Male pattern baldness: an update
Keywords:
Alopecia, Androgens, Hair follicle, MlnoxidilAbstract
Androgenetic alopecia or baldness in men is clinically defined by symmetrical hair loss in the frontal hairline and scalp vertex. Development of androgenetic alopecia is genetically determined and dependent on the androgen receptor. The prevalence of this condition is thought to be as much as 50% in white males by age 50 years. Although there are no serious health consequences, hair loss can interfere with quality of life. The understanding of hair growth cycles and
pathogenesis of androgenetic alopecia has increased markedly in the last years. The growth cycles of the preprogrammed scalp follicles shorten and the follicle thins, a process called miniaturization of the follicle. Many genes seem to be involved in this condition, but, to date, only the androgen receptor gene has been implicated. Many treatment options are available for male androgenetic alopecia and are summarized in this article; however, few of them have achieved effective results.
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References
Hamilton JB. Patterned loss of hair in man: types and incidence. Ann NY Acad Sei. 1951; 53(3):708-28.
Norwood OT, Lehr B. Female androgenetic alopecia: a separate entity. Dermatol Surg. 2000; 26(7): 679-82.
Norwood OT. lncidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001; 27(1):53-4
Ackerman AB, Viragh PA, Chongchitnant N. Anatomic, histologic, and biologic aspects of hair follicles and hairs. ln: Neoplasms with follicular differenciation. Philadelphia: Lea & Febiger; 1993. p.35-102.
Sampaio SAP, Rivitti E. Parte 1: pele normal. ln: Der matologia. São Paulo Artes Médicas; 1998. p.3-35.
loannides G. Alopecia: a pathologist's view. lnt J Dermatol. 1992; 21(6):316-28.
Stenn KS, Paus R. Contrais of hair follicle cycling. Physiol Rev. 2001; 81(1)449-94.
Kligman AM. Pathologic dynamics of human hair loss. Arch Dermatol. 1961; 83(2):37-60.
Bergfeld WF. Alopecia. Histologic changes. Adv Dermatol. 1989; 4(1):301-20.
Courtois M, Loussouarn G, Hourseau C, Grollier JF. Hair cycle and alopecia. Skin Pharmacol. 1994; 7(1-2): 84-9.
Dawber R, van Neste D. Hair and scalp disorders. Martin Dunitz; 1995. p.1-40.
Jenkins EP, Andersson S, lmperato-McGinley J, Wilson JD, Russell DW. Genetic and pharmacological evidence for more than one human steroid 5 alphareductase. J Clin lnvest. 1992; 89(1):293-300.
Eicheler W, Dreher M, Hoffmann R, Happle R, Aumüller G. lmmunohistochemical evidence for differential distribution of 5 alpha-reductase isoenzymes in human skin. Br J Dermatol. 1995; 133(3):371-6.
Hiort O, Holterhus PM, Nitsche EM. Physiology and pathophysiology of androgen action. Baillieres Clin Endocrinol Metab. 1998; 12(1):115-32.
McPhaul MJ, Young M. Complexities of androgen action. J Am Acad Dermatol. 2001; 45(3 Suppl): s87- s94.
Avila DM, Zoppi S, McPhaul MJ. The androgen receptor (AR) in syndromes of androgen insensitivity and in prostate cancer. J Steroid Biochem Mol Biol. 2001; 76(1-5):135-42.
Griffin JE, Wilson JD. The resistance syndromes: 5alpha-reductase deficiency, testicular feminisation and related disorders. ln: Seriver CR, Beudet AL, Sly WS, Valle D, editors. The metabolic basis of inherited disease. New York: McGraw Hill; 1989. p.1919-44.
Hamilton JB. Male hormone stimulation is a prerequisite and an incitant in common baldness. Am J Anat 1942; 71(3):451-80.
lmperato-McGinley J, Guerrero L, Gautier T, Peterson RE. Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science. 1974; 186(4170): 1213-5.
Sawaya ME, Price VH. Different leveIs of 5 alpha reductase type I and li, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia. J lnvest Dermatol. 1997; 109(3): 296-300.
Osborn D. lnheritance of baldness. J Heredity. 1916; 7(8):347-55.
Victor McKusick's online mendelian inheritance in man. [cited 2007 Mar 6] Available from: <http://www.ncbi.nlm.nih.gov/Omim; entry number 109200>.
Kuster W, Happle R. The inheritance of common baldness: two B or not two B? J Am Acad Dermatol. 1984; 11(5 Pt 1):921-6.
Harrap SB. Hypertension: genes versus environment. Lancet. 1994; 344(8916):169-71.
Ellis JA, Stebbing M, Harrap SB. Genetic analysis of male pattern baldness and the 5alpha-reductase genes. J lnvest Dermatol. 1998;110(6):849-53.
