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Giornale Italiano di Dermatologia e Venereologia 2001 February;136(1):7-19


language: Italian

Male pattern hair loss

Alinovi A. 1, Barbieri L. 2, Calvieri S. 2, De Giacomo P. 2, Guarrera M. 3, Piraccini B. M. 4, Rebora A. 3, Rossi A. 2, Tosti A. 4, Gruppo Italiano di Tricologia (SIDEV-GITRI)

1 Università degli Studi di Parma, Istituto di Clinica Dermatologica, Parma, Italy; 2 Università degli Studi di Roma «La Sapienza» , Istituto di Clinica Dermatologica, Roma, Iatly; 3 Università degli Studi di Genova, Istituto di Dermatologia, Genova, Italy; 4 Università degli Studi di Bologna, Istituto di Clinica Dermatologica, Bologna, Italy


Androgenetic alopecia is the most frequent cause of hair loss affecting at least 50% of men by the age of 50. Male pattern hair loss affect the front-vertical scalp. Hairs in this area progressively become like vellus hairs. The development of androgenetic alopecia requires the interaction of genetic and hormonal factors. Although there is agreement that it is an inherited condition, it may not be genetically homogeneous. Several data have confirmed the significant role of androgens in the development of androgenetic alopecia. Dihydrotestosterone is currently thought to be the most potent androgen affecting the human hair growth cycle, with adverse effects in male pattern hair loss. The enzyme 5a-reductase is responsible for catalyzing the conversion of testosterone to dihydrotestosterone. It is now known that two separate isoenzymes of 5a-reductase exist: type I and type II, specifically localized within the hair follicle itself and in the innermost layer of the outer root sheath. The importance of type II 5a-reductase in the development of androgenetic alopecia is demonstrated by the evidence that individuals with hereditary type II 5a-reductase deficiency do not develop androgenetic alopecia. In men, the diagnosis of androgenetic alopecia can usually be confirmed by medical history and physical examination alone. Andro-genetic alopecia can be treated with oral finasteride (inhibitor of type II 5a-reductase) or topical minoxidil. Oral finasteride at the dosage of 1 mg/day produced clinical improvement in up to 66% of patients treated for 2 years. Moreover the exact role of the hair specialist is discussed and the dermatologist is confirmed as the more indicated specialist and for the field.

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