Images of Alopecia, Female Pattern
Female pattern baldness (alopecia) is a form of hair loss affecting women due to an inherited susceptibility. It is most commonly noticed after menopause, although it may begin earlier.
Female pattern baldness is due to a combination of a family history of balding (in men or women from either parent's side of the family), aging, and hormones. Female pattern baldness is not due to a vitamin deficiency, poor circulation, dandruff, or wearing hats. There is progressive shrinking of the hair follicles until they produce only a fine, wispy hair or cease functioning.
Who's at risk?
Because there is a genetic basis to female pattern baldness, different racial populations are affected at different rates. Almost half of men, and perhaps as many women who are postmenopausal, are affected by hair loss to some degree. Onset of hair loss seems most common at either 20–30 or 40–50 years of age. The incidence is highest in whites followed by Asians and blacks, and the lowest incidence of hair loss is in Native Americans.
Signs and Symptoms
The pattern of hair loss is different in women than men; the hairline is preserved while there is diffuse thinning of the hair of the crown and frontal scalp. Total hair loss is very rare.
The hair loss associated with female pattern baldness, although permanent, requires no treatment if you are comfortable with your appearance.
Hair loss can have a significant psychologic impact, particularly in western society, which puts such a large emphasis on appearance.
For mild to moderate hair thinning, creative hair styling, hair weaving, or hairpieces may be adequate to improve appearance. Protect the scalp from sunburn with a hat.
The only medication approved to treat women in the US is topical minoxidil; the 2% preparation recommended for women is available over the counter. This may help hair to grow in a quarter of the women using it, and it will stop or slow hair loss in the majority of users. The medication is expensive, however, and the hair will fall out when its use is discontinued.
There is no known prevention for hair loss; shampooing and other hair products have no adverse effects other than harsh products or practices that may damage the hair shaft, causing breakage.
When to Seek Medical Care
If you are having significant, persistent hair loss or if there is redness, itching, or skin changes associated with the hair loss, seek medical advice, as there are sometimes other causes for hair loss that can be treated.
If you have hair loss that is cosmetically concerning and other causes have been ruled out, you might consult a surgical specialist in hair replacement.
Treatments Your Physician May Prescribe
The diagnosis of female pattern baldness is usually easy for the physician because of the typical pattern. However, certain blood tests will help to rule out other causes such as anemia (low blood count) or a thyroid disorder. A skin biopsy may be recommended.
Current therapies are aimed at stimulating regrowth of terminal hairs and might include topical minoxidil, and the oral medications spironolactone or cyproterone acetate (not available in the US). Finasteride, also an oral medication, is approved for male balding only, and studies show no effect for female pattern hair loss.
Finasteride, spironolactone, and cyproterone should not be used in women of childbearing potential.
Surgical therapy to improve the appearance includes scalp reduction, flaps, and hair transplants (micrografting). Not everyone is a good candidate for these procedures.
Trusted LinksMedlinePlus: Hair Diseases and Hair Loss
Bolognia, Jean L., ed. Dermatology, pp.1047, 2430-2431. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 643-645. New York: McGraw-Hill, 2003.