notes

1. 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

2. 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.

3. 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.

4. 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.

5. • Trichoscopy
Noninvasive 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

6. 3 Main Characteristic Patterns of FPHL
• Ludwig
Diffuse thinning and widening of central part of
the scalp
• Christmas tree
Frontal accentuation of hair loss
• Hamilton
Frontotemporal recession of hairline

8. 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

9. 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

10. 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

11. Treatment for FPHL

12. • 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

13. • 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

14. COSMETIC OPTIONS
-Camouflage areas of
baldness
-Can be used in
combination with medical
treatments
-Options include:
Micropigmentation
Fibers
Hair extensions
Hair shaft thickeners
Wigs

15. 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.