Clinical features of pattern baldness in women usually occur during early teens and late middle age. This is shown by the gradual thinning of hair over the frontal area. Usually, pattern baldness in women is not accompanied by increased shedding of hair, but unlike telogen effluvium, hair loss may be seen from the start. The scalp becomes more and more visible as the disease progresses.
Most of the time, the central part of the head widens due to diffused reduction of the hair’s density, which involves the frontal scalp and crown. Some women may experience hair loss on some small areas of the frontal scalp while others may experience the effect on the entire scalp including the areas of parietal and occipital. During hair loss, women usually retain a rim of hair along the frontal hairline.
Most women with pattern baldness have normal menstruation, normal fertility, and normal endocrine function, including correct levels of circulating androgens. Therefore, they would only need extensive hormonal testing when symptoms and signs of androgen excess become really visible. Laboratory measurement of serum total or free testosterone, dehydroepiandrosterone sulfate and prolactin are appropriate when hirsutism, severe unresponsive cystic acne, virilization, or galactorrhoea are present. Measurement of serum thyrotropin, serum iron and ferritin, and complete blood count may eliminate common causes of hair loss.
Differential Diagnosis of Androgenetic Alopecia
Androgenetic alopecia in women can be confused with the former condition. This is in spite of the fact that features of chronic telogen effluvium are distinct. Anyway, horizontal sections of a scalp biopsy help to distinguish the two conditions once the ratio of terminal hairs shrinks.
As time goes by, the hairs in pattern baldness become progressively miniaturized. These hairs include the papillae and matrices, as well as the hair shafts. However, the degree of hair loss in women is not as extreme as it is with some men. Women with pattern hair loss have a mosaic of variable-diameter hairs in the affected region of the top of the scalp. Increased spacing between hairs makes the central part appear wider over the frontal scalp compared to the occipital scalp.
In some cases, hair volume may still appear normal but the hair would stop growing to its previous length and normally results to thin distal ends. Female pattern hair loss is seen on women by visual decrease in hair density while in men, it is by baldness on the affected areas.
Treatment of Androgenetic Alopecia
Hair loss is a result of abnormal hair cycle. Because of this, it is theoretically reversible. However, the current treatment options have limits in their performance and in some cases, only small improvements in hair density can be seen. Advanced pattern baldness may already be difficult to treat because irreparable damages may have already taken place on the follicular stem cell when inflammation surrounded the bulge area of the follicle. Some systematic treatment plans for this case include:
• The current treatment for pattern baldness is Minoxidil. The exact mechanism by which Minoxidil works is not known but the treatment appears to affect the hair follicle in three ways: it increases the span of time follicles spend in anagen, it rouses follicles that are in catagen and it enlarges the actual follicles. In effect, vellus hairs enlarge and are converted to terminal hairs, and shedding is reduced.
• Exogenous estrogen can be used to treat pattern baldness, but this regimen is no longer much in use because of Minoxidil’s efficacy.
• Finasteride has been effective on men with pattern baldness but definitely it was risky on women. This regimen is not advisable for women who are still in their childbearing age because of the presence of 5a-reductase inhibitors that may cause external genitalia abnormalities in male fetuses.
• Hairstyling, teasing, coloring, permanents, and the use of hair spray are means of coping with the cosmetic effects of pattern baldness. However, when the hair loss is grave, the affected person may opt to use wigs.
• Hair transplantation is another option since it has already been accepted in treating pattern baldness on men. Now, it is also being used to treat female hair loss although only a very few women go for this type of treatment because of the cost and the possible trauma that may go with it.
• For those women who have encountered ineffective and unsuccessful treatments for hair loss, surgery may be another option and thus, the most suited method for them.
Pattern hair loss in women is made up of many factors whose traits are genetically determined. It is possible that both androgen-dependent and androgen-independent mechanisms contribute to this strange form of hair loss. In women, it is usually patterned with the most marked thinning over the frontal and parietal scalp, and with greater density over the occipital scalp. Unusual hair loss in women may frustrate self-esteem, psychological well being, and body image. Because of this, it is quite vital for the physician to inform their affected patients that hair loss could bring about adverse effects on the quality of a person’s life.