Rudy Freno
Hairstyle For Female Pattern Baldness – Senior Dermatology and Dermatopathology Fellowship Director, Department of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH. Past President of the American Academy of Dermatology, American Society of Dermatopathology, American Academy of Dermatology
Pattern baldness is the most common type of hair loss in both men and women. Scalp hairs are usually affected in a typical distribution without other scalp or dermatological findings. Early detection and treatment can stop the progression and save as much hair as possible. Both drug and non-drug treatments have been shown to be beneficial.
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Pattern baldness is progressive baldness without scarring characterized by the gradual loss of tip hairs on the scalp in a typical distribution and the minimization of follicles down to the vulus fibers. It is the most common form of hair loss in both men and women and has psychosocial consequences such as stress and reduced quality of life.
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The condition goes by many names, including androgenetic alopecia, male pattern baldness, male pattern baldness, male pattern baldness, female pattern baldness, female pattern baldness, and hereditary pattern baldness. The term “androgenetic alopecia” was used in the past in recognition of the hormonal and genetic influences underlying the male condition.
As our understanding of both the pathophysiology and the phenotypic expression has expanded, so has the collection of terms used to identify this disease. A new term was coined to describe the different expression patterns of males and females and the unclear role and frequent absence of excess androgens in females.
Male and female pattern hair loss is a polygenic condition, which explains its high prevalence and variation in phenotypic expression.
Studies of genetic associations with female pattern baldness are less extensive and robust than those of male pattern baldness. Research on the relationship between female pattern baldness and baldness
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Androgens are believed to be required for the development of male pattern baldness. The condition usually begins after the onset of puberty and is characterized by a dramatic increase in androgen levels. Dihydroxytestosterone is a potent metabolite of testosterone synthesized in reactions catalyzed by 5-α-reductase in peripheral target organs, hair follicles and mammary glands, and is responsible for normal hair growth and hair loss in androgen-sensitive areas and other male hairs. Role in development of parietal and frontal scalp, moustache, armpits, pubic hair, limbs, etc. Dihydroxytestosterone promotes normal hair growth in these areas, but increases cellular levels of androgen receptors and 5-alpha reductase.
It has been reported in cases of male pattern baldness. There have been no reports of male pattern baldness in men with 5-alpha reductase deficiency.
The relationship between androgens and female pattern baldness is less clear. Female pattern baldness has been observed in women with high androgen levels.
Furthermore, most women with female pattern baldness have normal testosterone levels and no clinical symptoms of hyperandrogenemia.
Figure 2 From Finasteride Treatment Of Female Pattern Hair Loss.
The role of circulating estrogen in the development of female pattern baldness is also unknown. The incidence of hair loss increases after menopause. Evidence is conflicting as to whether estrogen stimulates or inhibits hair follicles.
The pattern of hair loss in men and women begins shortly after puberty. Thinning hair and terminal hair loss without scarring results in a decrease in hair density that usually progresses slowly over years. The scalp is healthy and there are no associated symptoms.
In men, hair loss usually affects the middle of the scalp, including the frontal, temporal, and parietal areas (Figure 1). The 7-point Hamilton-Norwood scale is commonly used to classify male pattern baldness.
However, in some men, hair loss may not follow this typical progression, or hair loss may be more severe in certain areas.
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In women, the typical distribution of hair loss is different. Female pattern baldness usually has two distributions: extensive thinning of the hair in the middle of the scalp and along the midline with significant thinning towards the front of the scalp with minimal involvement of the hairline. This is the typical “Christmas tree” pattern seen in
The frontal hairline is less likely to be involved, but thinning on both sides of the head is common. The Grade 3 Ludwig scale is commonly used to characterize female pattern baldness.
A careful medical history should be recorded, including age at onset of hair loss, time course, severity, distribution of hair loss, progression (ie, duration of “hair loss”) and accompanying symptoms. For women, a gynecological history can help uncover underlying factors such as polycystic ovary syndrome and hyperandrogenism. Patients should be asked about their family history of hair loss, metabolic syndrome (such as diabetes), and androgen excess. Medicines; and medical history.
Conditions that exacerbate hair loss, such as iron deficiency, thyroid dysfunction, and nutritional deficiencies, should be considered and managed to improve treatment outcomes.
What Exactly Is Male Pattern Baldness?
