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A 21-year-old college student presents with concerns about hair loss. The condition has worsened over the past 6 months and has not responded to topical minoxidil. She states that lab tests “couldn’t find the cause.” She also relates that her diet is “average for a college student” and denies a recent history of severe illness including COVID-19. Her periods are “somewhat” regular and she does not have obesity. Physical examination reveals diffuse scalp hair thinning accentuated when the hair is parted. The scalp is devoid of scale and scarring.
Female pattern hair loss, also referred to as androgenic alopecia, is a common form of hair loss that affects approximately 40% of women by age 50.1 The prevalence of female pattern hair loss increases with age. The condition is characterized by...
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Female pattern hair loss, also referred to as androgenic alopecia, is a common form of hair loss that affects approximately 40% of women by age 50.1 The prevalence of female pattern hair loss increases with age. The condition is characterized by diffuse hair thinning resulting from a combination of increased hair shedding coupled with decreased hair density. Miniaturization of hair follicles is most prominent in the central, frontal, and parietal scalp regions.2 Genetic predisposition and hormonal irregularities may play a role in the pathogenesis of female pattern hair loss, which remains poorly understood.
Diagnosis is usually made by physical examination. The condition becomes more apparent when centrally parting the hair, also known as the dividing line sign.2 Dermoscopy reveals an increased number of miniaturized hairs and short vellus hairs.3
Treatment aims to slow disease progression and stimulate new hair growth. Topical minoxidil is a mainstay of therapy and is available as both a foam and solution with the former formulation less irritating.4 Spironolactone is a weak androgen receptor inhibitor used off-label for this condition. Maximal efficacy may require 1 year of use.5 Oral finasteride, an oral 5 α‐reductase inhibitor, may also be effective.6
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
Reference
1. Yip L, Sinclair R. Female pattern hair loss. DermNet. Accessed May 3, 2023. https://dermnetnz.org/topics/female-pattern-hair-loss.
2. Ramos PM, Miot HA. Female pattern hair loss: a clinical and pathophysiological review. An Bras Dermatol. 2015;90(4):529-543. doi:10.1590/abd1806-4841.20153370
3. Bhat YJ, Saqib NU, Latif I, Hassan I. Female pattern hair loss-an update. Indian Dermatol Online J. 2020;11(4):493-501. doi:10.4103/idoj.IDOJ_334_19
4. Gupta AK, Foley KA. 5% Minoxidil: treatment for female pattern hair loss. Skin Therapy Lett. 2014;19(6):5-7.
5. Burns LJ, De Souza B, Flynn E, Hagigeorges D, Senna MM. Spironolactone for treatment of female pattern hair loss. J Am Acad Dermatol. 2020;83(1):276-278. doi:10.1016/j.jaad.2020.03.087
6. Won YY, Lew BL, Sim WY. Clinical efficacy of oral administration of finasteride at a dose of 2.5 mg/day in women with female pattern hair loss. Dermatol Ther. 2018;31(2):e12588. doi:10.1111/dth.12588
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