There is a common perspective that the beauty of a person lies in his hair. From centuries, men and women are putting their efforts to maintain the beauty of hair. But almost many of us experienced an awful situation i.e. alopecia. Alopecia (hair loss) is a condition in which hair are lost from entire body or some parts of body leading to baldness. Many factors are associated with alopecia. The most common are genetics, medical conditions, hormonal imbalance, stress, trauma and radiation therapy. A genetic condition called androgenic alopecia effect both males and females. In men, it is called male pattern hair loss and in women it is named as female pattern hair loss (FPHL). It is characterized by reduction in hair density and overall decrease in hair volume of women.
Female hair loss pattern clinical presentation
There are three clinical manifestation of female pattern hair loss.
In first clinical presentation, the patient presents with diffuse thinning of parietal areas of both sides and vertex area. In this type, the anterior hair line remains intact.
Second clinical manifestation includes Christmas tree appearance, the hair loss in a triangular form in the frontal and temporal areas of scalp.
Some women present with true baldness at the vertex region and recession of hairline at frontal and temporal areas. The third one is a rare manifestation in females but common in males.
Female pattern hair loss has onset with puberty in females and its incidence increases with age.25% of women suffer from this at age of 49 years and 50% of them are affected at age of 79 years.
Factors causing FPHL:
Androgen is considered as the predisposing factor for female pattern hair loss and many non androgenic factors are also associated with it. In women, hair follicles are miniaturized and converted to vellus hair with short hair cycle lacking anagen phase. The vellus hair have short hair shafts and hence incomplete areas of baldness is present in females accompanied by microinflammation that is different scaring alopecia.
It is found that Female pattern hair loss do not exist alone but many other medical conditions are associated with it. Most common among them are polycystic ovarian syndrome, metabolic syndrome characterized by insulin resistance, hyperprolactinemia, hypertension and obesity. Several heart diseases like carotid disease and coronary artery diseasehave been reported to link with it.
Patient’s past medical history, history of hair shedding that start with increase loss of hair at start and become progressive and physical examination of patient helps in diagnosing it correctly. Laboratory tests are not usually required for diagnosing it.
Treatment of Female pattern hair loss aims to reverse or inhibit hair follicles regression. Its treatment options are categorized into two types involving local and systemic treatment.
Local treatment include topical drugs, the most effective one is Minoxidilit promote hair follicles by vasodilatory effect of minoxidil it can be used by both genders.Ketoconazole, melatonin and some combination therapies are known to be other effective topicaltreatments available for female pattern hair loss.
Systematic treatment e.g. finasteride,dutasteride and spironolactonehave limited indications to use for FPHL and many of them are under investigations.
Hair transplantation is the ultimate solution for Females pattern hair loss in those women where medical treatment fails to get desired results. It can be performed either by follicular unit transfer or by follicular unit extraction, later being more common.
The treatment goal is to regrow the lost hair to some extend and preferably stop the hair growth. But it is important to mention here that the moderate to severe form of it is not a reversible condition. Treatment takes some time to start acting that may be probably one year.
Preventive measures include hair protection from breakage and hair shedding. Some common hair protection tips are eating balanced diet, taking alternative medications that do not cause hair loss, avoiding chemicals e.g. bleach, heat and dyes, limiting sun exposure and smoking.