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ALOPECIA

Androgenetic alopecia (pattern hair loss) or baldness

Androgenetic alopecia is the most common type of hair loss and affects the majority of white men, with varying degrees of seriousness. It is less frequent in other ethnic groups. Often it can be associated with a family history of baldness, but the absence of other affected family members does not exclude the diagnosis. The condition is characterized by progressive hair loss in the crown area, the front hairline and the temporal area.
As the term “androgenetic” indicates, the causes lie in the hormonal component and genetic predisposition to the illness. The process that leads to hair loss, at least in the early years of the condition, does not cause a complete stalling of hair growth but a progressive reduction of the growth phase (anagen), which results in premature hair loss, with the replacement by new hair that, however, grows increasingly thinner. This process is called follicular miniaturization and leads to visible thinning on the scalp.

Pattern hair loss starts to develop after puberty, a phase characterized by a strong increase in androgen production. The effect of androgens on cells is mediated by androgen receptors. Dihydrotestosterone (DTH) is the androgen that most heavily impacts the induction and evolution of pattern hair loss. It is an androgen produced from testosterone, but characterized by greater strength and affinity (ability to bind) to the receptor when compared to testosterone. The conversion from testosterone to DTH is mediated by the enzyme 5-alpha reductase. This enzyme exists in two different forms (isoforms) in the scalp follicles, type 1 and type 2. Type 2, found on the external face of the collagen shell at the root of the hair, is the type that has the most impact on hair loss. Once the androgen receptor is activated, it sends a series of signals that lead to the activation of the genes responsible for the gradual transformation of follicles from big to small ones suffering from a short anagen phase.
Young men with initial baldness have greater levels of 5-alpha reductase and a greater quantity of androgen receptors. Also the DTH production rate is higher in individuals with hair loss problems, when compared to those who do not suffer from this type of problem. Moreover, even if the testosterone levels are similar in both men affected by baldness and those who aren’t, many of the affected present high levels of free testosterone, which is testosterone unbound to the protein which stops it from binding to the receptor.

As far as the genetic component is concerned, many genes have been connected to the development of baldness. The hereditary scheme is complex and involves both the paternal and maternal lines.
We are therefore speaking of a model of polygenic inheritance with variable impact. The evolution of hair loss varies from case to case, due to many factors. Moreover, it is a process that progresses slowly over the course of many years. It may be defined as proceeding in waves, alternating periods in which the loss is rapid to periods in which the loss is nearly inexistent or quite modest.

Therefore, pattern hair loss is characterized by varying degrees of hair thinning and loss that typically begin in the temporal, frontal and crown areas. The degree of involvement of these three areas is quite variable; some men lose more hair from the crown, while others tend to lose hair in the front. In general, the occipital area is spared, and this is what makes the option of autotransplants possible.

The Hamilton-Norwood scale is generally used to classify the type and degree of hair loss. This scale features 7 categories and also distinguishes a more uncommon type of loss, identifying it as variant A, in which only a progressive hair line recession can be observed. Nevertheless, not all men follow these loss patterns. In 10% of cases, the loss is similar to that seen in women, i.e. the hairline is conserved and a scattered thinning of the central part is seen.
The diagnosis of male pattern hair loss is generally clinical and the patient history and direct observation of the individual’s scalp and hair may be sufficient. If, instead, the loss has been quite rapid and accompanied by burning and/or itchiness, other potentially associated causes need to be taken into consideration.

A dermatoscopy (or trichoscopy) may be useful, as may be a biopsy when other causes are suspected. The main differential diagnosis from which pattern hair loss must be distinguished are telogen effluvium and alopecia areata (spot baldness).

The first line therapies for a man suffering from pattern hair loss are topical use 5% minoxidil and oral use finasteride. Both these drugs have shown to be effective and highly tolerable. The effectiveness and results vary from case to case: while some individuals obtain significant growth, others benefit less from the therapy, perhaps only just reducing further loss.
Finasteride is a type 2 5-alpha reductase inhibitor, meaning that it blocks the production of DHT. The daily dosage is 1 mg. Age is an important factor in terms of response to the therapy. The drug seems to be more effective in individuals between 18 and 40 years of age when compared to those between 41 and 60 years of age.
In addition to growth in the number of hairs, finasteride produces an increase in the thickness, pigmentation and length of hair, all of which increase the perception of an improvement of the condition. To evaluate the drug’s full effectiveness, the treatment should be continued for at least a year, and it should then be continued to maintain its effects. If it is stopped, the results will be lost after approximately 6-8 months from the time of interruption. Collateral effects may include the reduction of libido, erectile and/or ejaculation dysfunction or a decreased sperm count, and the risk of these effects increases with age. Nevertheless, these side effects usually resolve after the end of the treatment. Other less common effects are gynecomastia, testicular pain and depression. However, these effects are generally observed only in the case of higher dosages than that used for treating prostatic hyperplasia.

