Additional Management Options: Several pharmacologic options are under investigation for use in female alopecia. Finasteride 1 mg Propecia is a 5-alpha-reductase inhibitor used in male-pattern baldness.
Research is ongoing about its possible use in females, but its use in females may be limited owing to its contraindication in women of reproductive age.
This approach is more commonly used in Europe, and large peer-reviewed studies showing efficacy are lacking. Aromatherapy involving the combination of oils such as lavender, thyme, rosemary, and cedarwood has been studied for use in patients with alopecia areata. Hair loss can be a traumatic experience for many females. The psychological impact in females tends to be greater than in males, because females often place more importance on their physical appearance than do males.
It is also more socially acceptable and understood when hair loss occurs in males, since hair loss is more recognized in this population. Females often utilize hair as a way to alter and enhance their physical appearance, through changing style, length, or color. When hair loss occurs, the ability to alter hair is compromised. The investigational study mentioned above found that females suffering from hair loss tend to have a less positive body image, more social anxiety, poorer self-esteem, and decreased quality of life compared with females without hair loss.
It is important to understand that not all females will be affected by alopecia to the same degree. Some females may more easily accept hair loss and be less bothered by it.
Other females may find it extremely unsettling, even to the point of trauma resulting in psychological illness e. Female patients have different ways of coping with alopecia. Patients may choose to wear eye-catching clothing, jewelry, or makeup to draw attention away from the scalp. Another method is to conceal the area of hair loss with accessories such as hats, scarves, and wigs. Alopecia is a significant problem for many females that should not be casually disregarded.
Whether or not a patient decides to utilize pharmacologic treatment, there are minimization strategies that can help reduce hair loss. Therefore, it is important to address both the medical and the emotional health needs of female patients with alopecia. American Academy of Dermatology. Hair loss. Accessed January 15, Evidence-based treatments for female pattern hair loss: a summary of a Cochrane systematic review.
Br J Dermatol. Mirimirani P. Managing hair loss in midlife women. Hair loss in men and women androgenetic alopecia : beyond the basics. Accessed January 29, Hair: what is new in diagnosis and management? Female pattern hair loss update: diagnosis and treatment. Dermatol Clin. Factors associated with female pattern hair loss and its prevalence in Taiwanese women: a community-based survey.
J Am Acad Dermatol. Accessed April 23, Chapter Skin manifestations of internal disease. When hairs are 3 cm or shorter, they are called vellus hairs, 2 and their number may serve as a diagnostic tool for AGA. The method is a modification of a method published by Quercetani et al. In addition, it allowed patients with lessening CTE to receive a proper diagnosis CTE in remission instead of being dismissed as dysmorphophobic.
Irrespective of their length, telogen hairs collected with the wash test varied greatly in number, accounting for the magnitude of the standard deviations. Large numbers suggest CTE diagnosis. The good concordance of our figures with the clinical diagnoses suggests that the best cutoff value is about hairs. In fact, the mean value for patients in whom the clinical diagnosis of AGA showed the best concordance with the wash test diagnosis was Hair diameter can be dismissed from the evaluation because, in our study, diameter and length proved to vary in parallel, irrespective of clinical diagnosis.
In other words, the shorter the hair, the thinner the diameter. This method is simple, noninvasive, and suitable for office evaluation. The actual time taken by the procedure varies from 5 to 20 minutes, depending on the number of collected hairs and on their length and curliness, with long hairs being easier to distinguish.
Tracing a line on a sheet of A3 paper of 3 cm in length helps speed up the measurement. The only drawback is that this cannot be used when patients usually young men wear their hair very short. Those patients can be evaluated by measuring the number of shed hairs and their diameter, but it is a longer and time-consuming procedure. In conclusion, counting the telogen hairs shed during a standardized shampooing and measuring the number of those hairs that are 3 cm or shorter is good tool to diagnose type and severity of hair loss, whether AGA, CTE, or the association of the 2 conditions.
Author Contributions: Study concept and design : Rebora. Aquisition of data : Rebora, Vecchio, Baldari, and Guarrera. Discoid lupus erythematosus is a type of cutaneous lupus , an autoimmune disease that affects the skin. It can lead to inflamed sores and scarring on the ears, face, and scalp.
Hair loss is one symptom of the disease. When scar tissue forms on the scalp, hair can no longer grow in that area. Hair loss caused by folliculitis decalvans, an inflammatory disorder that leads to the destruction of hair follicles, is often accompanied by redness, swelling, and lesions on the scalp that may be itchy or contain pus, known as pustules.
This type of hair loss is not reversible, but dermatologists can offer medication to control symptoms and, in some instances, stop the progression of hair loss.
Dissecting cellulitis of the scalp, a rare condition, causes pustules or lumps to form on the scalp. This condition may also cause scar tissue to develop, destroying hair follicles and causing hair loss. Medications may help control symptoms. Frontal fibrosing alopecia typically occurs in a receding hairline pattern and may also result in hair loss in the eyebrows and underarms. Frontal fibrosing alopecia most commonly affects postmenopausal women. Certain medications can manage symptoms and stop the progression of the disease.
The cause is unknown. Central centrifugal cicatricial alopecia may occur as a result of hair products or styling techniques that damage hair follicles. The frequent application of oils, gels, or pomades can also cause this condition, which may be reversible if you stop using these hair products or styling techniques.
Our dermatologists may recommend taking medication to help hair grow back. Several types of hair shaft abnormalities can lead to hair loss. These conditions cause strands of hair to thin and weaken, making them vulnerable to breaking.