Ellis JA, Harrap SB. The genetics of androgenetic alopecia. Clin Dermatol. 2001; 19(2): 149-54
Dallob AL, Sadick NS, Unger W, Lipert S, Geissler LA, Gregoire SL, et ai. The effect of finasteride, a 5 alpha reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. J Clin Endocrinol Metab. 1994;
(3):703-6
Sreekumar GP, Pardinas J, Wong CQ, Whiting D, Katz HI, Price V, et ai. Serum androgens and genetic linkage analysis in early onset androgenetic alopecia. J lnvest Dermatol. 1999; 113(2) 277-9
Cotsarelis G, Millar SE. Towards a molecular understanding of hair loss and its treatment. Trends Mol Med. 2001; 7(7):293-301.
Duskova M, Hill M, Straka L. The polycystic ovary syndrome and its male equivalent. Cas Lek Cesk. 2007; 146(3) 251-5
Starka L, Duskvoa M, Cermakova 1, Vrbikova J, Hill M. Premature androgenetic alopecia and insulin resistance. Male equivalent of polycystic ovary syndrome7 Endocr Regul. 2005; 39(4) 127-31
Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol. 1999; 141(3) 398-405.
Setty LR. Hair patterns of scalp of white and negro males. Am J Phys Anthropol. 1970; 33(1) 49-55
Lee WS, Ro BI, Hong SP, Bak H, Sim WY, Kim W, et ai. A new classification of pattern hair loss that is universal for men and women basic and specific (BASP) classification. J Am Acad Dermatol. 2007; 57(1) 37-46.
Sinclair R. Male pattern androgenetic alopecia. Br Med J 1998; 317865-9.
Lotufo PA, Chae CU, Ajani UA, Hennekens CH, Manson JE. Male pattern baldness and coronary heart disease: the Physicians' Health Study. Arch lntern Med. 2000; 160(2) 165-71.
Ellis JA, Stebbing M, Harrap SB. Male pattern baldness is not associated with established cardiovascular risk factors in the general population. Clin Sei (London). 2001, 100(4)401-4
Ahouanson S, Le Toumelin P, Crickx B, Descamps V Association of androgenetic alopecia and hypertension. Eur J Dermatol. 2007; 17(3):220-2.
Oh BR, Kim SJ, Moon JD, Kim HN, Kwon DD, Won YH, et ai. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998; 51(5) 744-8.
Hawk E, Breslow RA, Graubard BI. Male pattern baldness and clinicai prostate cancer in the epidemiologic follow-up of the first National Health and Nutrition Examination Survey. Cancer Epidemio! Biomarkers Prev. 2000; 9(5):523-37.
Rushton DH, Ramsay 1D, Norris MJ, Gilkes JJ. Natural progression of male pattern baldness in young men. Clin Exp Dermatol. 1991; 16(3) 188-92.
Unger WP. What's new in hair replacement surgery. Dermatol Clin. 1996; 14(4)783-802
Devine BL, Fife R, Trust PM. Minoxidil for severe hypertension after failure of other hypotensive drugs. Br Med J. 1977; 2(6088):667-9
Savin RC. Use of topical minoxidil in the treatment of male pattern baldness. J Am Acad Dermatol. 1987; 16(3 Pt 2):696-704.
Olsen EA, Weiner MS. Topical minoxidil in male pattern baldness effects of discontinuation of treatment. J Am Acad Dermatol. 1987; 17(1) 97-101.
Blume-Peytavi U, Kunte C, Krisp A, Bartels NG, Ellwanger U, Hoffman R. Comparison of the efficacy and safety of topical minoxidil and topical alfatradiol in the treatment of androgenetic alopecia in women. J Dtsch Dermatol Ges. 2007; 5(5)391-5
Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled triai to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med. 2002; 8(2):143
Loussouarn G, Courtois M, Hourseau C. A new approach to the prevention and cosmetic treatment of alopecia aminexil. BEDC. 1997; 5(1) 1-5
Olsen E. Finasteride (1 mg) in the treatment of androgenetic alopecia in men [abstract). Aust J Dermatol. 1997; 38(Suppl) A316.
Drake L, Hordinsky M, Fiedler V, Swinehart J, Unger WP, Cotterill PC, et ai. The effects of finasteride on scalp skin and serum androgen leveis in men with androgenetic alopecia. J Am Acad Dermatol. 1999; 41(4) 550-4
Roberts JL, Fiedler V, lmperato-McGinley J, Whiting D, Olsen E, Shupack J, et ai. Clinicai dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol. 1999; 41(4): 555-63.
Sinclair RD. Management of male pattern hair loss. Cutis. 2001; 68(1)35-40
Waiz M, Saleh AZ, Hayani R, Jubory SO Use of the pulsed infrared diode laser (904 nm) in the treatment of alopecia areata. J Cosmet Laser Ther. 2006; 8(1): 27-30.