When examining the scalp, note the distribution of hair loss, hair thickness, and other clinical characteristics. Male pattern baldness is usually manifested as a receding hairline and thinning hair in the frontal and parietal areas. In women, the frontal and middle scalp is usually affected, as described above. Hair loss can be assessed by comparing the central scalp hairs with the occipital scalp hairs which normally do not stay behind. Minimizing hair looks better using paper as a background and comparing the diameters of adjacent hair shafts.
Inflammation, scarring, or scaling of the scalp offer an alternative diagnosis because these signs are not usually accompanied by pattern baldness. However, seborrheic dermatitis is more common in people with hair loss patterns,
As such, male and female pattern hair loss can cause different conditions on the scalp. Seborrhea dermatitis is often accompanied by seborrhea (oily scalp) which is the result of androgenic stimulation of the sebaceous glands.
Nail involvement (eg, grooves, tracheitis, and longitudinal ridges) and sparse hair loss in non-scalp areas (eg, eyebrows) are inconsistent with the diagnosis of male or female patterns of alopecia.
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A hair pull test that helps detect advanced hair loss involves grasping 50 to 60 hairs near the scalp with your thumb, index, and middle finger and pulling them slowly. If you are missing 6 or more hairs, you may have advanced hair loss.
Extracted hairs can be examined microscopically to characterize type (eg, broken or dystrophic) and stage (eg, telogen [telogen] or anagen [anagen]). A study by McDonald et al.
He suggested that washing or brushing the hair did not affect the results of the tweezer test. In a pattern of hair loss, the tweezer test is usually negative, but may be positive early in the process on the frontal or middle scalp.
Examining the scalp with a dermatoscope reveals epidermal and dermal structures that cannot be detected with the naked eye. Dermatoscopic findings of variation in hair diameter, yellow spots (sebaceous glands), perifollicular pigmentation, and absence of scarring are consistent with a diagnosis of male or female pattern hair loss. Small focal areas of complete epilation were observed, and skin pigmentation in these areas may change with exposure to sunlight.
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Although not usually necessary, a scalp biopsy may be helpful if the clinical picture is unclear or if a scalp condition is suspected. Two 4 mm punch biopsies are taken in the direction of the hair axis and the horizontal and vertical planes are taken.
Histological features of male and female pattern baldness include terminal hair minimization (shaft diameter ≤ 0.03 mm), increased proportion of telogen hairs (15%-20%), terminal hairs and vellus hairs or reduction of a similar hair ratio (1.9:1). 1.5:1 in males and 1.5:1 in females), which reduces the total number of hairs per unit area.
Thyroid-stimulating hormone and iron studies (including serum ferritin, serum iron, and total iron-binding capacity) may help evaluate men and women.
Women with clinical manifestations of androgen excess, such as hirsutism, adult acne, menstrual irregularities and acanthosis nigricans, should be tested for hyperandrogenism.
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A complete blood count and a comprehensive metabolic panel are also routinely performed. Nutritional testing is recommended, including iron saturation, ferritin, zinc and vitamin D, as many people are on a restricted diet.
Other forms of baldness with similar symptoms to male pattern baldness and female pattern baldness include telogen effluvium, alopecia areata, traction alopecia, trichotillomania, centrifugal citrine alopecia, and platus follicles. This includes lichen vulgaris and alopecia fibrosus frontal (Figure 3).
Differential diagnosis of pattern baldness. A, thin alopecia areata. B, Totalis alopecia. C, traction alopecia; D, trichotillomania. E, central cicatricial alopecia. F, lichen pilaris planus; G, frontal fibrous alopecia.
Telogenic alopecia, diffuse non-inflammatory hair loss, is often difficult to distinguish from female pattern baldness. A careful medical history, usually months before telogen shedding, because precipitating factors such as psychological stress, childbirth, weight loss, drugs (eg, interferons, antihyperlipidemic drugs, retinol derivatives, anticoagulants) are very important. Hair loss usually occurs all over the scalp, but in some cases it is most noticeable on the sides of the head. The tweezer test is positive, and if telogen hair loss is active, telogen hair loss increases. It should be noted, telogen effluvium and female pattern baldness can coexist in the same patient.
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Alopecia areata usually presents as focal and patchy patches of hair loss that regenerate spontaneously (Figure 3A). Rarely, widespread alopecia with widespread loss of hair density (alopecia areata) or large patches of hair loss in the frontal, parietal and temporal regions of the scalp (reversible opiates) may present with symptoms similar to female pattern baldness and male pattern baldness. , respectively. .