Female Pattern Hair Loss
What is female pattern hair loss?
Female pattern hair loss (FPHL) is a form of androgenetic alopecia which, like male pattern hair loss (MPHL), is a genetically-determined condition. It occurs when an excess of male hormones, known as androgens, bind to the hair follicle, so damaging it and causing it to shrink. This prevents the hair shaft growing properly and results in miniaturisation. The pattern of the progression of the condition varies – whilst MPHL follows the Hamilton-Norwood Scale, FPHL is charted using the Ludwig scale or more recently the Sinclair Scale. Unlike with MPHL, it is very rare for a woman to lose all her hair.
What causes it?
All women have some testosterone in their bodies. If this testosterone is converted into excessive amounts of the hormone dihydrotestosterone (DHT), then FPHL is likely to occur. As with MPHL, the condition arises primarily due to genetic influences, where the predisposition to over-produce DHT is inherited from both sides of the family.
However, occasionally, FPHL occurs secondary to diseases of the endocrine system, such as polycystic ovarian syndrome (PCOS), and adrenal or ovarian tumours. FPHL may also be exacerbated by causes of telogen effluvium such as low ferritin (iron) levels or thyroid dysfunction.
Symptoms and signs
FPHL usually presents with diffuse reduction in hair volume to the mid-frontal scalp, often with the preservation of the frontal hair line.
This is typically recognisable as a widened central parting that is accentuated to the front, giving it the classic ‘Christmas Tree’ appearance.
The resulting hair thinning also causes many patients to complain of a loss of volume in their ponytail, which provides a useful finding in the diagnosis of FPHL.
Why see a trichologist?
A trichologist will be able to make or confirm a diagnosis of FPHL, particularly in distinguishing it from telogen effluvium, and will be able to recommend the appropriate action to take. This may take the form of seeing a GP and trying minoxidil to improve hair growth.
Treatment
As with MHPL, minoxidil can be applied as a topical treatment using either 2% or 5% lotion or a 5% foam. Minoxidil can stimulate blood supply to the follicle and so counter the effects of the DHT.
The 5% strength is more effective for regrowth, but has an increased likelihood of side effects such as facial hair growth and irritant dermatitis. If causes of telogen effluvium are found to co-exist with FPHL, then the causes of these should also be treated.
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