This can result in overall thinning, as well as in many small, brittle hairs. Making simple changes to the way you style and treat your hair can reverse some hair shaft abnormalities. Other conditions may require medical intervention. Types of hair shaft abnormalities include:. Loose anagen syndrome, which most commonly presents in young children, occurs when hair that is not firmly rooted in the follicle can be pulled out easily. Most of the time, hair falls out after it has reached an arbitrary maximum length.
Children with loose anagen syndrome often cannot grow hair beyond a relatively short length. The condition more commonly affects girls with blond or brown hair.
For example, hair loss may accelerate overnight because of the friction of a pillow. The cause of loose anagen syndrome is unknown, though it may be related to a disorder in the hair growth cycle that prevents hair from staying in the follicle. There are few reliable treatments, but the condition tends to improve greatly with puberty, and some medications may result in fuller hair.
People with trichotillomania pull their hair out and find it difficult to stop. Although oral corticosteroid therapy is effective in the treatment of alopecia areata, it is seldom used because of potential adverse effects. Systemic treatment may be indicated in women with progressive alopecia areata.
For active, extensive, or rapidly spreading alopecia areata, the recommended treatment in adults weighing more than 60 kg lb is prednisone in a dosage of 40 mg per day for seven days; the corticosteroid is then tapered slowly by 5 mg every few days for six weeks. Oral prednisone therapy can be used in combination with topical or injected corticosteroid therapy, as well as with topical minoxidil therapy. Topical administration of minoxidil, particularly the 5 percent solution, has been found to be somewhat effective in the treatment of alopecia areata.
In one study, 8 this treatment produced acceptable results in 40 percent of patients who had lost 25 to 99 percent of their scalp hair. The FDA has not labeled topically administered minoxidil for the treatment of alopecia areata. Treatment with anthralin, a nonspecific immunomodulator, is safe and effective, particularly in patients with widespread alopecia areata.
Anthralin is available in 0. After each application period, the scalp is rinsed thoroughly with cool to lukewarm water and then cleaned with soap. New hair growth becomes apparent in two to three months. Approximately 25 percent of patients have cosmetically acceptable results within six months.
Selection of the optimal treatment approach depends on the extent of the hair loss Table 1. If less than 50 percent of the scalp is affected, intralesional corticosteroid injections alone or with topical corticosteroid therapy can be tried.
If more than 50 percent of the scalp is involved, a multiple-agent regimen is appropriate. Treatment should be continued until remission of the condition or until residual bare patches can be covered with newly grown hair. Hence, treatment may need to be continued for months to years. Intralesional corticosteroid injections once a month triamcinolone acetonide [Kenalog] preferred.
Intralesional corticosteroid injections once a month, plus topical application of intermediate-potency corticosteroid solution or lotion twice daily. Prednisone, 40 mg per day orally for 7 days, then tapered by 5 mg every few days for six weeks. Telogen effluvium is diffuse hair loss caused by any condition or situation that shifts the normal distribution of follicles in anagen to a telogen-predominant distribution. Daily loss may range from to hairs.
If hair loss is at the lower end of the range, it may be inapparent. Telogen effluvium may unmask previously unrecognized androgenetic alopecia.
A number of conditions are associated with telogen effluvium Table 2. Telogen effluvium usually begins two to four months after the causative event and lasts for several months. If telogen effluvium is suspected, a thorough history should be obtained.
Early stages of androgenetic alopecia Physiologic effluvium of the newborn Postpartum effluvium. Crash or liquid protein diets High fever e. Anticoagulants especially heparin Anticonvulsants Antikeratinizing agents e. Hair diseases. Med Clin North Am ; Treatment is based on identifying and treating or correcting the underlying cause of telogen effluvium. It can be reassuring for women to understand the relationship of their hair loss to a specific event or agent, and to know that hair regrowth is probable Figure 4.
Cicatricial alopecia is hair loss resulting from a condition that damages the scalp and hair follicle 7 Figure 5. In addition to a bald spot, the scalp usually has an abnormal appearance. Plaques of erythema with or without scaling or pustules may be present. Conditions that can be associated with cicatricial alopecia include infections e. If the cause of the disorder is not readily apparent, a 4-mm punch biopsy of the scalp can be helpful.
Frequent findings on biopsy include lymphocytic proliferation around the follicle, destroyed follicles, a thin and atrophic epidermis, and a densely sclerotic dermis.
Traumatic alopecia can be caused by cosmetic practices that damage hair follicles over time. Chemicals used repetitively on the hair also can damage follicles. Examination of the scalp shows short broken hairs, folliculitis and, frequently, scarring.
Trichotillomania, another cause of traumatic alopecia, is a compulsive behavior involving the repeated plucking of one's hair. Women display this behavior more often than men, and children more often than adults.
Children are often aware that they are plucking their hair and may be amenable to behavioral interventions. When the behavior persists into adulthood, patients may not acknowledge the behavior. Trichotillomania is often difficult to treat. A variety of pharmacologic agents, mostly antidepressants, have been tried with some success. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Before entering academic medicine, Dr.
Thiedke was in private practice for 10 years. Address correspondence to C. Carolyn Thiedke, M. Box , Charleston, SC e-mail: thiedkcc musc. Reprints are not available from the author. The author indicates that she does not have any conflicts of interest. Sources of funding: none reported. Patient-perceived importance of negative effects of androgenetic alopecia in women.
Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects.
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