Li L, Hoffman RM. The feasibility of targeted selective gene therapy of the hair follicle. Nat Med. 1995; 1(7):705-6.
Sovak M, Seligson AL, Kucerova R, Bienova M, Hajduch M, Bucek M. Fluridil, a rationally designed topical agent for androgenetic alopecia: first clinicai experience. Dermatol Surgery. 2002; 28(8):678-85
Hamilton JB. Patterned loss of hair in man: types and incidence. Ann NY Acad Sei. 1951; 53(3):708-28.
Norwood OT, Lehr B. Female androgenetic alopecia: a separate entity. Dermatol Surg. 2000; 26(7): 679-82.
Norwood OT. lncidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001; 27(1):53-4
Ackerman AB, Viragh PA, Chongchitnant N. Anatomic, histologic, and biologic aspects of hair follicles and hairs. ln: Neoplasms with follicular differenciation. Philadelphia: Lea & Febiger; 1993. p.35-102.
Sampaio SAP, Rivitti E. Parte 1: pele normal. ln: Der matologia. São Paulo Artes Médicas; 1998. p.3-35.
loannides G. Alopecia: a pathologist's view. lnt J Dermatol. 1992; 21(6):316-28
Stenn KS, Paus R. Contrais of hair follicle cycling. Physiol Rev. 2001; 81(1)449-94.
Kligman AM. Pathologic dynamics of human hair loss. Arch Dermatol. 1961; 83(2):37-60.
Bergfeld WF. Alopecia. Histologic changes. Adv Dermatol. 1989; 4(1):301-20.
Courtois M, Loussouarn G, Hourseau C, Grollier JF. Hair cycle and alopecia. Skin Pharmacol. 1994; 7(1-2): 84-9.
Dawber R, van Neste D. Hair and scalp disorders. Martin Dunitz; 1995. p.1-40.
Jenkins EP, Andersson S, lmperato-McGinley J, Wilson JD, Russell DW. Genetic and pharmacological evidence for more than one human steroid 5 alphareductase. J Clin lnvest. 1992; 89(1):293-300
Eicheler W, Dreher M, Hoffmann R, Happle R, Aumüller
G. lmmunohistochemical evidence for differential distribution of 5 alpha-reductase isoenzymes in human skin. Br J Dermatol. 1995; 133(3):371-6.
Hiort O, Holterhus PM, Nitsche EM. Physiology and pathophysiology of androgen action. Baillieres Clin Endocrinol Metab. 1998; 12(1):115-32.
McPhaul MJ, Young M. Complexities of androgen action. J Am Acad Dermatol. 2001; 45(3 Suppl): s87- s94.
Avila DM, Zoppi S, McPhaul MJ. The androgen receptor (AR) in syndromes of androgen insensitivity and in prostate cancer. J Steroid Biochem Mol Biol. 2001; 76(1-5):135-42.
Griffin JE, Wilson JD. The resistance syndromes: 5alpha-reductase deficiency, testicular feminisation and related disorders. ln: Seriver CR, Beudet AL, Sly WS, Valle D, editors. The metabolic basis of inherited disease. New York: McGraw Hill; 1989. p.1919-44.
Hamilton JB. Male hormone stimulation is a prerequisite and an incitant in common baldness. Am J Anat 1942; 71(3):451-80
lmperato-McGinley J, Guerrero L, Gautier T, Peterson RE. Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science. 1974; 186(4170): 1213-5.
Sawaya ME, Price VH. Different leveIs of 5 alpha reductase type I and li, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia. J lnvest Dermatol. 1997; 109(3): 296-300.
Osborn D. lnheritance of baldness. J Heredity. 1916; 7(8):347-55
Victor McKusick's online mendelian inheritance in man. [cited 2007 Mar 6] Available from: .
Kuster W, Happle R. The inheritance of common baldness: two B or not two B? J Am Acad Dermatol. 1984; 11(5 Pt 1):921-6.
Harrap SB. Hypertension: genes versus environment. Lancet. 1994; 344(8916):169-71.
Ellis JA, Stebbing M, Harrap SB. Genetic analysis of male pattern baldness and the 5alpha-reductase genes. J lnvest Dermatol. 1998;110(6):849-53.
Ellis JA, Harrap SB. The genetics of androgenetic alopecia. Clin Dermatol. 2001; 19(2): 149-54
Dallob AL, Sadick NS, Unger W, Lipert S, Geissler LA, Gregoire SL, et ai. The effect of finasteride, a 5 alpha reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. J Clin Endocrinol Metab. 1994;
(3):703-6
Sreekumar GP, Pardinas J, Wong CQ, Whiting D, Katz HI, Price V, et ai. Serum androgens and genetic linkage analysis in early onset androgenetic alopecia. J lnvest Dermatol. 1999; 113(2) 277-9
Cotsarelis G, Millar SE. Towards a molecular understanding of hair loss and its treatment. Trends Mol Med. 2001; 7(7):293-301.
