Clinicians turn to off-label therapies to address female hair loss

August 1, 2011

There are very few therapies approved to treat hair loss in women, compelling clinicians to turn to off-label therapies to address this condition, according to the president of the North American Hair Research Society. "Limited drugs are available," says Wilma F. Bergfeld, M.D., senior dermatologist, department of dermatology, Cleveland Clinic, Cleveland.

Key Points

Cleveland - There are very few therapies approved to treat hair loss in women, compelling clinicians to turn to off-label therapies to address this condition, according to the president of the North American Hair Research Society.

Dr. Bergfeld says only minoxidil 2 percent is approved by the Food and Drug Administration for the treatment of hair loss in women, but clinicians are using off-label therapies that they use to treat male hair loss, such as minoxidil 5 percent, finasteride, and, more recently, dutasteride.

Therapeutic options

Alopecia occurring in women can be inflammatory, nutritional, hormonal or genetic/hereditary, Dr. Bergfeld says. The hair loss appears to be progressive over time.

"The onset of a condition like CCCA (central centrifugal cicatricial alopecia) has an earlier onset than hereditary alopecia," Dr. Bergfeld says.

Treatments for women who have hair loss include hormonal therapies, such as oral contraceptives, or antiandrogens, such as spironolactone, she says.

"It's important to choose oral contraceptives that have low estrogen, and nonandrogenic progesterone," Dr. Bergfeld says.

The caveat in treating the menopausal patient with hair loss is that she may have a lack of estrogen, but a clinician first must check family history for cancer and have the patient undergo a mammogram to determine whether estrogen therapy is appropriate and safe, according to Dr. Bergfeld. When in question, breast expert physicians should evaluate the patient.

Harsh haircare

Hair loss among black women is due in part to their haircare methods, Dr. Bergfeld says.

"The bottom line is to stop straightening the hair and wash it more often," she says. "If they are shampooing only every two or three weeks, and there is accumulation of sebum and micro-organisms that proliferate in the follicles, this scalp environment is ripe for bacterial and fungal infections, especially if the hair follicles become inflamed by pulling, tugging or traction. The damaged follicles put out smaller hair fibers and eventually the follicle can be destroyed.

"The patient perceives hair loss when scalp skin is visualized with her usual hair style and more frequently first by her beautician," she says. "If hair is braided tightly and left for long periods, the follicles become damaged, and they may never regenerate."

Dr. Bergfeld says she recommends that female patients, particularly black women, use haircare methods that are more gentle and don't contain harsh chemicals.

"If there is inflammation, no matter what the scalp disease, the key is to stop it as quickly as you can because it is destroying the hair follicle," Dr. Bergfeld says. "Sometimes the skin looks normal, but there is inflammation on the biopsy. It is not enough to look visually just with your eyes."