ANDROGENETIC ALOPECIA (AGA)
By Dr. Nektarios Logaras – Dermatologist/Venereologist
Androgenetic Alopecia (AGA) (or male pattern hair loss, commonly male baldness) is a skin disease that is successfully treated with the proper treatment.
Androgenetic Alopecia (AGA) is considered to be the most common type of hair loss as it is estimated that 98 out of 100 men and 70 out of 100 women will experience it at some point in their lives. Its main characteristic is the decrease in the hair density all over the scalp. This is called diffuse alopecia and affects men, women, and adolescents. Without treatment, people with Androgenetic Alopecia experience significant negative effects on their quality of life and psychology.
In Athens South Dermatology Clinic, the Androgenetic Alopecia (AGA) is treated by the experienced and specialized Dermatologist Dr. Nektarios Logaras following individualized protocols, having the most modern medical equipment. So, there is no hair loss and hair implantation can be avoided by prevention.
The etiology of Androgenetic Alopecia is multifactorial and polygenic. Androgen metabolism and receptors play a particularly important role. The action of dihydrotestosterone (DHT) and enzymes (5a reductase – I and II), which play an important role in the onset of the disease, has also been confirmed.
Hair loss (or thinning) differs between men and women, as it has a different clinical picture and hair loss distribution patterns are different. Early diagnosis and initiation of properly parameterized, and individualized treatment, with laboratory testing, detection and treatment of diseases such as thyroid disease, prevent and limit the fast progression of Androgenetic Alopecia (AGA).
AGA is due to the effect of androgens on genetically predisposed hair follicles. The Caucasian race has the highest frequency compared to other races. The severity and frequency increase over the years. At the age of 70, 80% of men and 45% of women have AGA.
A large number of children suffer from Adolescent onset AGA (AO-AGA) that is a special subtype of early onset AGA that requires special attention. The mean age of Adolescent onset AGA (AO-AGA) is 14 years in boys and 15 years in girls.
ETIOLOGY OF ANDROGENETIC ALOPECIA IN MEN – BOYS
The etiology of AGA in men is directly related to the effect of androgens on the hair follicles.
The appearance of AGA in men is hereditary. An increased risk of occurrence in twins and in women with afflicted fathers has been observed in the family tree. Many other areas of the androgen receptor and the 20p11 chromosome are also associated with the development of the disease in men. The exact pattern of inheritance has not been identified but it appears to be a genetically heterogeneous disease. An autosomal dominant inheritance with or without varying penetration, sex-linked and multifactorial etiology has been proposed.
It is confirmed that the interaction of genetic and hormonal factors is necessary for the onset of the disease.
From adolescence onwards, androgens interact in the genetically predisposed and sensitive androgen hair follicles, causing a sequence of events that gradually causes the miniaturization of the hair follicles. The effect of androgens also causes a change in the hair cycle and progressive thinning and hair loss.
The distribution of androgen receptors and enzymes involved in the androgen metabolism (5-α Reductase Type I and II, aromatase and 17β-hydroxysteroid-dehydrogenase) in different areas of the scalp affects the pattern and severity of AGA. The levels of androgen receptors (responsible for the cellular action of androgens) are different in the frontal from the occipital region, with 1.5 times higher levels in the frontal region than in the occipital region.
The balance of enzymes, of androgen-converting in the target-organs is crucial for the metabolism of hormones with different androgenic potency. The enzyme 5-α Reductase (5AR) is responsible for converting testosterone (T) to dihydrotestosterone (DHT). (5-α Reductase, 3 times more in the frontal than in the occipital region).
DHT appears to be responsible for miniaturization of the genetically predisposed hair follicles by reducing the anagen phase and the stem cell volume. Although 5-α Reductase Type I is the predominant form in the scalp, high levels of the isoform Type II have been found in dermal sheaths and dermal nipples.
The importance of 5a-Reductase Type II in the development of AGA in men is demonstrated by the fact that individuals with a congenital deficiency of 5-α Reductase Type II do not develop AGA. In the scalp of men with AGA has been found an increased conversion of T to DHT. The Aromatase cytochrome P450, the enzyme that is responsible for the conversion of T to estradiol and D4 to androstenedione to estrone, also seems to play an important role. The Aromatase cytochrome P450P is increased in the occipital region while it is minimal in the frontal region.
