Introduction
Female pattern hair loss (FPHL), also known as female pattern alopecia or androgenetic alopecia in females, is a common form of non-scarring hair loss primarily affecting adult women. Characterised by gradual thinning on the top and front of the scalp, FPHL can cause significant psychological distress and impact quality of life. This article provides an in-depth overview of current, evidence-based treatment strategies for FPHL.
Understanding FPHL
Female pattern hair loss (FPHL) typically presents as diffuse thinning on the crown and frontal scalp, often with preservation of the frontal hairline. Unlike male-pattern baldness, complete baldness is rare in FPHL. The condition is believed to be multifactorial, involving genetic predisposition, hormonal influences (androgens), and ageing.
Treatment Principles
The primary goals of Female Pattern Hair Loss treatment are to:
- Halt further hair loss: Stabilise the condition and prevent further miniaturisation of hair follicles.
- Promote hair regrowth: Stimulate the growth of new, thicker hair in affected areas.
- Improve cosmetic appearance: Enhance hair density and coverage to achieve a more aesthetically pleasing result.
- Address psychological impact: Provide support and counselling to manage the emotional distress associated with hair loss.
Assessing Treatment Response
Monitoring treatment progress is crucial to determine efficacy and adjust therapy as needed. Common methods for assessing treatment response include:
- Clinical examination: Visual assessment of hair density, scalp coverage, and hair shaft thickness.
- Standardised photographic documentation: Serial photographs taken at regular intervals to track changes over time.
- Patient-reported outcome measures: Questionnaires and scales to assess patient satisfaction and perceived improvement.
- Hair pull test: Gently pulling a small number of hairs to assess the degree of shedding.
- Trichoscopy: Examination of the scalp and hair shafts using a specialized magnifying device.
- Hair density measurements: Quantitative assessment of hair follicles per square centimetre using a densitometer.
Treatment Options for Female Pattern Hair Loss
First-Line Therapy: Topical Minoxidil
Topical minoxidil, available in 2% and 5% solutions and foam formulations, is considered the first-line treatment for FPHL.
- Mechanism of action: Minoxidil is a vasodilator that increases blood flow to the scalp, prolongs the anagen (growth) phase of the hair cycle, and stimulates hair follicle activity.
- Application: Apply directly to the affected areas of the scalp once or twice daily, depending on the concentration and formulation.
- Efficacy: Numerous studies have demonstrated the efficacy of minoxidil in increasing hair count, improving hair density, and slowing down hair loss progression in women with FPHL.
Adjunctive Oral Therapy: Antiandrogens
For women who do not respond adequately to topical minoxidil alone, or who desire more aggressive treatment, oral antiandrogens can be considered as adjunctive therapy.
- Spironolactone: An aldosterone antagonist with antiandrogenic properties, spironolactone is often the preferred oral agent for Female Pattern Hair Loss It blocks androgen receptors and reduces testosterone production, thereby inhibiting the effects of androgens on hair follicles.
- Finasteride: A 5-alpha-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT). While primarily used in men with AGA, higher doses of finasteride (2.5 to 5 mg) have shown some efficacy in women with FPHL.
- Cyproterone acetate: Another antiandrogen with potential benefits in FPHL, although evidence supporting its use is less robust compared to spironolactone and finasteride.
Other Treatment Modalities
- Platelet-Rich Plasma (PRP): Involves injecting concentrated platelets from the patient’s blood into the scalp to stimulate hair growth by releasing growth factors. Some studies suggest potential benefits, but further research is needed to establish standardised protocols and confirm long-term efficacy.
- Low-Level Laser Therapy (LLLT): Devices emitting low-level laser light can stimulate hair follicles and promote hair growth. Several studies have shown improvements in hair density with LLLT, but its exact mechanism of action remains unclear.
- Oral Minoxidil: Low-dose oral minoxidil can be considered for women who cannot tolerate or dislike topical minoxidil. It has shown promising results in improving hair density, but systemic side effects require careful monitoring.
- Hair Transplantation: Surgical transplantation of hair follicles from donor areas to thinning areas can be an option for women with stable FPHL and sufficient donor hair.
Addressing Concomitant Conditions
- Hyperandrogenism: Women with FPHL and underlying hyperandrogenic conditions, such as polycystic ovary syndrome (PCOS), may benefit from treatment of the underlying endocrine disorder in addition to standard hair loss therapies.
- Scalp Disorders: Inflammatory scalp conditions like seborrhoeic dermatitis can exacerbate hair loss. Effectively managing these conditions can improve scalp health and potentially enhance the response to hair loss treatments.
Cosmetic Approaches
- Hair Styling and Camouflage: Strategic hairstyling, volumizing products, and hair fibres can help conceal thinning hair and create the illusion of fullness.
- Scalp Micropigmentation: A cosmetic tattooing technique that creates the appearance of hair follicles on the scalp, giving the illusion of denser hair.
- Wigs and Hairpieces: High-quality wigs and hairpieces can provide a non-surgical option for concealing hair loss and restoring confidence.
Prognosis and Conclusion
While Female Pattern Hair Loss can be a progressive condition, complete baldness is uncommon. With early intervention and appropriate treatment, it is often possible to slow down or halt the progression of hair loss and, in some cases, achieve significant regrowth. A comprehensive approach that combines medical therapies, lifestyle modifications, and cosmetic strategies can help women with Female Pattern Hair Loss improve their hair appearance and overall quality of life.