Duskova M, Hill M, Straka L. The polycystic ovary syndrome and its male equivalent. Cas Lek Cesk. 2007; 146(3) 251-5
Starka L, Duskvoa M, Cermakova 1, Vrbikova J, Hill M. Premature androgenetic alopecia and insulin resistance. Male equivalent of polycystic ovary syndrome7 Endocr Regul. 2005; 39(4) 127-31
Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol. 1999; 141(3) 398-405.
Setty LR. Hair patterns of scalp of white and negro males. Am J Phys Anthropol. 1970; 33(1) 49-55
Lee WS, Ro BI, Hong SP, Bak H, Sim WY, Kim W, et ai. A new classification of pattern hair loss that is universal for men and women basic and specific (BASP) classification. J Am Acad Dermatol. 2007; 57(1) 37-46.
Sinclair R. Male pattern androgenetic alopecia. Br Med J 1998; 317865-9.
Lotufo PA, Chae CU, Ajani UA, Hennekens CH, Manson JE. Male pattern baldness and coronary heart disease: the Physicians' Health Study. Arch lntern Med. 2000; 160(2) 165-71.
Ellis JA, Stebbing M, Harrap SB. Male pattern baldness is not associated with established cardiovascular risk factors in the general population. Clin Sei (London). 2001, 100(4)401-4
Ahouanson S, Le Toumelin P, Crickx B, Descamps V Association of androgenetic alopecia and hypertension. Eur J Dermatol. 2007; 17(3):220-2.
Oh BR, Kim SJ, Moon JD, Kim HN, Kwon DD, Won YH, et ai. Association of benign prostatic hyperplasia with male pattern baldness. Urology. 1998; 51(5) 744-8.
Hawk E, Breslow RA, Graubard BI. Male pattern baldness and clinicai prostate cancer in the epidemiologic follow-up of the first National Health and Nutrition Examination Survey. Cancer Epidemio! Biomarkers Prev. 2000; 9(5):523-37.
Rushton DH, Ramsay 1D, Norris MJ, Gilkes JJ. Natural progression of male pattern baldness in young men. Clin Exp Dermatol. 1991; 16(3) 188-92.
Unger WP. What's new in hair replacement surgery. Dermatol Clin. 1996; 14(4)783-802
Devine BL, Fife R, Trust PM. Minoxidil for severe hypertension after failure of other hypotensive drugs. Br Med J. 1977; 2(6088):667-9
Savin RC. Use of topical minoxidil in the treatment of male pattern baldness. J Am Acad Dermatol. 1987; 16(3 Pt 2):696-704.
Olsen EA, Weiner MS. Topical minoxidil in male pattern baldness effects of discontinuation of treatment. J Am Acad Dermatol. 1987; 17(1) 97-101.
Blume-Peytavi U, Kunte C, Krisp A, Bartels NG, Ellwanger U, Hoffman R. Comparison of the efficacy and safety of topical minoxidil and topical alfatradiol in the treatment of androgenetic alopecia in women. J Dtsch Dermatol Ges. 2007; 5(5)391-5
Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled triai to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med. 2002; 8(2):143
Loussouarn G, Courtois M, Hourseau C. A new approach to the prevention and cosmetic treatment of alopecia aminexil. BEDC. 1997; 5(1) 1-5
Olsen E. Finasteride (1 mg) in the treatment of androgenetic alopecia in men [abstract). Aust J Dermatol. 1997; 38(Suppl) A316.
Drake L, Hordinsky M, Fiedler V, Swinehart J, Unger WP, Cotterill PC, et ai. The effects of finasteride on scalp skin and serum androgen leveis in men with androgenetic alopecia. J Am Acad Dermatol. 1999; 41(4) 550-4
Roberts JL, Fiedler V, lmperato-McGinley J, Whiting D, Olsen E, Shupack J, et ai. Clinicai dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol. 1999; 41(4): 555-63.
Sinclair RD. Management of male pattern hair loss. Cutis. 2001; 68(1)35-40
Waiz M, Saleh AZ, Hayani R, Jubory SO Use of the pulsed infrared diode laser (904 nm) in the treatment of alopecia areata. J Cosmet Laser Ther. 2006; 8(1): 27-30.
Li L, Hoffman RM. The feasibility of targeted selective gene therapy of the hair follicle. Nat Med. 1995; 1(7):705-6.
Sovak M, Seligson AL, Kucerova R, Bienova M, Hajduch M, Bucek M. Fluridil, a rationally designed topical agent for androgenetic alopecia: first clinicai experience. Dermatol Surgery. 2002; 28(8):678-85
