Diffuse Unpatterned Alopecia (DUPA) and Hair Transplant

To understand what DUPA is, we must first understand what male pattern baldness (MPB) is.

MPB is also known as Androgenetic Alopecia or Androgenic Alopecia. It is characterised by a receding hairline and hair loss on the top and front of the head. It occurs in men who are genetically predisposed to be more sensitive to the effects of the DHT hormone, and this condition can be inherited from either side of the family.

The male body produces DHT (Dihydrotestosterone), a sub-product of the testosterone through the 5-alpha-reductase enzyme. This enzyme is the one that transforms a certain percent of testosterone that can be found in tissue such as the skin, liver, prostate, and follicles. If the patient is genetically sensitive to hair loss, the DHT can join the follicle receptors and make them reduce, weaken, and finally die. This process results in provoking the end of the growth in the affected follicles.

Knowing that the MPB can be categorised by the Norwood-Hamilton scale, which defines it in seven stages of baldness with different models for each one, we must understand that DUPA is a subtype of hereditary hair loss and that this categorisation does not apply to all men with hair loss.

What is DUPA?

To understand this type of alopecia, we must know the differences between Diffuse Pattern Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA); however, both are subtypes of hereditary hair loss.

Diffuse Patterned Alopecia (DPA) is characterised by the thinning across the entire frontal scalp from the front to the crown while the back and sides are not affected.

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    In Diffuse Unpatterned Alopecia (DUPA) the pattern affects not only the frontal and crown but also the sides and the back, causing thinning, weakness, dryness, falling, and density loss.

    DUPA is diagnosed by looking for miniaturisation or changes in the hair diameter. This can be difficult to detect in young patients because this pattern of thinning does not show clearly until the late twenties.

    The symptoms are fast and rampant thinning on the hair throughout the front, crown, sides, and back of the head.

    The hair starts to miniaturise and looks like in strands showing the scalp, but normally it does not fall directly. It starts to thin and depending on the patient, falls slower or faster.

    Dupa and medical treatment

    Finasteride and Minoxidil are known to be effective for any type of androgenic alopecia; the Finasteride blocks the DHT hormone, stopping the fall of the hair and sometimes even thickening it, and Minoxidil sends more blood to the follicles, giving them nutrition.

    This medicine combination yields results after at least 6 months of taking it. The peak of its effectiveness is only after 18-24 months of usage.

    Finasteride is a hormonal treatment; therefore, it needs to be managed progressively. The body needs to process and assimilate this medication. Some patients may experience some side effects when they start this treatment with 1 mg per day right away.

    We have detected that those side effects are observed less in many of our patients who start with a lower dose and then increase it month by month. Under these conditions, less than 3% of the patients experience side effects.

    Minoxidil is a vasodilator medication, commonly used for high blood pressure and hair loss. It comes in pills, in a topical solution, or foam presentation. These options can be applied before going to sleep or if no styling products are gonna be used after. This medication produces a widening of the blood vessels and opening potassium channels, allowing more blood, nutrients, and oxygen to the follicles. It is completely normal to have a shedding upon starting the medication as the hairs need to be renovated and re-grow with more strength.

    Dupa and hair transplant

    In most of the cases, a patient that has been diagnosed with DUPA will not be an eligible candidate for a hair transplant. As mentioned above, DUPA provokes an overall thinning of our hair, including our donor area hair.

    Due to this thinning, our donor area is not considered a safe zone. Those grafts to be extracted from the donor area and implanted in any of the balding areas in the recipient area are likely to fall as they can get affected by the DHT hormone.

    So am I doomed if I suffer from DUPA? We have seen some patients who have responded very well to medication treatments (Finasteride/Dutasteride and Minoxidil) after 12-18 months. After this time, not only the progression of the thinning was halted but there was also a recovery of the thinned areas.

    In some cases, these patients become eligible for a hair transplant. It is worthy to remark that the patients will have to continue using medication without any interruption after the hair transplant; otherwise, those implanted grafts are likely to fall as they would without using the medication in the first place.

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      What extraction technique would be more advisable if I suffer from DUPA?

      Accepting the limitation of success of a patient with DUPA, FUE (Follicular Unit Extraction) would be more advisable than FUT (strip surgery) if you are planning to undergo a hair transplant surgery after using the medication.

      It is best when extracting via FUE that we will be able to identify the areas that are less affected by the thinning while looking for the healthiest available grafts.

      If we were using FUT as an extraction method, the higher yield per cm² being its biggest advantage, it wouldn’t be applicable to patients suffering from DUPA, as the thinning is happening across the entire safe zone.

      In essence, a precise and on time diagnosis of the condition altogether with the right medical treatment will be paramount to create the foundation to perform a hair transplant. In these cases, a regular monitoring of a dermatologist or trichologist will be ideal to achieve a successful outcome.


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