Update on Female Pattern Hair Loss:

Advances in Diagnosis and Treatment

Antonella Tosti, MD; Lakshi M. Aldrege, MSN, ANP-BC; Amy J. McMichael, MD 

Reported by: Rhona Justine A. Chagas

What is Female Pattern Hair Loss (FPHL)?

• Characterized by a decrease in hair density in the region of the central scalp and the temporal region due to a progressive decrease in the ratio of terminal hairs to vellus hairs in a process termed miniaturization of the hair follicle.

Epidemiology of Female Pattern Hair Loss (FPHL)

• Nearly 50% of women will experience hair loss at some time in their lifetime.

• Female pattern hair loss increases with advancing age and is more prevalent following menopause

• Studies from several different countries reported a prevalence in the range of 1% to 12% between ages 20 to 29 years, and from 12% to 56% in women older than age 70 years.

DIAGNOSIS

• Examination of the hair and scalp to investigate the distribution of hair loss and the quality of remaining hair in the areas involved

• Histopathology and assessment of hair counts in a 4-mm punch biopsy.

• TrichoscopyNoninvasive Diagnostic tool

-It provides a magnified view of the scalp and hair shafts.

-One sign indicative of FPHL is a more than 20% variation in the diameter of the hair shaft

3 Main Characteristic Patterns of FPHL

• LudwigDiffuse thinning and widening of central part of

the scalp

• Christmas treeFrontal accentuation of hair loss

• HamiltonFrontotemporal recession of hairline

Common Types of Hair Loss in Women

TYPE CLINICAL DESCRIPTION CAUSES

ALOPECIA AREATA (AA)

Non-scarring; no signs of erythema or skin inflammation; occurs in patches; acute onset

Uncertain etiology; possible autoimmune origin

CHRONIC TELOGEN EFFLUVIUM (CTE)

Non-scarring; early shedding of hair; not associated with thinning hair

Idiopathic and multifactorial; typically no specific trigger

FEMALE PATTERN HAIR LOSS (FPHL)

Progressive and gradual hair loss in characteristic patterns; non-scarring

Some hormonal causes; role of genetics is unclear; possibly polygenic

Common Types of Hair Loss in Women (cont)TYPES CLINICAL DESCRIPTION CAUSES

FRONTAL FIBROSING ALOPECIA (FFA)

Scarring form of hair loss: characterized by hairline recession; associated with decrease/loss of eyebrows; mostly in postmenopausal women

Inflammatory; cause unknown

TELOGEN EFFLUVIUM (TE)

Acute, diffuse hair loss of <50%; non-scarring; duration of approximately 3 months; transient but may precede FPHL

Can be due to diseases, medications, pregnancy, dietary deficiencies, atoimmune disorders, emotional distress

Psychosocial Implications of FPHL

• Hair is associated with general beauty and appearance, self-esteem, and social identity

• FPHL is associated with reduced quality of life.• Women with FPHL experience:

-Negative body image-Poorer self-esteem

-Impaired functioning at school, home, and work-Depression-Diminished personal relationship

Treatment for FPHL

• MINOXIDIL-Approved by the FDA for FPHL

2% topical solution applied twice daily

5% foam applied once daily-No sysytemic side effects reported-Local adverse effects includes: Pruritis, facial hypertrichosis, and dandruff

• LASER/LIGHT THERAPY-Devices that use low level laser light– HairMax laser comb

was approved for male pattern hair loss, and in 2011 it was approved for FPHL

Side effects are: Scalp irritation and erythema

COSMETIC OPTIONS

-Camouflage areas of baldness-Can be used in combination with medical treatments-Options include:

MicropigmentationFibersHair extensionsHair shaft thickenersWigs

Conclusion:• Women with FPHL present a challenge because of the

lack of curative treatments.• Therapeutic success can be enhanced with early

identification and treatment.• Patients must be informed about realistic goals for

treatment and the importance of adherence to therapy for results to be sustained. The effect of FPHL on patients’ self-esteem and psychological well-being should be taken into consideration when developing a management plan for this condition.