Hair loss in women | Female Pattern Hair Loss | causes & treatment | Dermatologist

Female pattern hair loss: This is a slowly progressive hair loss seen in women. It can affect women at any age.
This is second part of the videos on hair fall in women. We discuss causes of hair fall and the condition telogen effluvium in detail. We have the video in both Hindi    • बाल झरने  के कारण और इलाज। Hair fall in wo...   and English    • Hair fall in women | causes & treatment | ...  
It affects 6% to 12% of women between the ages of 20 and 30 years, and more than 55% of women older than 70 years.
It occurs after 18 years of age mostly. In severe cases, it may be noticeable as early as 12 years. However, most of the patients who approach us for treatment are in the age group of 25-40 years. There is a second peak incidence at menopause, between 50 and 60 years of age
What is the cause?
The reason for this hair loss is thought to be due to multiple factors. It may be influenced by genetics, hormonal imbalance or even environmental factors.
The age of onset, how it will progress, the severity that is whether it will be restricted to one area or involve the entire scalp and the pattern of hair loss, are all determined by genetics.

multiple marriages, lack of photo protection, higher income and little physical activity. However, more studies are required to prove an association with these factors.

Hormones have also been implicated in the causation. Though it has not been unequivocally proven. Especially androgens. It is thought that testosterones and DHT play an important role in hair loss. Also, the lack of estrogen with age is responsible. The levels of estrogen drop after menopause which is why we see this condition more after menopause.
Women with FPHL usually first notice a gradual thinning of their hair, mostly on the top of their heads, and their scalp becomes more visible. Over time, the hair on the sides may also become thinner. The patient may notice that her “ponytail” is much smaller or that her longer hair looks “skimpy” at the ends. The thinning of the hair can vary in extent but it is extremely rare for a woman to become bare on top.
lower systemic estrogen levels have been implicated in the increase of FPHL after menopause

How does it appear?
Intact hairline, with thinning of hair, increased visibility of scalp especially when hair is wet or oily. So incarese in width of partition and thinning of hair on top of scalp. The hair are lightly coloured tin and fine.
How do we manage?
Blood tests are usually not done. Some studies show that serum ferritin are usually low in these patients, while other say there is no difference, But it is thought that if your ferritin levels are above 20ug then the response to medications is good.
When the diagnosis is in doubt, a skin biopsy maybe performed. Where a very small piece of skin like 4 mm is taken and examined.
References:
Ramos PM, Miot HA. Female Pattern Hair Loss: a clinical and pathophysiological review. Anais Brasileiros de Dermatologia. 2015;90(4):529-543

Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006;54:824–844
Gatherwright J, Liu MT, Gliniak C, Totonchi A, Guyuron B. The contribution of endogenous and exogenous factors to female alopecia: a study of identical twins. Plast Reconstr Surg. 2012;130:1219–1226

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