A Case of Diffuse Unpatterned Alopecia (DUPA)
This 24 year old man presented to my office today with hair falling out. He has been on Propecia for 9 months. Upon examination I made the following observations:
- His hair density was low all over the scalp.
- He is losing substantial amount of neck hair disproportionally to other hair.
- He has miniaturization in the donor area to about 30%.
I am concerned that this young man has Diffuse Unpatterned Alopecia (DUPA) and that he may lose some of his donor hair in the future. This condition is an absolute contraindication for hair transplants and at the age of 24, what is the rush? As you can see from the photo below, his hair looks full, but just thinner in the frontal area. I told him that he needs to be followed closely over the next few years and that his Propecia is the correct medication to try to hold his condition at bay. Many other doctors with less scruples might transplant him and if they did, he might accelerate his balding pattern in the recipient and the donor area and a see-through look could develop from the sides. The last doctor he visited never mapped out his hair for miniaturization and as such would have missed the diagnosis.
Click the photo to enlarge. Note that the miniaturized hair count is about 30% from the donor area.
![DUPA](https://baldingblog.com/wp-content/uploads/2019/03//photos/071205_dupa.jpg)
Can you please add more pictures so we can see the side views and back views of his head to see the donor area thinning?
This is exactly the type of hairloss i have, but i also have extreme total hairline recession and miniaturisation. I first noticed the loss of nape hair, and thereafter loss of density and complete recession of every area of hairline. I have miniaturisation throughout my entire scalp, but the emphasis seems to be on the hairline and top of my head (especially that front area like this photo). I have tried spironolactone 200mg, cyrpoterone acetate 50mg, diane35 birth control, 0.5mg dutasteride, 5% topical minoxidil, 2.5mg oral minoxidil, miconeedling, topical oestrogen, topical anti androgens (RU58841, Darolutamide), every manner of oral supplement, iron infusions, sulfasalazine, setipiprant..the list is endless. Nothing has stopped my hairloss or miniaturisation. I have been diagnosed with hypogonadotrophic hypogonadism as of 2015, but the hormone replacement therapy i am on addresses this issue. I have no other hormonal or autoimmune issues, and was diagnosed with androgenetic alopecia via scalp biopsy. It has been through my own research that i have come to understand that my hairless is classed as retrograde with diffuse female pattern loss, or diffuse unpatterned alopecia. I frequent hairless forums where a few others have this patter, and we have all been non responders to all treatments. I believe that there must be something more to this pattern than what we know.
You clearly have a difficult problem. There is a cosmetic treatment for the thinning and hair loss for women and it is called Scalp Micropigmenmtation (see here: https://scalpmicropigmentation.com/smp-for-women/). Maybe this is something worth considering to address what you look like. It will not fix the underlying problem.
William Rassman, M.D.