FEMALE PATTERN HAIR LOSS

By Gary M. White, MD

Female pattern hair loss


Female pattern hair loss (FPHL) is a progressive non-scarring alopecia. It used to be called female androgenetic alopecia, but most women with FPHL have no other signs or symptoms of hyperandrogenism and have normal androgen levels. Note the thinning hair across the top but maintenance of the hair line. One study showed that women who seek treatment for FPHL do not overestimate the severity of their loss. In fact they tend to underestimate it.

Clinical

Hair Miniaturization/Hair Thinning by Age

Three stages based upon age of onset:

Age Term
Puberty to 40 Androgenetic alopecia
45-55 years Female pattern hair loss
After 60 Senescent alopecia

Some have separated the major types of hair loss in women into three stages based upon age. Androgenetic alopecia is a genetically determined androgenetic-mediated hair loss that affects younger women. Female pattern hair loss is a less specific term as the role of androgens is less clear cut. Senescent alopecia refers to age-related hair thinning that is not dihydrotestosterone-mediated.

Workup

Treatment

Mild Disease, e.g., Ludwig stage I or II

First-Line

Minoxidil 5% daily (almost as good as BID) x 1 year. The FDA has approved in the US a once a day 5% minoxidil foam for women, available OTC. The primary goal is to grow hair, but the secondary goal is just to prevent further hair loss. The patient may need to use minoxidil long-term. The 5% foam is preferred with lower rates of irritation and less interference in hair styling compared with the solution [JAAD 2011;65;1126].

Sulfotransferase enzyme assay before minoxidil may predict the response to treatment. However, it is not yet commercially available [Derm Therapy 2015;28;13].

Low-Level Laser Light Therapy

Various "hats" that deliver low-level laser light therapy are available in the US without a prescription. For example, some are worn for 25 minutes 3 times per week. A systemic review and meta-analysis found LLLLT to be effective in men[JAAD 2017;77;136] and the combination of LLLLT and 5% minoxidil to be better than either therapy alone for women with AA [Laser Surg Med 2017].

Hair Transplant

If after 6 months of no growth, hair transplantation may be considered.

Advanced Disease, e.g., Ludwig stage III

There is no hope for regrowth so use of a wig or wiglet ($2000-$10,000) may be considered.

Additional Pictures

Female pattern hair loss

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