The Female Pattern Hair Loss: Review of Etiopathogenesis and Diagnosis

Female pattern hair loss (FPHL) is the most common hair loss disorder in women. Initial signs may develop during teenage years leading to a progressive hair loss with a characteristic pattern distribution. The condition is characterized by progressive replacement of terminal hair follicles over the frontal and vertex regions by miniaturized follicles, that leads progressively to a visible reduction in hair density. Women diagnosed with FPHL may undergo significant impairment of quality of life. FPHL diagnosis is mostly clinical. Depending on patient history and clinical evaluation, further diagnostic testing may be useful. The purpose of the paper is to review the current knowledge about epidemiology, pathogenesis, clinical manifestations, and diagnosis of FPHL.

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Diagnosis and Management of Female Pattern Hair Loss

BioScientia Medicina ◽

10.32539/bsm.v4i1.111 ◽

2020 ◽

Vol 4 (1) ◽

pp. 29-47

Author(s):

Sarah Diba ◽

Maria Mayfinna Gozali ◽

Yuli Kurniawati

Keyword(s):

Hair Loss ◽

Clinical Manifestations ◽

Term Treatment ◽

Hair Follicles ◽

Low Level Laser Therapy ◽

Female Pattern Hair Loss ◽

Level Laser ◽

Long Term Treatment ◽

Topical Minoxidil

Abstract Female pattern hair loss (FPHL) is the most common hair loss in post-puberty female. Prevalence of this nonscarring alopecia increases with age. The etiology of FPHL is still unclear, but hormonal and genetic factors are associated with pathogenesis of FPHL. Hormonal factor in FPHL is not as strong as in male pattern hair loss (MPHL). Clinical manifestations of FPHL are characterized by nonscarring baldness with shortening anagen phases and miniaturization of hair follicles, predominantly occur at the vertex, middle, and frontal regions. Hair shedding occurs progressively. The diagnosis of FPHL is established based on clinically. Classification of FPHL is according to Ludwig's criteria. Current FDA-approved FPHL therapy is topical minoxidil 2%, hair transplantation, and low level laser therapy (LLLT). Anti-androgen therapy still needs to be investigated further. The prognosis of FPHL is poor because the progressiveness continues with age. Long term treatment required for FPHL because it is a chronic residif disease. The treatment only prevents the progression of hair loss and does not cure.

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Sulfotransferase activity in plucked hair follicles predicts response to topical minoxidil treatment in Brazilian female pattern hair loss patients

Dermatologic Therapy ◽

10.1111/dth.13195 ◽

2019 ◽

Vol 33 (1) ◽

Author(s):

Paulo Müller Ramos ◽

Rodney Sinclair ◽

Hélio Amante Miot ◽

Andy Goren

Keyword(s):

Hair Loss ◽

Hair Follicles ◽

Female Pattern Hair Loss ◽

Topical Minoxidil

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Androgen tic alopecia (AGA) -New Approach

Bangladesh Journal of Dental Research & Education ◽

10.3329/bjdre.v5i2.24719 ◽

2015 ◽

Vol 5 (2) ◽

pp. 64-65

Author(s):

Md Ahsan Shafique

Keyword(s):

Hair Follicle ◽

Ethnic Groups ◽

Hair Loss ◽

Characteristic Pattern ◽

New Approach ◽

Dental Research ◽

Men 1 ◽

Significant Impairment ◽

Pattern Distribution ◽

Research And Education

Androgen tic alopecia is a no scarring progressive miniaturization of the hair follicle with a usual characteristic pattern distribution in genetically predisposed men 1. It is the most common hair loss disorder which causes significant impairment of life 2,3. The frequency and severity of male AGA increases with age in all ethnic groups 4.Bangladesh Journal of Dental Research and Education Vol.5(2) 2015: 64-65

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Integral Roles of Specific Proteoglycans in Hair Growth and Hair Loss: Mechanisms behind the Bioactivity of Proteoglycan Replacement Therapy with Nourkrin® with Marilex® in Pattern Hair Loss and Telogen Effluvium

Dermatology Research and Practice ◽

10.1155/2020/8125081 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17

Author(s):

Jan Wadstein ◽

Erling Thom ◽

Aida Gadzhigoroeva

Keyword(s):