For male pattern hair loss, the preferable solution is to use the 5% formula of minoxidil. The foam form, that doesn’t contain propylene glycol, has been available for a while and is less irritating for the skin. Minoxidil promotes hair growth by increasing the duration of the anagen phase, reducing the telogen phase and increasing the thickness of miniaturized follicles. The most frequent side effects are itchiness and skin rash. Hypertrichosis is generally not a problem in men. Also in the case of minoxidil, the results of the treatment are variable.
Patients with shorter-lasting baldness, with smaller affected areas and a greater number of still active follicles respond better to treatment. The use of the drug is indefinite and if treatment is suspended the results are lost within the following months. At the start of the treatment, it is normal to notice an increase in terms of the loss of hair. The hair lost in this phase is in the telogen phase and will be replaced by hair in the anagen phase. It is important to not to stop the treatment before it can become effective. To enjoy visible results, the patient must wait at least 4 months and then continue the therapy for at least 14-18 months, in order to stabilize the effect.

A surgical option may also be considered helping with the condition. Today the most common option is an autotransplant. Ideal candidates are those who suffer from stable hair loss or hair loss kept well under control by therapy and presenting a good reserve of hair in the occipital region, the donation area for the transplant. Since the hair in the occipital region is more resistant to pattern hair loss, it remains of a higher calibre. Nevertheless, patients may continue to lose non-transplanted hair and therefore face unsatisfying results in time.
It is therefore important to continue the treatment with minoxidil or finasteride, in order to limit further losses.

Other therapies are also available, and new ones are continuously being developed. Nevertheless, these cannot boast the same proven effectiveness as minoxidil and finasteride.
Among the most interesting new therapies worth mentioning, we can list:
- LLLT or low level laser therapy; its mechanism of action is still unclear, however appears to cause an increased proliferation of hair bulbs, stimulate follicle stem cells and keratinocytes, and lead to an increased production of adenosine triphosphate, an element that supplies energy to cellular activity and also has anti-inflammatory effects.
- Topical use atanoprost 0.1%, a prostraglandin analogue that seems to lead to an increase in hair density.

Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.

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I, the undersigned, hereby give my consent to the processing and communication of my personal data so as to receive newsletters, commercial communications and/or advertising material via e-mail, post, text message and/or telephone regarding products or services provided by the Data Controller as well as the measurement of the degree of satisfaction relating to the quality of said services. The provision of such consent is optional

PRIVACY POLICY STATEMENT (Art. 13 of EU Regulation n. 2016/679 regarding personal data processing)

ADVIHAIR S.R.L., VAT N° 11495171008, with its offices at Via Benini n. 11 - 40069 Zola Predosa (Bologna, Italy), (hereinafter referred to as the, "Data Controller"), in its capacity as Data Controller, hereby informs you, in accordance with Art. 13 of EU Regulation n. 679/2016 (hereinafter referred to as, "GDPR") that your personal data (provided at the moment of subscription, by means of which business relationships deriving from the existing contract are established) shall be processed in compliance with the methods and for the purposes specified below. In accordance with the provisions of both the GDPR, Italian Legislative Decree n. 196/2003 and any subsequent amendments (hereinafter referred to as the "Privacy Code"), the processing operations carried out by the Data Controller, shall be based on principles of correctness, lawfulness and transparency and they shall be carried with the aim of complying with the principles of relevance, completeness, non-excessiveness while also safeguarding confidentiality.

The scope of data processing

Such data shall be processed, also by using IT and telematic procedures, with the acquisition, where necessary, of images, in accordance with the abovementioned legislation as well as any foreseen confidentiality obligations. More specifically, the personal data shall be processed by the centre, that will carry out all the necessary, individual processing operations ? collection, registration, organisation, storing, processing, modification, extraction, etc. as well as any other operation deemed useful with regards to the provision of the services requested.

Data processing purposes, Nature of data provision and consequences arising from the refusal to provide the requested data

