An Up Close Look at AGA

AGA - Magnified

What does androgenetic alopecia (male balding and female thinning) look like up close and magnified?

This photo is a dermatoscopic image of early staged androgenetic alopecia. It shows a variation in the thickness of hairs that is typical of this type of hair loss. "Anisotrochosis" is a term that was introduced to the medical literature in 2007 to describe a simple phenomenon - namely the great diversity and variation in the thickness and thinness of hair follicles that is seen in individuals with genetic hair loss. This photo shows a large thick terminal hair (labelled “1”) as well as three progresively thinning hairs (labelled 2,3 and 4). In individials with androgenetic aloepcia, hairs get thinner and thinner over time. When more than 20 % of hairs are displaying this variation in size in an individual with hair loss, there is a good chance that genetic hair loss is present although the diagnosis may be possible to determine even with a 10 % variation in size using certain other strict criteria as well.

Over time, the thin “miniaturizing” hairs become thinner and thinner. Hair follicle 2 in the photo was once as thick as hair follicle 1. Hair follicle 3 in the photo was once as thick as hair follicle 2 and hair follicle 4 was once as thick as hair follicle 3. 
Treatments for androgenetic alopecia differ very slightly for men and women but include minoxidil, antiandrogens, laser, PrP, essential oils (rosemary), pumpkin seed oil, saw palmetto, ketoconazole shampoos, oral contraceptives (women), zinc. For women with AGA in the setting of PCOS resveratrol, and selenium can be considered. Hair transplants and scalp micropigmentation are treatments to also be considered.

Reference

Sewell L et al Anisotrichosis: A novel term to describe pattern alopecia. J Am Acad Dermatol 2007; 56: 856.