Revisiting Diffuse Unpatterned Alopecia: Reappraisal Of A Controversial Diagnosis

Diffuse unpatterned alopecia (DUPA) is a poorly understood variant of androgenetic alopecia characterized by diffuse follicular miniaturization across the entire scalp, including the occipital region, which complicates hair transplantation. This review highlights that DUPA presents with diffuse thinning across all scalp regions, with trichoscopy showing widespread miniaturization without scarring. Diagnosis is clinical due to the lack of established histopathologic criteria. It is often confused with conditions like telogen effluvium and diffuse alopecia areata, necessitating thorough examination and sometimes scalp biopsy. Management focuses on stabilization using treatments like minoxidil, with additional therapies such as platelet-rich plasma and low-level light therapy considered. Significant gaps exist in understanding DUPA's epidemiology, pathology, and treatment outcomes, and further studies are needed to determine if it is a distinct condition or part of the AGA spectrum.