I think you are making DUPA up to have people come to your office for a miniaturization study. Here’s way….

I have spent a lot of time looking into balding and watching balding people. Your last post said that you don’t think DUPA has anything to do with DHT. You also mentioned that FPB is not DUPA even though FPB most of the time has miniaturized hair in the donor area and entire scalp.

Also, if you look at probably 80% of all balding people I bet they would have SOME miniaturization in the donor area. I for one have thinner donor area then I did when I was 20,(I’m 42). You also mentioned that FPB & DUPA don’t respond to drugs when we know the cause of miniaturization is the effects of DHT. Science has proven this.

I think that a lot of men can have hair loss in both a MPB & FPB patterned combined. Thus resulting in a slightly thinner donor area. (less than 30% miniaturization throughout the whole head). Maybe some people just miniaturize throughout their whole heads and never progress from there.

I understand the importance about evaluation someone for miniaturization in donor area to avoid a disastrous transplant scar. I applaud you for it. My problem is the fear of god you have imposed on some people about this thing called DUPA and how nothing can diagnoses it accept a miniaturization study, which you and a few colleauges provide. I think it is just a male with a female diffused pattern. This in theory should response to DHT blockers. Unless you can think of another cause for miniaturized hair throughout the entire scalp other than MPB/FBP or as you call it DUPA.

I doubt you will post this but I felt it important to express my personal opinion.

I am posting this just to allow other opinions.

Less than 1% of the men I examine in my office have DUPA. There is always some appearance of miniaturized hair all over the head, but I believe that we are looking at are the vellus hairs in the follicular unit which may account to about 20% of the hair in the “permanent zone”. Medical science is a descriptive science and DUPA is a description of what we are seeing — diffuse unpatterned alopecia (alopecia without a pattern to it that is diffusely found all over the head).

I guess if you were a blind man, you would doubt the existence of something that is clearly visible to a sighted person.

Doctor, when a patient have DUPA, his/her ANF (Anti-Nuclear Factor) is positive? I have no balding parents nor relatives (until the 4th generation above myself), but I think I’m suffering DUPA and it began just after a heavy stressing period

The diagnosis of DUPA (diffuse unpatterned alopecia) is made by mapping out your hair and scalp for miniaturization. A good examination is critical. Hair loss in men comes about for four reasons:

1. Genes
2. Male hormones
3. Stress (you seem stressed)
4. Time (the longer #1-3, the worse the problem will become)

To avoid confusion, ANF and ANA are the same thing (see Wikipedia for more info). I am not familiar with a positive ANA factor as a participating cause of DUPA. Conditions like DUPA can occur with a variety of autoimmune diseases of which some of them may have positive ANAs.

Dr Rassman,
I suffer from Trigeminal Neuralgia (all 3 divisions), as well as Occipital Neuralgia following an accident and subsequent surgery. I have been experiencing burning, stabbing and lancinating pains all over my entire scalp for the past 5 years, and my scalp is continually painful and tender to the touch.

The pain has been intense and my hair has been falling out for the past 4 years, virtually gone on the top, and thin on the sides and bace almost like diffuse hair loss of the entire scalp. In your opinion would the hair loss be as a result of Trigeminal and Occipital neuralgia? It is causing me much distress as there seems no end to the pain and hair loss continuation.

Since I suffer from severe neuralgia I would be extremely grateful for any advice about my hair loss and what could be done to ameliorate it, considering my medical condition. I am 34 years old and male.

There is no direct connection between hair loss and your condition. This is a rare and quite painful disease, and I would expect that hair loss would be worsened with the stress of your intense pain. Stress can accelerate genetic hair loss, so first I would get a diagnosis as to what is the cause of your hair loss and if it is genetic patterned hair loss, then I would certainly go on finasteride daily to slow, stop, and possibly reverse the hair loss. Talk with your doctor about this, as it is a prescription medication.

I was brought to your site by asking the question about missing facial hair. I am a 31 year old Male, I have first stage chyrosis of the liver, I was born with biliary atresia, other than that I have been very healthy throughout my life and lead an active lifestyle. Up until about Easter of 2008 I had a full face of hair, then a small spot appeared about the size of a pencil eraser, now I have three patches about the size of a silver dollar all located by the chin bone. Should I see skin specialist of just ask my Internist if this is related to my disease. Thank you.

It sounds like you are a fortunate man, as so many people do not live a good life with biliary atresia (see Wikipedia). I would imagine that you should first consult your primary doctor, then a good dermatologist. Patches of hair loss can reflect a wide variety of problems and I am uncomfortable with evaluating you for them over the Internet without examining you.