DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20204997

Skin care physicians insight on epidemiological patterns, diagnosis and treatment modalities for female pattern hair loss

Krishna Rajesh Kilaru, Suhasini Attada, Pooja Munnangi, Manogna Chowdary Kilaru

Abstract


Background: Female pattern hair loss (FPHL) is a common cause of hair loss in women characterized by a diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. The underlying pathophysiology is multifactorial. There are no universally agreed treatment guidelines available. The objective of the study was to understand the diagnosis and treatment pattern of female pattern hair loss and the role of minoxidil topical formulation and its combination in the management of FPHL.

Methods: Predesigned questionnaire on FPHL was prepared based on review of literature and was filled by 80 consultant dermatologists. Recorded data was statistically analyzed.

Results: Common age of onset of FPHL was between 20 to 30 years. Majority (96.25%) have reported FPHL in association with psychological morbidity. The most preferred treatment in mild and severe FPHL was minoxidil 5% and platelet rich plasma (PRP) plus minoxidil respectively. Most dermatologists (47.5%) treated with minoxidil for over 6 months. Majority (27.5%) reported flaking as the most common side effect with minoxidil followed by dryness, scalp irritation and itching. Majority (27.5%) observed that long treatment duration was contributing to non-compliance followed by medication cost and side effects. Majority of the dermatologists (90%) felt the need for treatment guidelines in the current Indian scenario.

Conclusions: Minoxidil was the most common preferred treatment for mild and severe FPHL. PRP is the most common choice of combination therapy with minoxidil. Minimizing side effects, patient education and universal treatment guidelines can help manage FPHL better.  


Keywords


Female pattern hair loss, Minoxidil, PRP

Full Text:

PDF

References


Ramos PM, Miot HA. Female pattern hair loss: A clinical and pathophysiological review. A Bras Dermatol. 2015;90:529 43.

Sinclair R. Winding the clock back on female androgenetic alopecia. Br J Dermatol. 2012;166:1157 8.

Bhat YJ, Saqib N, Latif I, Hassan I. Female pattern hair loss—An update. Indian Dermatol Online J. 2020;4:493-501.

Messenger AG. Hair through the female life cycle. Br J Dermatol. 2011;165:2-6.

Futterweit W, Dunaif A, Yeh HC, Kingsley P. The prevalence of hyperandrogenism in 109 consecutive female patients with diffuse alopecia. J Am Acad Dermatol. 1988;19(5 Pt 1):831-6.

Singal A, Sonthalia S, Verma P. Female pattern hair loss. Indian J Dermatol Venereol Leprol. 2013;79:626-40.

Shrivastava SB. Diffuse hair loss in an adult female: Approach to diagnosis and management. Indian J Dermatol Venereol Leprol. 2009;75:20-8.

Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. British Journal of Dermatology. 1977;97(3):247-54.

Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. Journal of the American Academy of Dermatology. 2004;51(2):89-199.

Olsen EA. Current and novel methods for assessing the efficacy of hair growth promoters in pattern hair loss. Journal of the American Academy of Dermatology. 2003;48(2):253-62.

Wang TL, Zhou C, Shen YW. Prevalence of androgenetic alopecia in China: a community-based study in six cities. British Journal of Dermatology. 2010;162(4):843-47.

Paik JH, Yoon JB, Sim WY, Kim BS, Kim NI. The prevalence and types of androgenetic alopecia in Korean men and women. British Journal of Dermatology. 2001;145(1):95-99.

Olsen EA. Female pattern hair loss. J Am Acad Dermatol. 2002;45:S70-S80.

Tosti A, Piraccini BM. Androgenetic alopecia. In: Tosti A, Piraccini BM, editors. Diagnosis and treatment of hair disorders: An evidence-based atlas. London: Taylor and Francis.

Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. British Journal of Dermatology. 1999;141(3):398-405.

Van der Donk J, Hunfeld JAM, Passchier J, Knegt-Junk KJ, Nieboer C. Quality of life and maladjustment associated with hair loss in women with alopecia androgenetica. Social Science and Medicine. 1994;38(1):159-63.

Dinh QQ, Sinclair R. Female pattern hair loss: current treatment concepts. Clin Interv Aging. 2007;2(2):189-99.

Zhang X, Caulloo S, Zhao Y, Zhang B, Cai Z, Yang J. Female pattern hair loss: clinical-laboratory findings and trichoscopy depending on disease severity. Int J Trichology. 2012;4(1):23-28.

Sinclair R. Chronic telogen effluvium: A study of 5 patients over 7 years. J Am Acad Dermatol. 2005;52:512-6.

Siah TW, Muir-Green L, Shapiro J. Female pattern hair loss: A retrospective study in a tertiary referral center. Int J Trichol. 2016;8:57-61.

Khandpur S, Suman M, Reddy BS. Comparative efficacy of various treatment regimens for androgenetic alopecia in men. J Dermatol. 2002;29:489 98.

Hoedemaker C, van Egmond S, Sinclair R. Treatment of female pattern hair loss with a combination of spironolactone and minoxidil. Australasia J Dermatol. 2007;48:43 5.

Olsen EA, Dunlap FE, Funicella T. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002;47:377-85.

Sinclair RD. Female pattern hair loss: A pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. Int J Dermatol. 2018.

Friedman ES, Friedman PM, Cohen DE, Washenik K Allergic contact dermatitis to topical minoxidil solution: etiology and treatment. J Am Acad Dermatol. 2002;46(2):309-12.

Abd E, Benson HAE, Roberts MS, Grice JE. Minoxidil Skin Delivery from Nanoemulsion Formulations Containing Eucalyptol or Oleic Acid: Enhanced Diffusivity and Follicular Targeting. Pharmaceutics. 2018;10(1):19.

Lee PJ, Langer R, Shastri VP. Novel microemulsion enhancer formulation for simultaneous transdermal delivery of hydrophilic and hydrophobic drugs. Pharm. Res. 2003;20:264-9.