Hair loss is a widespread occurrence. Over 85% of men [1] and 55% of women [2] experience it during their lifetime. And the number one cause of hair thinning is androgenetic alopecia. When thinking about this condition, most people imagine male and female pattern baldness, its most common forms. But did you know there is also a much rarer variety called diffuse unpatterned alopecia?
This condition looks more like telogen effluvium than androgenetic alopecia, as it involves diffuse, hair thinning, rather than patterned. However, unlike telogen effluvium, it will only get worse if left untreated [3][4]. Discover all you need to know about this type of hair loss, such as:
Diffuse unpatterned alopecia (DUPA) is a rare form of androgenetic alopecia [3]. As its name indicates, unlike female and male pattern baldness, this type of alopecia does not affect specific parts of the scalp but causes diffuse hair thinning all over your head [5]. Since this condition is uncommon, it has received little attention so far among researchers [3].
While both genders can experience diffuse unpatterned alopecia and normally, hair loss is more common in men than in women, DUPA is thought to be 10 times more common in female patients [5]. That is likely due to a combination of genetic and hormonal reasons.
There are no specific studies conducted on DUPA, but researchers believe that it is caused by the same factors that cause androgenetic alopecia: a combination of genetic predisposition and hormonal factors [3]. However, while in patterned baldness, hair follicles from specific areas of the head are especially sensitive to male hormone dihydrotestosterone (DHT), in DUPA, sensitive and non-sensitive hair follicles are randomly distributed across the scalp instead of being clustered together. That is why people who experience this form of androgenetic alopecia don’t go through the normal Norwood scale stages [3].
The main symptom of DUPA is diffuse hair loss across the entire scalp, rather than concentrated in any specific area. It also causes affected hair follicles to produce thinner, finer hair (vellus hair). However, it does not lead to complete baldness in any area of the scalp, it only makes your hair so thin you can see your scalp [6].
While other types of hair loss can also cause scalp inflammation (e.g. alopecia areata) or burning scalp syndrome (e.g. telogen effluvium), DUPA does not normally show any of these symptoms. Hair thinning is the only noticeable symptom.
The only known factor that predisposes to DUPA is gender, as women are far more likely to experience this condition than men.
However, it appears that people with diffuse unpatterned alopecia tend to start experiencing hair loss at an earlier age than average, often in their teens [5]. So if you are a young person and experience hair thinning that doesn’t resolve in 4-6 months, it is best to see a trichologist to rule out DUPA. Getting a correct diagnosis from the first signs of hair thinning and balding can lead to better treatment results.
To the untrained eye, diffuse unpatterned alopecia can sometimes be difficult to differentiate from other types of hair loss it resembles, such as telogen effluvium or patterned hair loss (especially in women). Here are some good ways to tell them apart.
Telogen effluvium (TE) is a condition that presents with diffuse hair loss that looks just like DUPA. However, the main difference is that TE is brought about by physical or psychological stress and it is temporary. It normally resolves itself 3-4 months after the triggering event ends [7].
In contrast, DUPA often starts early in life, with no discernable triggering event, and does not subside without treatment (it typically worsens).
Typically, male pattern baldness starts with a receding hairline and temple hair loss. If left untreated, it progresses to a bald spot on the crown [8]. However, the hair on the back and sides of the head are normally unaffected.
DUPA, on the other hand, affects hair follicles all over the scalp, including the back and sides, with no discernable pattern.
Most women experience a widening central hair parting and a Christmas tree pattern as the main symptoms of female pattern baldness [9]. However, those with DUPA only experience diffuse hair loss, without their central parting or crown being particularly affected.
If you are experiencing a thyroid dysfunction that causes hair loss, you may notice diffuse hair shedding, just like you would in DUPA. In some cases, hair texture can also be altered, making your strands either coarser or finer. While DUPA can also lead to finer hair, it will not normally make it coarser.
Furthermore, many people experience hair regrowth a few months after treating their thyroid condition [10], while those with DUPA will see no improvement.
In rare cases, alopecia areata can manifest as diffuse hair loss, rather than the typical patchy bald spots [11]. In milder cases, it can be very difficult to distinguish visually from DUPA. Even specialists can have difficulty telling these conditions apart. However, in many cases, diffuse alopecia areata tends to resolve itself within a year, resulting in hair regrowth.
While these considerations can sometimes help understand the nature of your diffuse hair shedding, the only way to know for sure why your hair is falling out is to see a trichologist.
Your hair doctor will first ask you about your health history and any treatments you may be taking. Then they will conduct the necessary diagnostic trichology tests to determine the cause of your hair loss. If DUPA is suspected, they may perform a dermoscopy or a trichoscopy to check for elements such as the degree of hair miniaturisation. And if the results are still inconclusive, a scalp biopsy may be needed to confirm the DUPA diagnosis [12][4].
Diffuse unpatterned alopecia is normally treated with the same non-surgical treatments and therapies as patterned hair loss, such as:
Medications and medical therapies:
No — unfortunately, people who experience diffuse unpatterned alopecia are not normally good candidates for a hair transplant. That is because hair restoration surgeries work on the principle that the hair follicles at the back of your head are less sensitive than those on your frontal area and crown. With DUPA, there is no safe donor area to harvest healthy hair follicles from, as this condition manifests all across your scalp.
So while a permanent hair transplant may be a highly effective treatment for patterned hair loss, it will not normally be successful in treating diffuse unpatterned alopecia. If you are living with this condition and non-surgical treatments aren’t working for you, you may want to consider masking solutions, such as trying non-surgical hair replacements or buying a human hair wig.
If you have noticed signs of diffuse hair loss and are concerned it may be DUPA, book a consultation today with one of our dedicated trichologists. They will run all the necessary tests to rule out other types of alopecia and recommend the best, personalised treatment for you.
Diffuse unpatterned alopecia is progressive, so the sooner you treat it, the greater the chances of containing and even reversing it. So don’t hesitate to place your hair in the hands of experts who can help restore its growth and beauty.
No, DUPA will not normally resolve without treatment once it has set in. On the contrary, this condition will likely worsen over time if left unaddressed. The only way to restore hair growth in patients with DUPA is to treat them with one or more hair loss medications and therapies.
Telogen effluvium is more common than diffuse unpatterned alopecia. This type of hair loss tends to last a few months before resolving itself, and often follows periods of intense stress.
No. While medication-induced diffuse hair loss is possible, this is a form of telogen effluvium (or anagen effluvium, in the case of chemotherapy hair loss or radiotherapy hair loss). Hair regrowth will occur in most cases shortly after treatment cessation.
DUPA is caused by a combination of genetic and hormonal factors. And while certain medications that impact your hormones may worsen its symptoms, they do not cause the condition.
No. While DUPA can drastically reduce your hair density if left untreated, it will not normally cause complete baldness, as alopecia totalis would. Your hair will simply become much thinner and sparser than it used to be.
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