What kind of alopecia is this? (Photo)

Question

Hi, I'm a 34 male with AGA since I was 24. I've been taking topical minoxidil 5% and topical finasteride 0.25% for a long time. Upper scalp situation is stable, with few hair but stable. However, I noticed that my side hair is thinning, more on one side than on the other. What kind of alopecia could this be? Thanks

Anna Chacon, MD, FAAD · Answer

From what you've described, your pattern is not the classic presentation of androgenetic alopecia (AGA). AGA typically affects the temples, frontal hairline, and crown while preserving the hair on the sides and back of the scalp until very advanced stages.

If you're noticing progressive thinning on the sides—especially if it's more pronounced on one side—there are several possibilities:

Diffuse alopecia areata, which can occasionally involve the sides of the scalp.
Diffuse unpatterned alopecia (DUPA), a less common form of hair loss in which thinning affects the entire scalp, including the donor areas on the sides and back. This is important because it can influence treatment options such as hair transplantation.
Chronic telogen effluvium, particularly if there has been a recent illness, significant stress, weight loss, or nutritional deficiency.
Scalp inflammation, such as seborrheic dermatitis or other inflammatory scalp disorders, which can contribute to shedding.
Less commonly, traction, pressure, or localized conditions affecting one side of the scalp.

The fact that your top scalp has remained stable on topical minoxidil and topical finasteride for several years suggests your current regimen is helping control your AGA. The newer thinning on the sides may represent a separate process rather than progression of your original hair loss.

A close examination of the scalp with dermoscopy (trichoscopy) is often very helpful. It allows us to look for signs such as:

Miniaturized hairs (seen in AGA and DUPA)
"Exclamation point" hairs (suggestive of alopecia areata)
Inflammation or scaling
Variation in hair shaft diameter

If the thinning continues to progress, laboratory testing to evaluate for contributing factors such as iron deficiency, thyroid dysfunction, vitamin D deficiency, or other nutritional issues may also be appropriate depending on your overall history.

The good news is that many causes of diffuse hair thinning are treatable once the correct diagnosis is made. Because the involvement of the sides is unusual for typical male pattern hair loss, I would encourage a careful scalp examination before assuming it's simply progression of AGA. That distinction can make a meaningful difference in both prognosis and treatment recommendations.

Matt Tahsini, MD · Answer

Hello and thank you for your question.  It's very difficult to say by looking at your photo.  I suggest seeing at doctor in person for a proper diagnosis.  Best of luck toyou.

Dr. T

What kind of alopecia is this? (Photo)

Answers (2)

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