Author: Dr. William Rassman

Dear Dr. Rassman, et al.,

I hope you are all having a good Labor Day holiday, and thanks for keeping this informative blog.

I am writing to share my experience with DUPA with others who may be affected by the condition, and to ask a couple of questions. This is a long email, but I hope it will be helpful to those who are in a similar situation, and I hope you’ll be able to post a reply.

I was diagnosed with DUPA this past January, 2007, and my doctor prescribed me Finasteride, 2.25 mg/day. I first noticed that I have thin hair about 7 years ago, but since then, while I had been disturbed by the thinness, I had not noticed it getting any worse, i.e., any thinner. Since being on Finasteride for about 8 months, I have noticed no difference in my hair, either positive or negative (which, I suppose, can be viewed as an overall positive). However, I have searched and searched the internet for information about DUPA, and apart from the websites that you have linked to in your previous posts (which themselves contain scant information), there is nothing. Therefore, I hope you can answer a couple of questions:

(1) Are there any DUPA resources that you know of, other than those you have previously linked to?

(2) Have you noticed, in your practice, any common progression to DUPA? (Specifically, I am wondering whether I can expect my thinness to get any worse-considering that I haven’t noticed any difference over the last 7 years (I’m 28 now)-or if DUPA tends to stabilize after a point).

I would also like to share with your readers the cosmetic solutions that I have found to work well for me, and ask you a few questions about them. I have found that both Toppik and Dermmatch work extremely well, both alone and in combination. For my particular situation (general thinness all over, but no large bald spots) I find that Dermmatch is the best cosmetic solution, and is most affordable (Toppik, I found, ended up costing about $60/month for me because of the amount I need to use, whereas Dermmatch costs me only about $15/month).

And the Dermmatch looks absolutely amazing, even after being caught in a rainstorm. My bathroom has a very bright, harsh florescent light, and I often stare at my hair after putting in the Dermmatch, and even though I know it’s there, I can’t detect it.

I have found that the best way to apply the Dermmatch is to use my fingers, rather than the paltry applicators that they provide. After showering, I wet my fingers, load them with a lot of wet Dermmatch, and apply it all over my scalp and hair using gentle circular motions, all the while regularly rewetting the Dermmatch container. Then I dry it and fluff it up with a couple of paper towels, to separate my hair and prevent it from clumping, and to remove the excess Dermmatch. Then I use a hair dryer to finish drying it, and finally I use a fair amount of hair spray to ensure that it doesn’t transfer onto my hands or pillow (or a girl’s, for that matter). The hair dryer and hair spray are essential, or else my hands and pillow become black if rubbed against my hair.

All in all, from the start of application to the time it’s fully dry and I’m ready to head out the door, it takes about 45 minutes. However, I have found that I can keep it in my hair for even up to a week without having to reapply it. I can even shower with it in-if I use just a small amount of shampoo, just enough to wash the sweat and greasiness out of my hair, the Dermmatch is relatively unaffected-all I need do is use a little bit of Toppik as a touch-up afterwards. This leads to my next question:

(3) Do you believe that there is any negative effect to leaving Dermmatch on my scalp for a multiple days and nights at a time? That is, could it accelerate my hair loss/inhibit growth by clogging my pores, or by some other mechanism-is it true what the Dermmatch website says, that “Sebum does not cause hair loss by blocking your follicles, nor do cosmetic products like DermMatch”?

I apologize for the long email, and I thank you and your colleagues again for keeping your informative blog—I have found it an invaluable salve to my vanity and intellect in the face of the misinformation that is rampant on the internet, for you prove that “at the length truth will out.”

Best regards.

Thanks for sharing your story with us. I believe that our original paper first documented the term Diffuse Unpatterned Alopecia (DUPA) over 10 years ago. There is not much on this variation of the alopecias which appear in men. When it appears in women, it is called the same thing, but we expect that this is a presentation of the female version of genetic hair loss that impacts almost half of the female population, particularly weighted to the post-menopausal woman.

I personally believe that the appearance of DUPA in men can occur at any time in their lifetime. When seen in the elderly it is called senile alopecia, but I believe that the patients who are very old (75+), are just the sum of men who developed it in each decade (30s-70s), so it is more frequently seen in the older groups. Most of my patients who present with DUPA have what appears to be a stable condition, but that is probably because they come to me later in the process to get the diagnosis. A small number of men with DUPA that I have treated have responded to Propecia, but I do not believe that it is mediated by DHT so there is a questionable value with this approach. Using minoxidil would require a massive application to the entire scalp, but if there are areas that are particularly important, then it is worth trying.

Using DermMatch or other masking products should not cause damage and can be left on the scalp for days.