Hair loss (alopecia) is a common problem. It occurs due to a disorder of the hair follicle in which the scalp skin appears normal (non-scarring alopecia) or due to a problem within the scalp skin, which leads to permanent loss of the hair follicle (scarring or cicatricial alopecia). Scarring alopecia causes shiny atrophic bald areas in the scalp skin. These areas are lack of hair follicles.

Androgenic alopecia is the most common type of non-scarring hair loss. It depends on an unusual sensitivity to male hormones (androgens) and some genetic factors. Male pattern baldness is common in young men. It presents with a baldness of the forehead followed by thinning of the crown of the head. Usually, a person with androgenic alopecia has male family members with the same condition (positive family history). Sometimes, androgenic alopecia occurs in women but is likely to occur at a later age compared to men. It causes milder type of alopecia and shows little in the form of baldness of the forehead in women. If menstrual irregularities and acne are also present, the reason may be overactivity of androgens (male hormones) or polycystic ovary syndrome (PCOS).

Management

Usually, treatment may not be needed. Local application of 5 % minoxidil lotion or oral finasteride can help prevent progression of the condition and may lead to a small amount of hair regrowth. Treatment should be started early in androgenic alopecia and needs to be continued probably lifelong. About one-third of people with male pattern baldness won’t respond to either treatment. Finasteride can cause adverse effects in 1 % of people such as loss of libido. It shouldn’t be used in women of childbearing age because it can affect the sexual development of a male foetus. Sometimes, anti-androgen medication like spironolactone and cyproterone may help manage the condition in some women.

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