Female Pattern Hair Loss

Female pattern hair loss is the most common reason of hair loss in women and increases with advancing age

. Not more than 35% of women go through life with a full head of hair. 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.

Affected women may experience impaired social functioning and psychological distress. 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 non pharmacological treatment modalities such as counseling, cosmetic camouflage and hair transplantation are important measures for some patients.

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.

Female pattern (FPHL) has emerged as the preferred term for androgenetic alopecia (AA) in females owing to the uncertain relationship between androgens and this entity (Olsen 2001). It is characterized by a reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. In 1977, Ludwig clearly described the distinctive features of FPHL and classified it into three grades of severity referred to as Ludwig grades I, II, and III. The prevalence increases with age from approximately 12% amongst women aged between 20 and 29 years to over 50% of women over the age of 80. Hair loss in women is associated with significant psychological morbidity. Cash and colleagues (1993) suggested that women place a greater emphasis than men on physical appearances and outward attractiveness. Societal norms dictate that hair is an essential part of a womans sexuality and gender identity, and any hair loss generates feelings of low self-esteem and anxiety from a perception of diminished attractiveness. Women are more likely than men to have a lowered quality of life and to restrict social contacts as a result of hair loss. While men do consider androgenetic alopecia as an unwanted and stressful event that diminishes their body image satisfaction (studies indicate 50% of men with mild hair loss and 75% with moderate to severe hair loss report concern, society tends to regard hair loss in men as expected and normal due to the greater visibility of hair loss within men.

Current management options are limited, and even in positive responders, there is a significant time delay before improvement becomes apparent. Regardless of which option is chosen, sufficient time should be spent counseling the patient. While some women are content to be reassured that their hair loss is not a manifestation of a serious disease, many are sufficiently concerned by the prospect of going bald to seek active treatment.

by: Mats Stolt

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