Home Dr.Mahadevia Links Miscellaneous Sitemap FAQ Contact
 
 
Free online consultation
HAIR TRANSPLANT
FUE (NO STITCHES)
FUT (Strip Method) With Stitches
FUT OR FUE
What to Chose?
BEFORE TRANSPLANT
RECOVERY
SIDE EFFECTS
COST
img AM I THE RIGHT CANDIDATE FOR TRANSPLANT?
ARTICLES AND DAILY HAIR LOSS TIPS
 
Female and Hair Loss
 

Hair loss in females has significant differences compared to that in the males.
Hair Loss in women can be Localized or Generalized Hair Loss:
Localized (patchy) Hair Loss (Alopecia)

Localized hair loss:

Localized hair loss in women may scarring and non-scarring types.
Alopecia areata is recognized by the sudden appearance of discrete, round patches that are completely devoid of hair. Occasionally, the entire scalp may be involved (alopecia totalis) and even the entire body hair including the eyebrows and eyelashes (alopecia universalis). When localized, the lesions respond well to injections of cortisone. Generalized alopecia is more difficult to treat. The prognosis is better the older the age of onset. Alopecia areata can occasionally be associated with other conditions such as thyroid disease
Hairstyles that exert constant pull on the hair, such as Dread lock; . “corn rows” or tightly woven braids produce a characteristic pattern called “Traction Alopecia”

Trichotillomania where the person twists, tugs or pulls out her hair. This can be scalp hair, eyebrows or eyelashes.
Face-lift and brow-lift procedures

Tinea Capitis is a fungal infection of the scalp.

Pseudopalade is a non-specific scarring alopecia

Lichen Plano-pilaris  is an inflammatory condition of the scalp

Discoid Lupus Erythematosus (DLE) a potentially serious autoimmune disease.

Triangular Alopecia

  Loose anagen syndrome
Diffuse Hair Loss (Alopecia):

1.  Female Patterned Hair Loss (FPHL)

Females rarely have as sever hair loss as that of males. Young women have much higher levels of cytochrome p-450 aromatase in frontal follicles than men have. Man has minimal aromatase, and women have even higher aromatase levels in occipital follicles. The diagnosis of AGA in women is supported by Family history, early age of onset, the pattern of increased thinning over the frontal/parietal scalp (Christmas Tree pattern) with greater density over the occipital scalp, retention of the frontal hairline, and the presence of miniaturized hairs. Most women with AGA have normal menses and pregnancies.

Females rarely have as sever hair loss as that of males. Young women have much higher levels of cytochrome p-450 aromatase in frontal follicles than men have. Man has minimal aromatase, and women have even higher aromatase levels in occipital follicles. The diagnosis of AGA in women is supported by Family history, early age of onset, the pattern of increased thinning over the frontal/parietal scalp (Christmas Tree pattern) with greater density over the occipital scalp, retention of the frontal hairline, and the presence of miniaturized hairs. Most women with AGA have normal menses and pregnancies.

 
  • Type I (mild)
  • Type II (moderate)
  • Type III (extensive)
 

2. CTE (Chronic Telogen Effluvium),  
Women’s hair seems to be particularly sensitive to underlying medical conditions. Since “systemic” problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed hair loss, be properly evaluated.

Medical conditions that can cause diffuse hair loss in women:

  • Obstetric and gynecologic conditions such as post-partum and post-menopausal states or ovarian tumors
  • Iron deficiency- rather than Anemia
  • Thyroid disease ( both Hyper and Hypo Thyroid State
    During pregnancy and in early phase of OC pills/ HRT usage female can have good growth of hairs due to higher estrogen levels; during post partum and lactation phase, OC pills/HRT withdrawal and menopause there is increase loss of hair due to low estrogen levels). Higher free testosterone (PCOD)  Androgens (CAH, Adrenocortical Tumours, Androgen Secereting tumours of Ovaries) , Progesterone (some OC pills) , Corticosteroids(cushing’s syndrome/ stress )  and Prolactine ( Hyperprolactenemia) can also cause hair loss.
  • Connective tissue diseases such as Lupus
  • Nutritional – crash diets, bulimia, protein/calorie deficiency, essential fatty acid or zinc deficiency, malabsorbtion, hypervitaminosis A
  • Stress – surgical procedures, general anesthesia, and severe emotional problems

A relatively large number of drugs can cause “telogen effluvium,” a condition where hair is shifted into a resting stage and then several months later shed. Fortunately, this shedding is reversible if the medication is stopped, but the reaction can be confused with genetic female hair loss if not properly diagnosed.

  Drugs that can cause diffuse hair loss in women:

  Cardiology:
  • 1. Blood thinners (anti-coagulants), such as warfarin and heparin
  • 2. Blood pressure medication, particularly the b-blockers (such as Inderal) or diuretics
  • 3. cholesterol Lowering Medications
  Neurological:
  • Antidepressents: drugs – lithium, tri-cyclics, Elavil, Prozac
  • Antoconvulsants: , most commonly dilantin
  Endocrinology:
  • Thyroid medications: for Hypo and Hyper thyroidism
  • Oral contraceptive agents, particularly those high in progestins
  Orthopedics:
  • Medication for gout, colchicines and alopurinol (Xyloprim)
  • Anti-inflammatory drugs such as prednisone, Indomethacine, Ibugesic etc
  Oncology:
  • Chemotherapy
  Others

