Female Hair Loss

Female hair loss is a major problem for women, regardless of age. Generaly talking, a woman who loses more than 150 hairs a day does suffer from female hair loss and should seek treatment.

The most common ages for the onset of female hair loss are puberty, the postpartum period, and menopause. In all three cases, the psychological stress caused by female hair loss is intense, as hair has always been a crucial element of femininity and beauty.

The causes of female hair loss vary and may be either normal or pathological. Normal hair loss is a seasonal phenomenon that occurs mainly during autumn. It is estimated that all women will experience some degree of hair loss at some stage of their lives.

Female Hair Loss

Types of alopecia in women

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.

Treatment options

Diagnosis

Diagnosis starts by taking the patient’s history, performing blood and hormonal tests, phototrichogram, or even with skin biopsy, depending on the type of hair loss. The prognosis depends on the type. Generally, the prognosis for diffuse hair loss in women of childbearing age is better than for men, as the female hormones act protectively. In case that female hair loss is due to underlying causes, the latter’s elimination leads to treatment e.g. with increased iron intake, improved diet, and avoidance of stress.

At Advanced Hair Clinics, each case of female hair loss is treated individually, starting with the correct diagnosis and resulting in the appropriate treatment that is different for everyone. Our clinic is one of the most specialised clinics in the treatment of female hair loss having extensive experience that counts thousands of cases in Greece and abroad, from Europe to the Middle East.

Medication

Minoxodil (2%), an FDA approved medication for hair loss, rejuvenates and enhances blood flow around shrunken hair follicles, leading to their increase in size, and causing their thickening. Furthermore, it extends the growth phase of hair follicles and encourages hair regrowth. Minoxidil lotion is applied once or twice per day. It stimulates the local blood flow in the region that exhibits alopecia, resulting in the growth of hair.

The main side effects are the irritation, erythema, oily hair and skin peeling, but they can be resolved once the dose is appropriately adjusted. Finasteride must be given only during menopause. It is an anti-androgen and it can be taken as follows: 1mg/day.

Hair transplant

Hair transplantation offers an optimum solution to many cases of female hair loss. It is applied for androgenetic alopecia and other types of diffuse or cicatricial hair loss.

Advanced Hair Clinics is specialised in clinical treatment of both male and female hair loss. The medical team of Advanced Hair Clinics applies FUE hair transplant method which leaves no scars, causes no pain, does not require stitches and gives a perfectly natural result.

In the majority of female hair loss restoration cases, Unshaven FUE method is applied. As the scalp is not shaved, there is no indication that the patient has undergone hair transplantation. The patient can return to her normal activities with no delay.

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RESULTS

Hair loss treatment & Hair Transplantation

WHAT IT IS

The life cycle of hair

The hair life cycle consists of the anagen, catagen and telogen phases. Female hair loss occurs when there is a rapid transition from the anagen phase to the catagen phase and then to the telogen phase.

In the scalp, 95% of the hair is in the anagen phase, which lasts several years, while the catagen and telogen phases last a few months. In some forms of female hair loss, the anagen phase lasts only a few months. A daily loss of 100-150 hairs is normal and does not constitute female pattern hair loss.

The loss of these catagen hairs occurs mainly during shampooing and combing and does not necessarily indicate female pattern hair loss. A woman should seek hair loss treatment if she loses more than 150 hairs per day.

1. Anagen phase
2. Catagen phase
3. Telogen phase

Alopecia DNA test

A total of almost 500 different DNA regions are being tested and analyzed, providing significant information regarding the underlying genetic predisposition to hair loss.

FAQs

The causes of female hair loss vary and may be either normal or pathological. Normal hair loss is a seasonal phenomenon that occurs mainly during autumn. Hair loss may also be due to hormonal reasons, such as:

Polycystic ovary syndrome that coexist with acne, overweight and menstrual disturbances
Thyroid and parathyroid diseases
Cushing’s syndrome
Hypercortisolism
Chronic medication with systemic corticosteroids
Pituitary adenomas such as prolactinoma
Hyperandrogenism, which may occur in the case of adrenal or ovarian neoplasms,
Use of oral contraceptives

Causes that lead to diffuse, i.e. the shedding and thinning of the hairs that is evenly distributed over the entire scalp, are:

Poor diet, thus diet low in iron, proteins, minerals, vitamins and trace elements
Iron deficiency anaemia (a very common cause of female hair loss that occurs during the reproductive age of women, usually with menometrorrhagia or during pregnancy)
Stress (one of the most common causes of female hair loss)
Excessive use of chemicals and hair styling products
String pulling and rearward combing (e.g. ponytail) undoubtedly lead to female hair loss.
Frequent hair straightening and salon styling lead to hair loss from traction.
Exposure to the sun without hat or suitable protection damages the scalp; the skin becomes thinner and the resulting immunosuppression causes the hair follicles to degenerate, intensifying all forms of female hair loss.

Telogen hair loss in women is due to factors that cause the hairs to pass quickly into the telogen phase. Such factors may be:

endocrine or metabolic diseases
malnutrition
childbirth
heavy surgery
chronic disease
cancer
certain drugs
heavy metals
harmful environmental factors

The most common causes of patchy female hair loss, i.e. localised and not diffused, are:

alopecia areata
fungal infections
injuries
skin carcinomas
folliculitis
skin infections
lichen planus
cutaneous lupus erythematosus