DUPA — diffuse unpatterned alopecia — is a form of androgenetic hair loss that differs from classical male pattern baldness in a critical way: the hair loss affects the donor zone as well as the recipient area, rather than being confined to the top of the scalp. This distinction has profound implications for hair transplant candidacy.
In classical androgenetic alopecia, the back and sides of the scalp are spared — follicles in this zone are DHT-resistant and remain. In DUPA, this donor zone stability is absent. Follicles at the back and sides are also subject to miniaturisation, meaning that transplanted grafts taken from these areas will themselves be subject to continued loss after transplantation. The fundamental principle that makes hair transplants permanent — donor-resistant follicles — does not apply in DUPA.
DUPA is identified through careful assessment of the donor zone under dermoscopy. Signs of miniaturisation in the donor area — finer, shorter hairs mixed with normal calibre hairs at the back and sides of the scalp — indicate DUPA rather than classical androgenetic alopecia. It is more common in women than men, though it occurs in both.
Patients with DUPA are generally not appropriate candidates for hair transplant surgery in the conventional sense. Transplanting miniaturising follicles produces a result that degrades over time as the grafts continue to be subject to the DHT-driven miniaturisation process. Any surgeon who assesses your donor zone and offers you a full hair transplant procedure without identifying or discussing DUPA if it is present is not providing adequate pre-operative assessment.
Related reading
