Women Hair loss
Female pattern baldness (FPB) involves a specific pattern of hair loss in females, usually caused by hormones, aging and genetic. This condition is also called alopecia in women; female baldness and androgenic alopecia in women.
Causes, incidence, and risk factors of women hair loss
Rate of hair growth from follicle is about 1/2 inch per month. Life circle of each hair including growth and rest that will be completed with fall of hair, takes about 2 - 6 years. After fall of any hair a new hair soon begins to grow in its place. 85 percent of hair is growing at any given time and the other 15 percent is resting.
Baldness is a condition that new hair does not grow when old hair fall. The causes of the failure to grow new hair in female pattern baldness is not entirely understood, but it seems to be associated with hormonal changes, genetic predisposition, and aging. Hormonal changes are commonly seen in menopausal period when the hair on the head is thinned, while facial hair is getting coarser.
The typical pattern in female patten baldness is generally different from that of male pattern baldness MPB. In female pattern baldness the hair thins more diffuely but the frontal hairline is maintains in most of the cases (unlike male pattern baldness). Female pattern baldness can occasionally present similar to male pattern baldness, but it rarely progresses to total or even near total baldness as it may in men.
Baldness is a condition that new hair does not grow when old hair fall. The causes of the failure to grow new hair in female pattern baldness is not entirely understood, but it seems to be associated with hormonal changes, genetic predisposition, and aging. Hormonal changes are commonly seen in menopausal period when the hair on the head is thinned, while facial hair is getting coarser.
Pattern and grading of hair loss
The typical pattern in female patten baldness is generally different from that of male pattern baldness MPB. In female pattern baldness the hair thins more diffuely but the frontal hairline is maintains in most of the cases (unlike male pattern baldness). Female pattern baldness can occasionally present similar to male pattern baldness, but it rarely progresses to total or even near total baldness as it may in men.
Some of the typical patterns hair loss in women are:
- Diffuse pattern of hair thinning over entire scalp, often more noticeable thinning toward the back.
- Diffuse thinning with more noticeable thinning in front, but with no involvement of the frontal hairline.
- Diffuse thinning with more noticeable thinning toward the front of the scalp with involvement and sometime breaching the frontal hairline[Ref].
Figure 1: Ludwig classification of female pattern baldness
other causes of hair loss in women
- Telogen effluvium: temporary shedding of hair more than the usual rate
- Instrumental: breaking of hair (usually from styling treatments)
- Alopecia areata: Patchy areas of total hair loss (an immune disorder causing local hair loss)
- Scarring alopecia: Patchy hair loss due to sever inflamation or injury, which is followed by scar
- Trichotillomania: Anxiety and psychological related compulsive pulling of hair
- Medications
- Certain skin diseases such as lupus or other inflammatory conditions
Treatment of Female Pattern Baldness
Treatment of alopecia in women can be started when common treatable causes of hair loss is excluded. Rogaine (topical Minoxidil 2%) is aften the first step in treatment. Rogaine is the only FDA approved medication that is currntly available for treatment of female pattern hair loss. The other FDA approved hair loss treatment in males, Propecia, did not show any positive results in female pattern baldness.
Aldactone (Spironolactone) pills help many women and can be used in selected female patients. Other hormonal treatments including Cyproterone acetate have shown some results in patients with evidence of increased androgen (hyperandrogenism) especially in women after menopause.
Hair transplant surgery, using new techniques of follicular unit and minigraft done by experienced hair transplant surgeons can often acheive excellent results. Although effective in most cases, hair transplantation have minimal results in female patients with generalized hair loss. The candidacy of women should be assesses carefully. Women with thin eyebrow or eyebrow hair loss may also be candidates for hair transplant surgery to the eyebrows.
Transgender hair transplant is one of the important hair transplants in transformation of a male to female hairline. Hair transplant for transgenders should be one of the first procedures to be considered in the process of the sex change. A male patterned hairline could be easily converted to a nice feminine hair line with microscopic follicular unit transplantation with perfect results. However in some patients there is some degrees of male patterned baldness that might create more challenge especially in patients with significant miniaturization of scalp hair that indicate future hair loss.