Misc. – diet pills, high doses of Vitamin A, street drugs (cocaine)
Chronic TE affects women age 30-60. It starts abruptly with or without an initiating factor. In CTE, women in the fourth to sixth decade, with above average hair density, describe sudden onset of marked shedding from the entire scalp. Excess hair fall, diffuse hair loss with < 10% miniaturization, pull test positive for bulbed hair, reduced Anagen / Telogen ratio on trichogram/ trichoscan or Biopsy. Post pregnancy and postmenopausal effluvium is common. Hair pull test may extract increased numbers of telogen hairs easily, yet scalp hair density appears normal or minimally decreased even though the shedding may be prolonged. Miniaturized hairs are not seen. Horizontal sections of a scalp biopsy distinguish CTE from AGA: the ratio of terminal hairs to miniaturized hairs in CTE is 9: 1, in AGA is 2: 1, and in a normal scalp is 7: 1.
Others causes of CTE needs special investigations: insulin resistant diabetes, obesity Exclusion of Adrenal or Ovarian androgen secreting tumor (increased 17 DHEAS), Cushings Syndrom (increased Cortisol), Hyperprolactenemia by pituitary tumor ( increased serum prolactin) , CAH-congenital adrenal hyperplasia, (increased 17 OHP)17-hydroxyprogesterone to rule out 21-hydroxylase deficiency (CAH).
You must have clinical and trichoscopic examination and following tests to rule out common causes of effluvium (CTE) such as Thyroid problem, Low Iron, or POCS (Poly cystic ovarian Syndrome- symptoms and signs of androgen excess are present such as hirsutism, severe unresponsive cystic acne, virilization, or galactorrhea) or use of contraceptive pills.
1. T3, T4, TSH
2. Free  Serum Testosterone, LH/FSH ratio
3. Serum Prolactin
4. Serum Ferritin
5. trans vaginal sonography to rule out polycystic ovaries

  3. ATE (Acute Telogen Effluvium),

A reversible type of female hair loss is seen with stress, pregnancy, drug reactions and a variety of other conditions. Telogen effluvium generally occurs 2-3 months after a stressful event and affects 35-50% of one’s hair. Over 300 club hairs (telogen hairs that have rounded ends) can be shed per day shed

Besides densitometry, two other common diagnostic tests that can be performed in the physician’s office are the hair-pull and hair pluck. In the hair pull, the physician grabs on to 20-30 hairs with his fingers and gently pulls on them. If five or more come out in the pull then this is suggestive of the increased shedding associated with telogen effluvium

In the hair pluck, 20 to 30 hairs are forcibly plucked from the scalp with a small clamp. The hair bulbs are then examined under a microscope to determine the ratio of anagen (growing) hairs to telogen (resting) hairs. Normally, at least 80% of the follicles should be in the anagen stage. A lower ratio would suggest telogen effluvium. With the hair pluck, various abnormalities of the hair shaft may be observed that can contribute to hair breakage and poor growth.

Laboratory Evaluation for Androgen Excess

Occasionally, when a woman presents with female pattern hair loss, increased androgen production may be a contributing factor. The following signs and symptoms suggest that specific blood tests might be appropriate to rule out

  • 1. Irregular periods – for an extended period of time
  • 2. Cystic acne – severe acne which usually leaves scars
  • 3. Hirsuitism – increased body hair that doesn’t normally run in your family
  • 4. Virilization – appearance of secondary male sex characteristics such as a deepened voice
  • 5. Infertility – inability to become pregnant
  • 6. Galactorrahea – breast secretions when not pregnant (this is due to prolactin which is not actually an androgen)
  4. DUPA ( Diffuse Unpatterned Allopecia)
  5. Anagen Effluvium

Anagen effluvium occurs when hair is shed in its growing phase and is characterized by large numbers of tapered or broken hairs (>80%). It can be caused by chemotherapy or radiation and can result in extensive hair loss in women. Chemotherapy causes a diffuse type of hair loss called “anagen effluvium” that can be very extensive, but often reversible when the medication is stopped. C.f. Loose Anagen Syndrome.

  6. Hereditary Shaft Disease,

A rare condition where; the hairs since childhood or birth are in poor quantity and quality. They may not grow in length and are thin and less in number all over the scalp. Usually there is no medical answer. Concealer, Wig are the usual answer.

Medications and therapies:
  • 1. Minoxidil 2 to 5% local application
  • 2. Use of 2% Nizoral shampoo thrice a week
  • 3. Vitamins, Minerals, Nutrient, Iron pills as required
  • 4. Low level Laser therapy (although of unproven value as now)
  • 5. Estrogen Cream is often beneficial in Female Pattern Loss - to be applied on scalp 2-3 times a week.

This will help to prevent further loss and will help thicken the existing thin hairs.  The medications do not re grow the lost hairs.
Finasteride, Hormone Pills Aldectone etc. are prescribed by some practitioners but are of inadequate value and can have may possible serious side effects so are best avoided.

Finasteride is a competitive inhibitor of type II 5alpha-reductase, and is contraindicated in women who are or may become pregnant, because 5alpha-reductase inhibitors may cause abnormalities of the external genitalia of a male fetus. Finasteride was not effective in postmenopausal women in a placebo-controlled study

Cosmetics:

Use of Cosmetic Concealer like Toppik is useful to make the hair look thicker or gives a temporary cosmetic benefit.

Hair Transplant:

Transplant may be useful in Pattern hair loss and not for CTE; therefore the accurate diagnosis is essential because the transplant in CTE will do more damage to your hairs then any help.

Females have usually less dense donor site at the back and side of the head unlike the males and the Post transplant Effluvium is more common in Females than in male.

Wig / Hair piece/ Hair Extension etc.

For more details you may refer to this link at my blog

Go to Top
 
                 
®goodbyehairloss.com All Rights Reserved.