L-12   WHAT'S NEW IN ANDROGENETIC ALOPECIA

A. Tosti, BM Piraccini, S. Mantovani Department of Dermatology University of Bologna, Italy.

Androgenetic alopecia is the most common type of hair loss in both men and women. Accumulating evidence indicates that androgens are not the only factor involved in the pathogenesis of this condition but that other elements may be important as well. Recent work indicates that androgenetic alopecia in men is a different pathophysiologic event as compared to androgenetic alopecia in women. In women, miniaturization is not the main event. Hair loss is mostly correlated with reduced hair density and the "empty follicle phenomenon" can be very important in determining this feature. The finding that miniaturization may not be gradual but rather occurs rapidly is also new. The role of inflammation and seborrheic dermatitis in the etiology of hair loss has been debated for years but today we have consistent data to conclude that the inflammation that often accompanies androgenetic alopecia is an important aggravating factor. Inflammation can accelerate the progression of hair loss by promoting telogen effluvium and may also induce perifollicular fibrosis and scarring. Microinflammation may therefore be a significant factor in determining long-term prognosis as well as response to treatment. We have recently found a significative association between superficial perifollicular lymphocytic infiltration and the presence of peripilar signs at the scalp dermoscopy. Although it is easy for any dermatologist to recognize and diagnose androgenetic alopecia just by looking at the patient, we still lack of a simple and reliable method to evaluate severity of androgenetic alopecia. The lack of such methods compromises our ability to diagnose early disease. Still, patients frequently require hair analysis and as dermatologists we should be able to perform the test using good and reliable methods. Distinguishing between normal and abnormal hair loss can even be more difficult in middle-aged individuals where androgenetic alopecia and senescent thinning of the hair may be associated or even overlap.