Female pattern hair loss: current treatment concepts

Quan Q Dinh, Rodney Sinclair, Quan Q Dinh, Rodney Sinclair

Abstract

Fewer than 45% of women go through life with a full head of hair. Female pattern hair loss is the commonest cause of hair loss in women and prevalence increases with advancing age. Affected women may experience psychological distress and impaired social functioning. In most cases the diagnosis can be made clinically and the condition treated medically. While many women using oral antiandrogens and topical minoxidil will regrow some hair, early diagnosis and initiation of treatment is desirable as these treatments are more effective at arresting progression of hair loss than stimulating regrowth. Adjunctive nonpharmacological treatment modalities such as counseling, cosmetic camouflage and hair transplantation are important measures for some patients. The histology of female pattern hair loss is identical to that of male androgenetic alopecia. While the clinical pattern of the hair loss differs between men, the response to oral antiandrogens suggests that female pattern hair loss is an androgen dependant condition, at least in the majority of cases. Female pattern hair loss is a chronic progressive condition. All treatments need to be continued to maintain the effect. An initial therapeutic response often takes 12 or even 24 months. Given this delay, monitoring for treatment effect through clinical photography or standardized clinical severity scales is helpful.

Figures

Figure 1
Figure 1
Ludwig scale (1977). Grade I: Perceptible thinning of the hair on the crown, limited in the front by a line situated 1–3 cm behind the frontal hair line. Grade II: Pronounced rarefaction of the hair on the crown within the area seen in Grade I. Grade III: Full baldness (total denudation) within the area seen in Grades I and II.
Figure 2
Figure 2
Sinclair Scale (Collins et al 2006; Yip and Sinclair 2006). Grade 1: is normal. This pattern is found in all girls prior to puberty but in only forty-five percent of women aged eighty or over. Grade 2: shows a widening of the central part. Grade 3: shows a widening of the central part and thinning of the hair on either side of the central part. Grade 4: reveals the emergence of a diffuse hair loss over the top of the scalp. Grade 5: indicates advanced hair loss.
Figure 3
Figure 3
Savin Scale (Savin 1994). The Savin scale measures overall thinning of the crown scalp, and consists of 8 crown density images reflecting a range from no hair loss to severe hair loss (Stages I-1, I-2, I-3, I-4, II-1, II-2, III, advanced). The ninth and final image in the scale demonstrates frontal anterior recession.

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