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  • Male pattern hair loss (MPHL) is the most common form of non-scarring alopecia in men, characterized by diffuse hair thinning over the central scalp.

  • MPHL is a slowly progressive hair disease.


  • The diagnosis of MPHL is usually made clinically, but trichoscopy is useful to confirm the diagnosis in early phase and to follow up the patient.

  • Trichoscopy shows the typical hair miniaturization.

  • A scalp biopsy is almost never requested.


  • The goal of the therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth.

  • The most effective drugs are topical minoxidil and oral finasteride.

  • New formulations of the same drugs are recently published with the use of oral minoxidil and topical finasteride.


  • MPHL can have a significant psychological impact, leading to anxiety and depression.

  • Treatment should be continuous and not suspended to maintain efficacy.


  • The onset may be at any age following puberty and the frequency increases with age.

  • Clinically, it shows hair thinning at the vertex or temporal hairline.

  • In severe case, both sites can be involved.


  • Male pattern hair loss is the most common form of non-scarring alopecia in men.

  • Regular clinical and trichoscopic evaluations are very important to monitor the disease evolution and treatment effectiveness.

  • Annual follow-up of the patient is important to establish a maintenance of treatment results.


  • Early diagnosis is very important to start treatment promptly.

  • If used correctly, available medical treatments for MPHL arrest the progression of the disease and reverse miniaturization in most of cases.

  • If untreated, MPHL leads to a slow progressive hair thinning of the androgen-sensitive scalp areas.


Male pattern hair loss (MPHL) is the most common cause of non-cicatricial alopecia, affecting up to 80% of men,1 with a frequency increasing with age after puberty. Its prevalence is higher in Caucasians than in Afro-Americans and Asians.2,3

MPHL is characterized by a progressive hair thinning developing under the influence of a testosterone metabolite, dihydrotestosterone (DHT), against a background of genetically determined susceptibility of the hair follicles, in frontal, temporal, and vertex regions. The sensibility of the hair follicle to androgens is determined by specific polymporphisms of the receptor gene. Among these, the Stu1 polymorphism has the most significant association.4 Moreover, the role of prostaglandins in modulating the hair follicle cycle is emerging.


Clinical manifestations of male MPHL are specific and diagnostic. They include:

  • Classical pattern: Fronto-temporal recession, hair thinning at the top of the head, thinning at the vertex, complete alopecia at the top of the head. Maintenance of the hair in the parietal and occipital areas (Fig. 26.1).

  • Non-classical/female pattern: ...

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