Female Pattern Hair Loss-neograft hair clinic

Understanding and Treating Female Pattern Hair Loss (FPHL)

Introduction: Female pattern hair loss (FPHL) and male androgenetic alopecia (AGA) share common features but have distinct underlying causes. While the role of androgens in male hair loss is well-established, their involvement in FPHL remains less clear. Recent research suggests that nonandrogenic factors and genetic predisposition may play significant roles in FPHL development. This article aims to provide a comprehensive understanding of FPHL, including its diagnosis and characteristics, as well as explore available treatment modalities.

Diagnosis and Characteristics: Accurate diagnosis of FPHL requires a comprehensive medical history and a thorough physical examination. It is essential to differentiate FPHL from other conditions that can mimic its symptoms, such as acute and chronic telogen effluvium (TE). An in-depth evaluation of the onset and pattern of hair loss, along with consideration of potential stressors, assists in identifying the underlying cause. Physical examinations focus on identifying signs of hyperandrogenism and may include a detailed assessment of the occipital area. In FPHL, hair density reduction over the frontal scalp is diffuse, in contrast to the complete baldness typically observed in men with AGA.

Understanding FPHL: FPHL is characterized by a progressive miniaturization of hair follicles. Terminal follicles undergo a transformation into vellus-like follicles, resulting in shorter hair cycles and the production of thin and fine hair shafts. Unlike in men, women experience non-uniform and less severe miniaturization, leading to rare instances of complete baldness. In addition to the miniaturization process, FPHL may be accompanied by a mild-to-moderate lympho-histiocytic inflammatory infiltrate in the peri-infundibular region. This localized inflammation, referred to as “microinflammation,” is distinct from the inflammation observed in scarring alopecia.

Treatment Modalities:

Topical Medications: Topical treatments represent a common approach to targeting androgenic activity in FPHL. Minoxidil, an over-the-counter medication, is a vasodilator that promotes hair growth and can be effective in FPHL. It is available in different strengths and formulations. Topical antiandrogens, such as spironolactone or flutamide, may also be used to counteract the effects of androgens on hair follicles, thereby promoting hair regrowth.
Systemic Medications: For more severe or advanced cases of FPHL, systemic medications may be prescribed. Antiandrogens, including cyproterone acetate and spironolactone, can be used to reduce androgen levels or block their effects. These medications help in mitigating the influence of androgens on hair follicles. Another systemic medication, finasteride, is a 5-alpha reductase inhibitor that inhibits the conversion of testosterone to dihydrotestosterone (DHT), a potent androgen involved in hair follicle miniaturization.

Considerations and Precautions: It is important to note that certain systemic medications used to treat FPHL, especially those that are androgen-dependent, can cause abnormalities in the male fetus if taken during pregnancy. Therefore, these drugs are contraindicated for pregnant women. As a result, oral contraceptive therapy is often recommended throughout the entire treatment course for women of childbearing potential to ensure effective contraception and minimize the risk of fetal harm.

Emerging Treatment Options: In addition to the conventional treatment modalities, several emerging therapies show promise in the management of FPHL. These include:

Prostaglandin analogues: These compounds have shown potential in promoting hair growth and prolonging the anagen (growth) phase of the hair cycle,like bimatoprost/lanatoprost.
Ketoconazole: An antifungal medication that also has anti-androgenic properties, ketoconazole may help mitigate the effects of androgens on hair follicles.
Melatonin: This hormone has been investigated for its potential role in promoting hair regrowth and regulating the hair cycle.
Platelet-rich plasma (PRP) therapy: In PRP therapy, the patient’s own platelet-rich plasma is injected into the scalp to stimulate hair growth.
Microneedling: This procedure involves using tiny needles to create micro-injuries on the scalp, which can promote hair regrowth by stimulating the release of growth factors and enhancing blood circulation to the hair follicles.
Scalp Micropigmentation can be an option to hide baldness and create an head full of illusion till the time treatment takes its effect.

Combination Therapies: Combining different treatment modalities can maximize results in FPHL management. Customized treatment plans, based on individual patient characteristics and needs, should be developed in collaboration with dermatologists or healthcare professionals specializing in hair disorders. Regular follow-ups and monitoring are important to assess treatment response and make any necessary adjustments.

Conclusion: Female pattern hair loss (FPHL) presents unique challenges in understanding its etiology and devising effective treatment strategies. While androgens play a role in FPHL, other nonandrogenic factors and genetic predisposition are likely involved. Accurate diagnosis, considering potential mimicking conditions, and personalized treatment plans that encompass topical and systemic medications, along with emerging therapies, offer hope in addressing FPHL and promoting hair regrowth. Future research and advancements in understanding FPHL will likely lead to further improvements in its diagnosis and treatment options.