Female alopecia: Diagnosis and treatment

October 20, 2008

Las Vegas - A meticulous history and scalp examination are key in diagnosing and managing hair loss in women, says Jerry Shapiro, M.D., F.R.C.P.C., department of dermatology, New York University, New York, and department of dermatology and skin science, University of British Columbia, Vancouver, Canada, in a presentation at the Fall Clinical Dermatology Conference here.

Las Vegas

- A meticulous history and scalp examination are key in diagnosing and managing hair loss in women, says Jerry Shapiro, M.D., F.R.C.P.C., department of dermatology, New York University, New York, and department of dermatology and skin science, University of British Columbia, Vancouver, Canada, in a presentation at the Fall Clinical Dermatology Conference here.

"You need to be Sherlock Holmes to figure out the cause of hair loss in some women," Dr. Shapiro says, it is important to distinguish between the two causes; common and uncommon.

Common causes include female pattern hair loss, telogen effluvium and alopecia areata, while uncommon causes are cicatricial alopecia, trichotillomania and hair shaft abnormalities, he says.

When evaluating a patient’s history, it is necessary to pinpoint duration of hair loss, pattern of hair loss, whether the hair is thinning or shedding, whether hair is falling out from the roots or breaking, family history, hair care products used, recent surgery, childbirth systemic illness psychosocial stressors and any new medicines started one to three months prior to hair loss, Dr. Shapiro says. All these things will help determine treatment.

Next comes the five stages of clinical examination, Dr. Shapiro says. The stages are:

  • 1. Distribution of hair loss
  • 2. Inflammation, scale and erythema
  • 3. Scarring vs. non-scarring
  • 4. Quality of hair shaft
  • 5. Pull test

"Female pattern hair loss is the most common cause," Dr. Shapiro says, which affects 38 percent of women.

The youngest girl I’ve ever seen with female pattern hair loss was age 10," Dr. Shapiro says.

Treatment occurs based on Ludwig Stage, with factors such as androgen excess considered. If a patient is Ludwig stage 1 or 2, a topical minoxidil solution is used for one year, Dr. Shapiro says. If the patient is unsatisfied, options such as anti-androgen therapy plus OCA (if childbearing age), hair transplantation, hair prosthesis and hair cosmetics are considered.

However, Dr. Shapiro says, "Anti-androgens are not first line therapy in female pattern hair loss patients, as the efficacy is in question."DT