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Androgenetische Alopezie

Aktuelle Aspekte eines vertrauten Phänotyps

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Zusammenfassung

Die androgenetische Alopezie ist die weitaus häufigste Form des Haarverlustes bei Männern und Frauen. Sie ist ein quantitativer Phänotyp, dem eine genetisch komplexe Disposition zugrunde liegt. Noch ist allerdings keines der ursächlichen Gene bekannt. Unter der Wirkung von Androgenen als Manifestationsfaktoren kommt es in den betroffenen Kopfhautregionen zu einer Verkürzung der Anagenphase und einer Reduktion des zellulären Haarmatrixvolumens. Dies bewirkt eine Umwandlung kräftiger Terminalhaarfollikel in feine Vellushaar-ähnliche Miniaturhaarfollikel. Klinisch äußert sich dies bei Männern und Frauen in einem Haarverlust, der definierten Mustern folgt ("pattern baldness") und in unterschiedlichem Ausmaß kontinuierlich fortschreitet. Beim Mann findet sich im Endstadium eine typische Glatzenbildung mit einem lediglich noch okzipital und temporal bestehenden hufeisenförmigen Haarkranz. Bei der Frau hingegen ist die Haarlichtung in der Regel diffuser mit einer maximalen Ausdünnung in der Parietalregion. Die androgenetische Alopezie stellt in den meisten Fällen eine diagnostisch einfache, jedoch therapeutisch schwierige Aufgabe dar. Der behandelnde Arzt wird in der Regel mit einer sehr hohen Erwartungshaltung der Patienten hinsichtlich des Wiederwachstums der ausgegangenen Haare konfrontiert. Heute sind mit Minoxidil und insbesondere Finasterid Wirkstoffe erhältlich, die zum Sistieren des Haarausfalls führen können. Die Identifizierung der für die androgenetische Alopezie verantwortlichen Gene wird die Entwicklung neuer kausaler Therapien ermöglichen.

Abstract

Androgenetic alopecia is the most common type of hair loss in men and women. The disorder represents a quantitative phenotype with an underlying genetic disposition. So far none of the causative genes have been identified. Under the influence of androgens there is a shortening of the anagen phase as well as a reduction of the cellular hair matrix volume in the involved scalp area. This results in the transformation of thick terminal hair follicles into thin vellus-like hair follicles. Clinically, patients present with an alopecia that follows a defined pattern (pattern baldness) and progresses continuously but in varying degrees. In advanced cases, men may develop baldness with remaining hair exclusively in the temporal and occipital regions. Women are prone to exhibit a more diffuse type of hair loss with pronounced thinning in the parietal region. Whereas the diagnosis of androgenetic alopecia is easy, its treatment is often difficult. The physician is commonly confronted with high patients' expectations regarding hair regrowth. Today, with minoxidil and finasteride, effective therapies are available which can lead to cessation of hair loss. The identification of underlying genes will make a more specific therapy easier to achieve.

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Danksagung

Wir danken den Personen, die ein Foto vom behaarten Kopf für diesen Übersichtsartikel zur Verfügung gestellt haben. Des Weiteren danken wir der Deutschen Forschungsgemeinschaft, die unser Projekt "Genetische Analyse der androgenetischen Alopezie" in der DFG-Forschergruppe FOR 423 "Genetische Epidemiologie und medizinische Genetik komplexer Erkrankungen" finanziell unterstützt, der Medizinischen Fakultät der Universität Bonn für Stipendien bzw. Sachbeihilfen im Rahmen des BONFOR-Programms sowie der Firma Merck, Sharp & Dohme, die unsere Arbeitsgruppe in der Vergangenheit mit einer Sachbeihilfe unterstützt hat. Darüber hinaus danken wir ganz herzlich den vielen Probanden, die sich bereits für unser Forschungsprojekt zur Verfügung gestellt haben.

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Authors and Affiliations

  1. Hautklinik der Heinrich-Heine-Universität Düsseldorf

    S. Hanneken, S. Ritzmann & R. Kruse

  2. Institut für Medizinische Genetik, Universität Antwerpen, Belgien

    M. M. Nöthen

  3. Hautklinik der Heinrich-Heine Universität, Moorenstraße 5, 40225 , Düsseldorf

    S. Hanneken

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  1. S. Hanneken
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  4. R. Kruse
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Correspondence to S. Hanneken.

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Hanneken, S., Ritzmann, S., Nöthen, M.M. et al. Androgenetische Alopezie. Hautarzt 54, 703–712 (2003). https://doi.org/10.1007/s00105-003-0561-y

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