One important class of female hair loss, is the male pattern hair loss or androgenetic alopecia. This type is inherited and the causes are polygenic. Unlike with men, the genes that are responsible for this type of female hair loss are inherited as an autosomal or X-linked recessive trait. For this reason, female hair loss of this type is less frequent, as its occurrence requires the existence in both parents.
The clinical picture of this form of female hair loss is different than in men, as it is diffuse and rarely leads to baldness. Usually there is a predisposition, but it manifests itself only during menopause. The Ludwig scale ranks male pattern hair loss in women in stages, depending on its severity. One discerning feature is that in female hair loss, the frontal hairline is maintained and thinning occurs mainly at the crown of the head.
Lichen planus is the most common form of cicatricial hair loss in women. It is an autoimmune disease that affects the skin, the hair and the mucous membranes. It causes cicatricial alopecia which appears as smooth shiny patches, with hyperkeratosis around the opening of the follicle. Female hair loss of this type has a very poor aesthetic clinical picture, as there are scars, the hair is doll-like, and it is irreversible. It is treated with hydroxychloroquine, minoxidil and corticosteroids.
Hair loss in women due to discoid lupus is the second most common autoimmune form of cicatricial alopecia. It is caused by a disease called lupus erythematosus, which among others affects the skin and the scalp. Erythematous inflammatory patches, leaving atrophic scars with hair loss, are the main feature of this type of female hair loss. The diagnosis is made by biopsy and immunofluorescence, and the treatment of lupus that induced hair loss in women is done with steroids and immunosuppressants.
Alopecia areata is a common autoimmune cause for both male and female hair loss. It can be distinguished into monolocalularis (in one spot), multilocularis (in more spots), circumscribed, diffuse, ophiasis, total and universal. Often other autoimmune diseases coexist, such as thyroiditis. The diagnosis of this form is performed clinically or through biopsy.
Female hair loss has significant psychological effects, which in turn aggravate the problem. Treatment consists of topical application of corticosteroids, steroid infiltrations, minoxidil, calcineurin inhibitors, local sensitizing substances and PUVA.
Female hair loss of fungal aetiology is due to dermatophytes and various types of trichophyton. It is diagnosed by cultivation and treated with antifungals. Female hair loss due to microbial infections occurs in the form of folliculitis in the scalp. The little pustules may discharge pus and the region is led to scarring and hair loss. This does not occur only in women, but also in men and children and is treated with antibiotics.