Many people mistakenly believe that pattern hair loss is strictly something men experience. The fact is that women make up a significant percentage of Americans who experience hair loss. In fact, according to the American Academy of Dermatology, 40 percent of women — approximately 30 million in all — have visible hair loss by the time they are age 40.
The patterns of hair loss in women are not as easily recognizable as those in men. Male Pattern Baldness is manifest with distinct patterns described by Hamilton in 1941, later revised and expanded upon by Dr. Norwood in 1975. Ludwig described the Female Pattern Hair Loss in 1977 and his description has become the standard.
Hair loss in women can be devastating for self image and emotional well-being. Unlike the case for men, thinning scalp hair in women does not uniformly grow smaller in diameter (miniaturize). As you can see in the photo at right, women with hair loss due to androgenetic alopecia tend to have miniaturizing hairs of variable diameter over all affected areas of the scalp. While miniaturizing hairs are a feature of androgenetic alopecia, women usually do not progress to complete baldness, which usually makes it easier for them to mask the thinning with comb over hair styling.
Female scalp hair loss may begin at any age through 50 or later, may not have any obvious hereditary association, and may not occur in a recognizable “female-pattern alopecia” of diffuse thinning over the top of the scalp. In fact, a woman who notices the beginning of hair loss may not be sure if the loss is going to be temporary or permanent. For example, if there has been a recent event such as pregnancy or illness that may be associated with temporary hair thinning.
Patterns of hair loss among women can vary considerably in appearance. Patterns that may occur include:
- Diffuse thinning of hair over the entire scalp, often with more noticeable thinning toward the back of the scalp.
- Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp but not involving the frontal hairline.
- Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp, involving and sometimes breaching the frontal hairline.
Possible causes are many. Pattern hair loss among women can occur post-pubescent or after hormonal changes such as post-menopause or after discontinuing birth control pills. This pattern hair loss usually spares the hairline and manifests with thinning in the frontal, and mid-scalp areas Ludwig I and II. Ludwig III is the most severe pattern in which the thinning on the top is most severe and it also thins in the back or occipital area. Fortunately, the Ludwig III is rare occurring in only one in seven patients.
The treatment of Female Pattern Hair Loss is both medical and surgical. The medical treatment includes Spironolactone, and Rogaine. The Spironolactone has weak anti-androgen action hence it needs to be used at higher dosages and for a prolonged time. The dosage should be 100-200 mg per day.
Caution needs to be employed that if the woman is fertile birth control needs to be used because of the potential feminization of male fetus. Also the monitoring of the serum potassium (K+) needs to done monthly since Spironolactone is a K + sparing diuretic. Rogaine 5% should be used twice per day for the first 6 months then once per day. This regimen ensures a more rapid response and it is much easier to be compliant with a once per day regimen. The use of 5% Rogaine carries a greater risk of the growth of facial hair.
The best results are obtained with the surgical treatment in the appropriate patients, which employs the use of ultra-refined follicular unit transplantation. The follicular unit transplantation (FUT) can be used to maximize the density in strategic areas to facilitate hair styling options. The FUT can also restore the hairline in those women with male pattern recessions.