In addition, the factors that may cause and worsen hair loss are the following:
-Drugs intake (Anticoagulants) etc.
-Unbalanced Diet (Poor in Vitamins)
-Some Chronic Diseases (Diabetes, Iron-Deficiency Anemia, Thyroid Diseases)
-Some Diseases and autoimmune skin diseases (Systemic Lupus Erythematosus (SLE), Fungal infections, Alopecia Areata).
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Diagnosis and Treatment of Androgenetic Alopecia (AGA)
In Athens South Dermatology Clinic, diagnosis and treatment are always performed only by the experienced and specialized Dermatologist Dr. Nektarios Lagaras (MD).
1. Step One – Digital Trichoscopy
The Digital Trichorizogram by the FotoFinder Trichoscale is useful to differentially diagnose other causes of hair loss and hair thinning as well as for assessing the development and to evaluate the treatment.
-It is painless in contrast to the traditional trichorizogram and without hair loss.
-It calculates the number, density and the phase of hair growth cycle (anagen, catagen and telogen)
-It provides an accurate custom PDF report as well as archiving and printing of the results.
2. Step Two – Laboratory Test
In women, men, and children for the exclusion or confirmation and treatment of hair loss related diseases.
In women with signs of hyperandrogenism, we recommend a laboratory test for polycystic ovary syndrome or late-onset congenital adrenal hyperplasia.
3. Step Three – Prescription
Prescription according to clinical and laboratory findings. Individualized prescription according to age, gender, comorbidity, ability to comply with treatment but also the evaluation of previous treatments.
Prescription of topical and oral, approved and effective drug combinations, such as Minoxidil, Finasteride, etc. for the prevention but also for the reversal of hair loss, the re-emergence of new hairs and the maintenance of the result for a lifetime.
4. Step Four -Θεραπεία (PRP) Autologous PRP Treatment with the Automatic Multiple Injection System HYCOOX injector
The pioneering, first and only in Greece, automatic system HYCOOX Multi Suction Auto Injector is the latest achievement of technology in the field of automatic multiple injection for the scalp.
In contrast to traditional techniques (Syringes, Pistols, Pens).
-It is completely painless.
-It is accurate in the amount of plasma injected into the scalp area.
-There are no leaks.
-It is Precise in the depth of the skin where the plasma should be injected.
-It enables a completely safe and fast Treatment.
-After double centrifugation, the precious plasma which contains proteins with Growth and Regenerative properties, with the necessary addition of special activators is injected into the scalp, achieving strengthening, utilizing the regenerative mechanisms of our own body, after restoring the function of the hair follicleshaving as a result the regrowth of new hairs but also the maintenance of the result for a lifetime.
Before & After
The Doctor’s experience
Dr. N. Logaras MD
Laser Dermatologic Surgeon
Graduate of Nottingham and Birmingham Universities of England.
-Specialization in Dermatologic Surgery, Department of Plastic Surgery, Hospital of Dermatology & Venereal Diseases “Andreas Syggros”
-Specialization in Digital Dermoscopy – Mole Mapping, at the Department of Dermoscopy and Melanoma, Hospital of Dermatology & Venereal Diseases “Andreas Syggros”
-Degree in Medicine, Bachelor of Medicine and Bachelor of Surgery, The University of Nottingham, UK.
Μετεκπαιδευθείς στο Miami Conventional Center από το American Academy of Dermatology στο Μαϊάμι των Η.Π.Α., καθώς και στο International Center of Lutronic, using Laser Systems for Medical and Cosmetic Applications, στη Σεούλ της Νοτιάς Κορέας.
CAREER AND PROFESSIONAL EXPERIENCE
-Dermatologist – Venereologist, Private Clinic – Athens South Dermatology & Laser Center, Alimos
-Dermatology – Venereology Specialty, Hospital of Dermatologic & Venereal Diseases “Andreas Syggros”
-Former Doctor, Royal Derby | Derby Teaching Hospitals NHS Foundation Trust, England
-Former Doctor, Taunton and Somerset Hospital NHS Trust-Musgrove Park, England
-Former Doctor, Worthing and Southlands Hospitals NHS Trust, England
-Former Doctor, Queen Alexandra Hospital, England
-Former Doctor, Portsmouth Hospital NHS Trust, England
-Former Doctor, Brighton and Sussex University Hospitals NHS Trust, England
19 years of medical experience
Phone No. for Appointment: +302109821431