Premature alopecia, also known as male pattern alopecia, familial baldness, or common baldness, refers to the premature and gradual loss of hair during young adulthood before old age. It often starts from the front hairline and progresses backward, or the hair on the top of the head becomes thinner until the entire scalp, except for the hairline, is completely bald. Alopecia areata is usually progressive, has a familial tendency, and is more common in men.

bubble_chart Etiology

The cause of premature alopecia areata is not yet fully understood. However, patients often have a clear family history, and genetic factors along with elevated levels of androgens in the blood are two significant contributing factors. Adequate levels of androgens in the blood are often crucial for the onset and progression of premature baldness. The following evidence supports this:

1. Males do not experience premature baldness before puberty, but those undergoing long-term testosterone treatment may develop it;
2. Premature baldness worsens with age;
3. Individuals with premature baldness do not lose their beard, pubic, or axillary hair;
4. It has been found that in the initial stage [first stage], the affected hair follicles contain 5-α-dihydrotestosterone abdominal mass, which may inhibit hair follicle metabolism. However, the further reasons remain unclear.

This condition is often accompanied by seborrhea, but it has been confirmed that there is no causal relationship between seborrhea and premature baldness. Additionally, local factors such as wearing tight hats, using hair-pressing caps at night, or washing hair with excessively cold (or hot) water are not primary factors.

The earliest detectable change is the degeneration of the lower part of the hair follicle sheath in the connective tissue of the hair follicle, accompanied by perivascular basophilic changes. The hair follicles gradually atrophy and shrink, eventually being replaced by vellus hairs. Finally, many vellus hairs and hair follicles disappear, leaving behind a bundle of hardened, glassy fibrous connective tissue. In the final stages of alopecia areata, the growth phase of the hair follicles shortens, the percentage of hair follicles in the resting phase increases, and the hair becomes loose and easily falls out. The epidermis becomes thin, the epidermal ridges flatten, and the subepidermal capillary plexus almost disappears. The deposition of sulfur-containing mucopolysaccharides in the dermis increases, while the activity of vellus hair follicle enzymes is generally normal.

bubble_chart Clinical Manifestations

It commonly occurs in adults aged 20 to 30. Males account for 80%, referred to as male pattern alopecia areata (male pattern alopecia); females account for 20%, referred to as female pattern alopecia areata (female pattern alopecia). The incidence of this disease is higher among Caucasians, while the incidence rate in our country is significantly lower. According to a 1976 survey in Shanghai, the incidence of early baldness was 0.63%.

Male pattern alopecia areata mainly occurs in the crown and frontal areas, especially with the hairline receding on both sides of the forehead. As a result, the forehead becomes higher, particularly noticeable at the temples, extending upward and backward. As the condition gradually worsens, the top of the head becomes completely bald, with only the occipital and bilateral temporal areas retaining some hair. The scalp in the alopecia areata area is smooth, with fine vellus hair visible, and there are no subjective symptoms or only mild itching.

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Female pattern alopecia areata is less common and generally milder. It usually presents as diffuse hair loss, most noticeable on the top of the head. The hair gradually thins but does not completely fall out, and alopecia areata at the temples is rare. The hair becomes fine and loses its luster. The scalp in the affected area becomes thinner and may have a burning sensation, itching, or tenderness. It is difficult for new hair to fully regrow later.

bubble_chart Diagnosis

Based on family history and clinical manifestations such as areas of hair loss, the diagnosis is not difficult. Diffuse hair loss in women must exclude other causes, such as postpartum hair loss, or be associated with other systemic diseases such as cold-damage disease, anemia, etc.

bubble_chart Treatment Measures

Eliminate mental concerns, reduce psychological burdens, avoid excessive washing and the use of external irritant medications.

Generally, no treatment is necessary, but if accompanied by seborrheic dermatitis, corresponding measures can be taken.