Learn to treat female pattern baldness with ease

June 1, 2005

New Orleans — Lack of exposure to female pattern baldness, plus an array of differential diagnoses, causes dermatologists to squirm when confronted with a case, says Jeffrey Miller, M.D, associate professor of dermatology, Penn State's Milton S. Hershey Medical Center in Hershey, Pa. He advises doctors to put themselves and patients at ease by developing an objective approach to diagnosis, treatment and management.

New Orleans - Lack of exposure to female pattern baldness, plus an array of differential diagnoses, causes dermatologists to squirm when confronted with a case, says Jeffrey Miller, M.D, associate professor of dermatology, Penn State's Milton S. Hershey Medical Center in Hershey, Pa. He advises doctors to put themselves and patients at ease by developing an objective approach to diagnosis, treatment and management.

The dermatologist explains, "For men, baldness is socially acceptable. The public sees many male models without hair but not female models. It takes a lot of courage for these women to show up in the office."

Careful, objective history Dr. Miller begins each visit with a standardized history.

The first question he asks is: When was the last time you had a normal head of hair?

"Patients tend to grasp that better than asking, 'When did your hair loss begin?'" he notes. "With female pattern baldness, hair loss generally occurs over a period of years, whereas telogen effluvium is marked by sudden onset."

Next he asks where the hair loss is occurring. Genetic baldness occurs predominately on the crown, sparing the sides and back of the head. Telogen effluvium presents with diffuse hair loss.

The third question is designed to let the patient know he takes her hair situation seriously. Dr. Miller asks: How are you managing?

"That goes a long way in separating an average from a good office visit," he says.

Finally, he asks how many brothers and sisters the patient has and whether any of them, or her parents, have experienced hair loss. Statistics indicate half of the female pattern baldness population has a family history - but the other half doesn't.

Physical exam, lab tests "In the physical exam," he says, "I focus on the part width on the crown of the head versus the part width on the back of the scalp. If it's wider on top, that helps establish a diagnosis of female pattern hair loss."

Sometimes both part widths are equal, but the hair shaft diameter is narrower on the crown so that the scalp is visible. This is another indicator of female pattern baldness.

In determining whether to test for a hormonal imbalance, Dr. Miller uses a second set of questions:

Dr. Miller adds, "If any of the answers are positive, I do a total and free hormone test and check DHEA. If either of those turn up abnormal, I often work with an endocrinologist to resolve the hormone problem as that will influence treatment for baldness."