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Androgenic alopecia or male pattern baldness is due to underlying susceptibility to hair follicles to active male hormone. It is the commonest type of hair loss, affects up to 70% of male and 40% of female population. Men presents with hairline recession of temple and vertex areas while women normally suffers from diffuse loss over scalp mostly near midline parting zone. Both genetic and environmental role play here. Hamilton-Norwood classification has been developed to grade male type of baldness.

Female androgenic alopecia causes diffuse thinning without hairline recession. Ludwig’s scale grades severity of female androgenic alopecia.

Cause:

Dihydrotestosterone (DHT) plays a major role in androgenic alopecia. Testosterone is converted to its active precursor DHT by the enzyme 5 alpha reductase in dermal papilla.

Androgenic alopecia treatment and treatment:

Many drugs are being used for androgenic alopecia of which only two drugs are USAFDA approved.

1. Minoxidil:

It increases blood supply to scalp, hence lengthens anagen phase of hair follicles. Regrowth is more pronounced in vertex than frontal area and is noted not before 4 months. Continuing usage of topical minoxidil is mandatory because discontinuation of treatment may lead to reversion to pretreatment balding area. Recent androgenic alopecia and small area of baldness are good candidates for minoxidil application. Increment concentration of minoxidil from 2% to 5% has 45 % better result than lower one. Females are more benefited by minoxidil than males.postural hypotension characterised by giddiness and black out may follow instantaneously after application of minoxidil. central chorioretinopathy is also recorded.

2. Finasteride:

It is an antiandrogenic drug which inhibits 5 alpha reductase type 2 and only used on male.

Surgical care:

Hair transplantation is the one and only answer for androgenic alopecia. Hair transplantation in Kolkata is successfully being performed for last three decades. Technique of hair transplantation evolves a lot in last few decades starting from punch graft to follicular unit extraction. Donor site should ideally have at least 40 follicular units /cm.square.

Hair weaving techniques with hairpieces are meant for prosthetic method of coverage of bald area for those who are not fit for time-tested hair transplantation techniques.

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