Interview with Dr. Tricomi (excerpt)

Can you describe the clinical picture of patients with mild and moderate androgenetic alopecia and explain what are the causes that lead to this condition that so afflicts mainly the male population, but not only?

L’androgenetic alopecia (AGA) is the most frequent cause of hair disease in the male sex and can affect up to 80% of adult males and has, while not a serious condition, strong implications on self-esteem and consequently on patients’ quality of life.

Hair loss can manifest itself in many forms of which the most common is androgenetic alopecia (AGA) which is characterized, in its early stages, by thinning of the hair, reduction in its number per follicular unit (called the process of miniaturization) to thinning and then to actual hair loss, i.e., absence of hair in skin regions normally characterized by its presence; baldness which is expressed in various stages according to the Hamilton’s classification.

Regarding the causes of this type of alopecia, it is now universally accepted that it is due to a genetic message that needs male hormones to occur, i.e., heredity for baldness (genotype) becomes clinical expression and thus phenotype only in the presence of androgens.

This does not mean that the entire male population is destined to baldness, but only those men who, in the presence of normal androgen hormones in the blood, have familial multigene inheritance (hence the term androgenetic) .

This type of inheritance leads to increased follicle sensitivity and the negative action of the dihydrotestosterone which forces the follicle into catagen and the hair into telogen, that is, premature fall.

This pathological mechanism leading to irreversible hair loss, especially in the later stages, is mediated by an enzyme called 5-alpha two reductase, which catalyzes the transformation of testosterone into dihydrotestosterone (DHT).

From this it can be inferred that hair loss in the frontoparietal area, and thus the regression of the frontal line (so-called receding hairline), are due to the direct action of testosterone, but it would not be considered true baldness, so much as frontoparietal alopecia, unlike true androgenetic alopecia, which affects the vertex and is due to the action of dihydrotestosterone.

Then it was seen that chronic inflammatory processes of the scalp, especially the presence of seborrheic dermatitis of the scalp, also play the lion’s share in addition to androgen interaction.

In fact, in scalp biopsies taken from men with androgenetic alopecia, the presence of follicular microinflammation.

Regarding therapy: do you prefer the use of the systemic, topical or combined routes?

The choice of therapy depends on the clinical picture of alopecia. In mild or moderate androgenetic alopecia, being a multifactorial disease, combination therapy is preferred.

In fact, I have treated several clinical cases, including 2 with truly brilliant results, through the combined use of Restax shampoo, Restax lotion e Restax male tablets, thus taking advantage of their synergy.

Lo Restax Shampoo possesses a nonaggressive and natural formulation, does not contain synthetic surfactants or parabens, which can create excessive dryness and skin irritation, and despite the lower foaming effect has a high cleansing and anti-inflammatory power with reduction of itching and trichodynia, thus very effective in reducing hair loss.

La Restax Men’s Lotion is very useful because it acts directly on the pilo-sebaceous follicle located on the scalp.

Because the scalp has a very permeable structure, application of topical lotions to its surface is the easiest way to reach the pilosebaceous follicle with minimal systemic repercussion. […]