1. Primarily, personal data shall be processed exclusively for purposes closely linked and instrumental to the fulfilment of contractual obligations to which you are party and that constitute the legal basis for the data processing itself in accordance with Art. 13, paragraph 1, letter c) of the GDPR. Such purposes particularly include:
- The conclusion of contracts for services and products provided by the Data Controller;
- The conclusion of contracts for services and products provided by the Supplier;
- Participation in presentation/courses/demonstration activities;
- The fulfilment of precontractual, contractual, administrative, and tax obligations arising from the existing business relationship established with you (requirements regarding operational, organisational, management, tax, administrative, insurance and accounting activities relating to the contractual and/or precontractual business relationship established);
- The fulfilment of obligations foreseen by law, by regulations, community legislation or by an order from a legal Authority (for example, with regards to anti-money laundering);
- The exercising of the Data Controller's rights, for example, with regards to the right to defence before a court. The processing of such data shall be carried out without the need for your express consent (Art. 6 letters b), c) of the GDPR) and the provision of such data is deemed as mandatory. In the absence of such provision, we cannot guarantee the establishment and execution of contractual relations with the Data Controller.
2. Secondarily, personal data may be processed only after obtaining your specific and explicit consent (Art. 7 of the GDPR) for the following purposes:
a) Marketing: to send you newsletters, commercial communications and/or advertising material via e-mail, post, text message and/or telephone, regarding products or services provided by the Data Controller as well as the measurement of the degree of satisfaction relating to the quality of said services.
b) The taking and use of portraits, photographic images and videos: the use and publication of portraits in photos and/videos that shall be taken, on the Data Controller's website and on its social network profile pages. For this purpose, the Data Controller hereby guarantees the fullest respect for rights relating to the honour and reputation of such data. The posing and use of the images are understood to be completely free of charge. The giving of one's consent with regards to Data Processing for Marketing purposes as well as for the use of the portrait, photographic image and video, for the abovementioned purposes and methods, is absolutely facultative and optional (and, in any case, such consent can be revoked without any formal procedure, also following the provision of services) and failure to provide such data shall not lead to any interference and/or consequences with regards to the abovementioned business relationship. In any case, also when the consent to authorise the Data Controller to carry out all the aforementioned operations has already been given, you shall be entitled to revoke such at any time whatsoever, by sending a registered letter regarding your "de-listing" and/or "image deletion" requests to the Data Controller's address as specified below. Following the receipt of such request, the Data Controller shall promptly remove and delete the relevant data from the databases used for Data processing for Marketing purposes and/or the use of the portrait, photographic image and video. The mere receipt of the de-listing request shall automatically be considered as a confirmation that such deletion process has been carried out.

Data Processing Methods

Data processing shall be carried out both manually (e.g. the collection of paper forms) and electronically or in any case, with the aid of appropriate electronic, IT and telematic tools so as to guarantee the security and confidentiality of the data itself, in accordance with what is stated in both Art. 32 of the GDPR and the Privacy Code. In any case, during the performance of data processing operations, all the necessary technical, IT, organisational, logistic measures and safety procedures shall be adopted, in order that the minimum level of protection of the data foreseen by law shall be guaranteed.

Duration of data processing

The Data Controller shall process the personal data for the necessary time so as to fulfil the aforementioned purposes and, in any case, for no longer than 10 years after the business relationship has ended, for the primary purposes and for no longer than 2 years after the need for data processing for Marketing Purposes has ended. The images shall be kept indefinitely and stored in the databases so as to have a historical memory of the events. Anyhow, a periodic verification is carried out relating to the obsolescence of the data stored in relation to the purposes for which they had been collected.

Categories of Individuals to whom the data may be communicated:

Your personal data may be communicated:
- To the Data Controller's employees in their capacity as persons in charge of data processing and/or internal data processors and/or system administrators;
- To self-employed professionals (lawyers, consultants, etc.), administrative and tax consultants for the necessary legal fulfilments, companies that carry out outsourcing activities on behalf of the Data Controller, in their capacity as appointed external Data Processors.
- To supervisory bodies, judicial authorities, insurance companies for the provision of insurance services, as well as those individuals to whom the communication of data is compulsory by law in order to carry out said purposes.
- For defensive investigations or to assert or defend one's rights before judicial courts, as long as it exclusively refers and is closely linked to such purpose.

Transfer of personal data

The Data Controller shall not transfer your personal data to a third-party country or to an international organisation.

Rights of the Data Subject

In your capacity as a data subject, you have rights in accordance with Art. 15 of the GDPR and more specifically, the right to obtain the confirmation from the Data Controller as whether or not personal data relating to you is being processed and, in which case, to obtain access to such personal data as well as the following information: a) the purpose of the processing; b) the categories of the personal data in question; c) recipients or categories of recipients to whom personal data has been or shall be communicated, in particular if these refer to third-party countries or international organisations; d) when possible, the foreseen period of retention of the personal data or, if this is not possible, the criteria used to determine such period; e) the right to ask the Data Controller to rectify or delete your personal data or the restriction of the processing of the personal data relating to you or to oppose to its processing; f) the right to lodge a complaint with a supervisory authority; g) if such data has not been provided by the data subject himself/herself, all the information available regarding its origin; h) the existence of an automated decision-making process, including profiling operations and, at least in such cases, significant information regarding the logic used, as well as the importance and the foreseen consequences of such processing for the data subject. Where applicable, you also have the faculty to exercise the rights pursuant to Articles 16-21 of the GDPR (the right to rectification, the right to be forgotten, the right to restriction of processing, the right to data portability and the right to object), as well as the right to lodge a complaint with the Italian Anti-trust Authority by following the procedures and indications published on said Authority's official website: www.garanteprivacy.it or alternatively, alternatively the right to lodge a complaint before a competent judicial authority.

Methods of exercising rights

You shall be able to exercise your rights at any time whatsoever by sending a registered letter to the Data Controller to such effect.

Data Controller

The Data Controller of the personal data you provided is: ADVIHAIR S.R.L., VAT N° 11495171008, with its offices at Via Benini n. 11 - 40069 Zola Predosa (Bologna, Italy) in the person of its Legal Representative. Articles from 15 to 22 of the GDPR are available by clicking on this link: http://eur-lex.europa.eu/legal-content/IT/TXT/HTML/?uri=CELEX:32016R0679&from=IT

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