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SUMMARY
Female pattern hair loss (FPHL) is the most common form of non-scarring alopecia in women, characterized by diffuse hair thinning over the central scalp.
FAGA is a slowly progressive disease.
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TIPS FOR DIAGNOSIS
The diagnosis of FPHL is usually made clinically, but blood examination is important to assess any associated diseases and trichoscopy is useful to follow up with the patient.
Trichoscopy shows the typical hair miniaturization.
A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecia with hair loss in the distribution of FPHL or alopecia areata are suspected.
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DON’T FORGET
The sex hormonal milieu is the main pathogenetic mechanism studied in FPHL.
The role of androgens is not clearly defined and only one-third of women with FPHL show abnormal androgen levels.
Several data suggest that chronic inflammation in the scalp may promote hair loss.
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PITFALLS AND CAUTIONS
The onset may be at any age following puberty and the frequency increases with age.
Clinically, it presents with diffuse hair thinning over the central scalp, while the frontal hairline is usually retained.
FPHL can have a significant psychological impact, leading to anxiety and depression.
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EXPERT PEARLS
FPHL is a common cause of non-scarring alopecia in women.
Endocrinological diseases with hyperandrogenism associated with FPHL comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia, and, rarely, ovarian and adrenal tumors.
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PATIENT EDUCATION POINTS
Early diagnosis is very important to stop the progression of the disease.
If untreated, it leads to a slowly progressive hair thinning of the scalp, though not to complete baldness, as happens in males.
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Female pattern hair loss (FPHL) is a common cause of non-scarring alopecia in women.1 Clinically it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. It is typified by a progressive follicular miniaturization and an increased telogen phase. Several studies have reported a reduced quality of life in women with FPHL. Indeed, it can have a significant psychological impact, leading to anxiety and depression.2 Androgenetic alopecia (AGA) is used to refer to this form of hair loss both in men and women, where “andro” signifies a hormonal etiology and “genetic” refers to the hereditary contribution.3,4
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The onset may be at any age following puberty and the frequency increases with age.5,6 Although the real prevalence of FPHL is difficult to determine due to the lack of universally accepted criteria for the diagnosis, it is generally agreed that the frequency of FPHL varies among different population groups. In Caucasian women, ...