Female Pattern Hair Loss-An Update

Abstract

Female pattern hair loss (FPHL) is nonscarring progressive thinning of hair with gradual decrease in the number of hair, especially in the frontal, central, and parietal scalp, due to a process known as follicular miniaturization. The etiopathogenesis of FPHL is complex with multiple factors such as genetics, inflammation, hormones, and environment playing role in it. It usually manifests as slowly progressive hair thinning, mainly over the vertex and upper parietal scalp, the frontal hairline is often spared and the miniaturization is also not as severe as in men. A thorough history, clinical examination, hair loss evaluation tests, dermoscopy, and scalp biopsy can help in establishing the diagnosis. Various biochemical tests may be needed in patients with hyperandrogenism. The treatment includes medical and surgical modalities. Topical minoxidil is still considered the first line of treatment. Along with medical therapy, cosmetic camouflage may also be needed in some cases.

Keywords: Alopecia; androgens; female pattern hair loss; minoxidil.

Figure 1

Multiple factors involved in female pattern hair loss

Figure 2

(a) Various growth factors that have a role in the pathogenesis of female pattern hair loss. (b) disorders associated with FPHL

Figure 3

Middle-aged female with thinning of hair over the vertex area of scalp

Figure 4

Trichoscopy of FPHL showing peripilar sign (black circle), yellow dots (red arrow), focal atrichia (white square), single hairs and honeycomb pigmentation in the background. Presence of hair of various diameters indicates increased hair diameter diversity

Figure 5

Rakowska's criteria for the diagnosis of FPHL on basis of dermoscopic findings

Figure 6

Biochemical evaluation to be done in a patient of FPHL

Figure 7

Other topical therapies for female pattern hair loss

Figure 8

Oral drugs and their mechanism of action for a patient with female pattern hair loss