Female Pattern Baldness - Diagnosis and Treatments

Clinical features of pattern baldness in women usually occur during early teens and late middle
age. This is shown by the gradual thinning of hair over the frontal area. Usually, pattern baldness
in women is not accompanied by increased shedding of hair, but unlike telogen effluvium, hair loss
may be seen from the start.

The scalp becomes more and more visible as the disease progresses.Most of the time, the central
part of the head widens due to diffused reduction of the hair’s density, which involves the frontal
scalp and crown. Some women may experience hair loss on some small areas of the frontal scalp
while others may experience the effect on the entire scalp including the areas of parietal and
occipital.

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During hair loss, women usually retain a rim of hair along the frontal hairline.Laboratory
EvaluationMost women with pattern baldness have normal menstruation, normal fertility, and
normal endocrine function, including correct levels of circulating androgens. Therefore, they
would only need extensive hormonal testing when symptoms and signs of androgen excess become
really visible.

Laboratory measurement of serum total or free testosterone, dehydroepiandrosterone sulfate and

prolactin are appropriate when hirsutism, severe unresponsive cystic acne, virilization, or
galactorrhoea are present. Measurement of serum thyrotropin, serum iron and ferritin, and
complete blood count may eliminate common causes of hair loss.Differential Diagnosis of
Androgenetic AlopeciaAndrogenetic alopecia in women can be confused with the former
condition.

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This is in spite of the fact that features of chronic telogen effluvium are distinct. Anyway,
horizontal sections of a scalp biopsy help to distinguish the two conditions once the ratio of
terminal hairs shrinks.MorphologyAs time goes by, the hairs in pattern baldness become
progressively miniaturized. These hairs include the papillae and matrices, as well as the hair shafts.
However, the degree of hair loss in women is not as extreme as it is with some men. Women with
pattern hair loss have a mosaic of variable-diameter hairs in the affected region of the top of the
scalp. Increased spacing between hairs makes the central part appear wider over the frontal scalp
compared to the occipital scalp. In some cases, hair volume may still appear normal but the hair
would stop growing to its previous length and normally results to thin distal ends. Female pattern
hair loss is seen on women by visual decrease in hair density while in men, it is by baldness on the
affected areas.Treatment of Androgenetic AlopeciaHair loss is a result of abnormal hair cycle.
Because of this, it is theoretically reversible. However, the current treatment options have limits in
their performance and in some cases, only small improvements in hair density can be seen.
Advanced pattern baldness may already be difficult to treat because irreparable damages may have
already taken place on the follicular stem cell when inflammation surrounded the bulge area of the
follicle. Some systematic treatment plans for this case include:• The current treatment for pattern
baldness is Minoxidil. The exact mechanism by which Minoxidil works is not known but the
treatment appears to affect the hair follicle in three ways: it increases the span of time follicles
spend in anagen, it rouses follicles that are in catagen and it enlarges the actual follicles. In effect,
vellus hairs enlarge and are converted to terminal hairs, and shedding is reduced.• Exogenous
estrogen can be used to treat pattern baldness, but this regimen is no longer much in use because
of Minoxidil’s efficacy.• Finasteride has been effective on men with pattern baldness but definitely
it was risky on women. This regimen is not advisable for women who are still in their childbearing
age because of the presence of 5a-reductase inhibitors that may cause external genitalia
abnormalities in male fetuses.• Hairstyling, teasing, coloring, permanents, and the use of hair
spray are means of coping with the cosmetic effects of pattern baldness. However, when the hair
loss is grave, the affected person may opt to use wigs.• Hair transplantation is another option since
it has already been accepted in treating pattern baldness on men. Now, it is also being used to treat
female hair loss although only a very few women go for this type of treatment because of the cost
and the possible trauma that may go with it.• For those women who have encountered ineffective
and unsuccessful treatments for hair loss, surgery may be another option and thus, the most suited
method for them.ConclusionPattern hair loss in women is made up of many factors whose traits
are genetically determined. It is possible that both androgen-dependent and
androgen-independent mechanisms contribute to this strange form of hair loss. In women, it is
usually patterned with the most marked thinning over the frontal and parietal scalp, and with
greater density over the occipital scalp. Unusual hair loss in women may frustrate self-esteem,
psychological well being, and body image. Because of this, it is quite vital for the physician to
inform their affected patients that hair loss could bring about adverse effects on the quality of a
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