or complications. However, as with any surgical procedure, there can be risks and side effects such as infection or scarring.

The result is obtained in about 2 weeks.

The time needed to carry out this assessment is about 20 minutes.

Trichoscopy is used when the patient experiences marked hair loss, with or without hair thinning/disappearance, for the diagnosis of scarring or non-scarring alopecia: androgenetic alopecia, alopecia aerata, telogen effluvium, tinea capitis, trichotillomania, lichen plankillaris, lupus erythematosus.

Your dermatologist recommends a trichoscopic evaluation before and after the treatment in the clinic to be able to objectively assess the results.

Scalp biopsy is performed to confirm the diagnosis in all patients with scarring alopecia. Scalp biopsies are not usually performed for the diagnosis of hair disorders because in this case microscopic examination of the hair is used. However, in genetic structural hair disorders, abnormalities may also be evident when the intrafollicular portion of the hair is seen on histological examination.

The scalp biopsy is performed under local anaesthesia, usually with xylin 1% or lidocaine 1%, which is injected intradermally. Next, using a 4-6 mm round preducel (punch), the doctor removes tissue from the scalp and sends it to the laboratory for examination by the pathologist. The lesion formed is closed with skin sutures and bandaged with a sterile dressing for 1-2 weeks, depending on the area sampled. Afterwards, the patient returns to remove the sutures as indicated.