What is DUPA (Diffuse Unpatterned Alopecia)?

DUPA: Why it matters?

DUPA is the short form for the term 'diffuse unpatterned alopecia.' This is a subtype of hereditary hair loss, or androgenetic alopecia. DUPA can affect both men and women.  Today, we'll focus on DUPA in men and why it is critically important to identify men with DUPA and to separate this pattern of hair loss from all others.  In order to understand DUPA, it is important to understand the normal pattern of hair loss in men. 


The Hamilton Norwood Scale

Hair loss in many men follows the so called Hamilton Norwood scale whereby men first lose hair in the temples and/or crown. The seven stages of the Hamilton Norwood scale is shown in the diagram on the right. Over time, some men will develop hair loss over the the entire frontal, mid-scalp and crown  - this defines the Advanced Hamilton Norwood Stages (Hamilton Norwood scale VI or VII).

Not all men with hair loss follow the Hamilton Norwood scale. 



DIffuse Patterned Alopecia (DPA)

In diffuse patterned loss, patients thin across the entire frontal scalp from front to crown. All of these hairs undergo miniaturization. The back and sides however - are spared. Treatment for diffuse patterned alopecia includes both medical and surgical treatments. Because the back of the scalp is unaffected in diffuse patterned alopecia, and therefore rich in good hairs hair transplantation is a good option.  Finasteride, minoxidil, low level laser and platelet rich plasma may also be good options.


Diffuse Unpatterned Alopecia (DUPA)

With this basis, we can begin now to understand a relatively uncommon pattern of hair loss in men called Diffuse Unpatterned Alopecia or "DUPA". About 2-6 % of men have this pattern of hair loss, so it is relatively uncommon.  Patients with DUPA develop hair thinning not only in the front and top of the scalp, but also in the sides and back. In men with DUPA, the majority of hairs on the scalp are undergoing miniaturization or will at some point undergo miniaturization. The importance of recognizing DUPA is the fact that hair transplantation is not an option. Hairs at the back are not of good quality to move as they are (or will someday become) miniaturized.  If a hair transplant is attempted in a patient with DUPA, it may look good for a few years, but the transplanted hairs are at very high risk to thin out and be lost over time. The only treatment for patients with DUPA is medical treatment - minoxidil, finasteride, low level laser and platelet rich plasma.



Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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