Female pattern hair loss (FPHL) is characterized by a decrease in hair density in the central scalp and temporal region due to miniaturization of hair follicles. Nearly 50% of women experience hair loss and prevalence increases with age and menopause. FPHL is diagnosed through examination of hair and scalp, histopathology, and trichoscopy. Treatment includes minoxidil to promote hair growth and laser therapy to stimulate follicles, while cosmetic options provide camouflage. FPHL presents a challenge without cure and therapeutic success relies on early identification, treatment adherence, and addressing psychological impacts on self-esteem.

1. Update on Female Pattern
Hair Loss:
Advances in Diagnosis and Treatment
Antonella Tosti, MD;
Lakshi M. Aldrege, MSN, ANP-BC;
Amy J. McMichael, MD
Reported by: Rhona Justine A. Chagas

2. What is Female Pattern Hair Loss (FPHL)?
• Characterized by a
decrease in hair density in
the region of the central
scalp and the temporal
region due to a
progressive decrease in
the ratio of terminal hairs
to vellus hairs in a process
termed miniaturization of
the hair follicle.

3. Epidemiology of Female Pattern Hair Loss (FPHL)
• Nearly 50% of women will experience hair loss at
some time in their lifetime.
• Female pattern hair loss increases with advancing age
and is more prevalent following menopause
• Studies from several different countries reported a
prevalence in the range of 1% to 12% between ages
20 to 29 years, and from 12% to 56% in women older
than age 70 years.

4. DIAGNOSIS
• Examination of the hair and scalp to investigate the
distribution of hair loss and the quality of remaining hair
in the areas involved
• Histopathology and assessment of hair counts in a 4-
mm punch biopsy.

5. • Trichoscopy
Noninvasive Diagnostic
tool
-It provides a magnified
view of the scalp and hair
shafts.
-One sign indicative of
FPHL is a more than 20%
variation in the
diameter of the hair
shaft

6. 3 Main Characteristic Patterns of FPHL
• Ludwig
Diffuse thinning and widening of central part of
the scalp
• Christmas tree
Frontal accentuation of hair loss
• Hamilton
Frontotemporal recession of hairline

8. Common Types of Hair Loss in Women
TYPE CLINICAL DESCRIPTION CAUSES
ALOPECIA
AREATA (AA)
Non-scarring; no signs of erythema
or skin inflammation; occurs in
patches; acute onset
Uncertain etiology;
possible autoimmune
origin
CHRONIC
TELOGEN
EFFLUVIUM
(CTE)
Non-scarring; early shedding of
hair; not associated with thinning
hair
Idiopathic and
multifactorial; typically no
specific trigger
FEMALE
PATTERN HAIR
LOSS (FPHL)
Progressive and gradual hair loss
in characteristic patterns; non-
scarring
Some hormonal causes;
role of genetics is unclear;
possibly polygenic

9. Common Types of Hair Loss in Women (cont)
TYPES CLINICAL DESCRIPTION CAUSES
FRONTAL
FIBROSING
ALOPECIA (FFA)
Scarring form of hair loss:
characterized by hairline recession;
associated with decrease/loss of
eyebrows; mostly in postmenopausal
women
Inflammatory; cause
unknown
TELOGEN
EFFLUVIUM (TE)
Acute, diffuse hair loss of <50%; non-
scarring; duration of approximately 3
months; transient but may precede
FPHL
Can be due to diseases,
medications, pregnancy,
dietary deficiencies,
atoimmune disorders,
emotional distress

10. Psychosocial Implications of FPHL
• Hair is associated with general beauty and appearance,
self-esteem, and social identity
• FPHL is associated with reduced quality of life.
• Women with FPHL experience:
-Negative body image
-Poorer self-esteem
-Impaired functioning at school, home, and work
-Depression
-Diminished personal relationship

11. Treatment for FPHL

12. • MINOXIDIL
-Approved by the FDA for
FPHL
2% topical solution applied
twice daily
5% foam applied once daily
-No sysytemic side effects
reported
-Local adverse effects
includes: Pruritis, facial
hypertrichosis, and dandruff

13. • LASER/LIGHT THERAPY
-Devices that use low level
laser light
– HairMax laser comb was
approved for male pattern
hair loss, and in 2011 it
was approved for FPHL
Side effects are: Scalp irritation
and erythema

14. COSMETIC OPTIONS
-Camouflage areas of
baldness
-Can be used in
combination with medical
treatments
-Options include:
Micropigmentation
Fibers
Hair extensions
Hair shaft thickeners
Wigs

15. Conclusion:
• Women with FPHL present a challenge because of the
lack of curative treatments.
• Therapeutic success can be enhanced with early
identification and treatment.
• Patients must be informed about realistic goals for
treatment and the importance of adherence to therapy for
results to be sustained. The effect of FPHL on patients’
self-esteem and psychological well-being should be taken
into consideration when developing a management plan
for this condition.