Case Report: Paired Vertex-Occipital Assessment Reveals Donor-Area Involvement in Diffuse Unpatterned Alopecia

This case report discusses two male patients with diffuse unpatterned alopecia (DUPA), a rare form of androgenetic alopecia characterized by diffuse thinning across the scalp, including the occipital region, which is typically considered a stable donor area for hair transplantation. The study used paired vertex-occipital assessments and found donor-area involvement, with increased hair-shaft diameter variability and follicular miniaturization in both regions. After 6 months of treatment with oral finasteride and topical minoxidil, both patients showed increased non-vellus hair density and reduced miniaturization, indicating short-term stabilization and partial improvement. The report emphasizes the importance of verifying occipital sparing to avoid overlooking donor-area involvement, suggesting that paired vertex-occipital trichoscopy and confirmatory biopsies can enhance diagnostic accuracy and guide treatment decisions.