Replacement Therapy ◽

Hair Loss ◽

Hair Growth ◽

Relative Concentration ◽

Follicular Phase ◽

Hair Follicles ◽

Growth Disorders ◽

Female Pattern Hair Loss ◽

Functional Involvement ◽

Pathogenetic Factor

Follicular proteoglycans are key players with structural, functional, and regulatory roles in the growth and cycling behaviour of the hair follicles. The expression pattern of specific proteoglycans is strongly correlated with follicular phase transitions, which further affirms their functional involvement. Research shows that bioactive proteoglycans, e.g., versican and decorin, can actively trigger follicular phase shift by their anagen-inducing, anagen-maintaining, and immunoregulatory properties. This emerging insight has led to the recognition of “dysregulated proteoglycan metabolism” as a plausible causal or mediating pathology in hair growth disorders in both men and women. In support of this, declined expression of proteoglycans has been reported in cases of anagen shortening and follicular miniaturisation. To facilitate scientific communication, we propose designating this pathology “follicular hypoglycania (FHG),” which results from an impaired ability of follicular cells to replenish and maintain a minimum relative concentration of key proteoglycans during anagen. Lasting FHG may advance to structural decay, called proteoglycan follicular atrophy (PFA). This process is suggested to be an integral pathogenetic factor in pattern hair loss (PHL) and telogen effluvium (TE). To address FHG and PFA, a proteoglycan replacement therapy (PRT) program using oral administration of a marine-derived extract (Nourkrin® with Marilex®, produced by Pharma Medico Aps, Aarhus, Denmark) containing specific proteoglycans has been developed. In clinical studies, this treatment significantly reduced hair fall, promoted hair growth, and improved quality of life in patients with male- and female-pattern hair loss. Accordingly, PRT (using Nourkrin® with Marilex®) can be recommended as an add-on treatment or monotherapy in patients with PHL and TE.

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Update on the Genetics of Androgenetic Alopecia, Female Pattern Hair Loss, and Alopecia Areata: Implications for Molecular Diagnostic Testing

Seminars in Cutaneous Medicine and Surgery ◽

10.1016/j.sder.2012.08.003 ◽

2012 ◽

Vol 31 (4) ◽

pp. 258-266 ◽

Cited By ~ 6

Author(s):

Pedram Yazdan

Keyword(s):

Hair Loss ◽

Alopecia Areata ◽

Diagnostic Testing ◽

Androgenetic Alopecia ◽

Molecular Diagnostic ◽

Molecular Diagnostic Testing ◽

Female Pattern Hair Loss

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Investigating the Safety and Efficacy of Platelet-Rich Plasma (PRP) Treatment for Female Androgenetic Alopecia: Review of the Literature

Medicina ◽

10.3390/medicina57040311 ◽

2021 ◽

Vol 57 (4) ◽

pp. 311

Author(s):

Santo Raffaele Mercuri ◽

Giovanni Paolino ◽

Matteo Riccardo Di Nicola ◽

Laura Vollono

Keyword(s):

Hair Loss ◽

Platelet Rich Plasma ◽

Androgenetic Alopecia ◽

Cochrane Central Register ◽

Review Of The Literature ◽

Psychosocial Burden ◽

Female Pattern Hair Loss ◽

Central Register ◽

Topical Minoxidil

Background: female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women, affecting approximately 40% of women by age 50, bearing a significant psychosocial burden on affected patients. Platelet-rich plasma (PRP) has been widely investigated as a potential effective treatment for several dermatological conditions, including male androgenetic alopecia (MAGA). However, few studies have been conducted focusing on the use of PRP in FAGA. The aim of this review was to identify reports that investigated the use of PRP for the treatment of FAGA. Methods: Electronic databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to September 2020 have been searched using different combinations of the following terms: “androgenetic alopecia,” “FAGA,” “female pattern hair loss,” “platelet-rich fibrin,” “platelet-rich plasma,” and “PRP”. Results and conclusions: Eight (n = 8) clinical studies consistent with our research were identified. A total of 197 subjects has been enrolled in the included studies. All of them were adult female patients (mean age: 38.9) affected by female pattern hair loss. PRP is a well-tolerated procedure which showed promising results in males-only and mixed populations of AGA patients. PRP showed to produce high levels of satisfaction and improvement in the quality of life in patients affected by FAGA. In the light of this evidence, PRP may be proposed in patients who did not respond or did not tolerate topical minoxidil, as well as in combination with topical and oral treatments.

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16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome

Lupus ◽

10.1177/09612033211020361 ◽

2021 ◽

pp. 096120332110203

Author(s):

Savino Sciascia ◽

Massimo Radin ◽

Irene Cecchi ◽

Roger A Levy ◽

Doruk Erkan

Keyword(s):

Risk Stratification ◽

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Task Force ◽

Current Knowledge ◽

Clinical Manifestations ◽

International Congress ◽

Level Of Evidence ◽

Task Force Report

The objectives of the 16th International Congress on Antiphospholipid Antibodies (aPL) Task Force on Clinical Manifestations of Antiphospholipid Syndrome (APS) were to critically analyze: a) the definition of “APS”; b) the current knowledge on non-traditional manifestations associated with aPL; and c) the risk stratification strategies in aPL-positive patients. The quality of evidence was assessed by the GRADE system. The task force concluded that: a) APS does not have a uniform definition given the heterogeneity of the clinical presentations and different aPL profiles; b) current literature supports the role for aPL testing in cases of thrombocytopenia and recurrent cardiac events but are limited by vast heterogeneity, providing an overall low-to-very low level of evidence; and c) risk stratification strategies in aPL-positive patients, such as aPL-Score and Global APS Score, can be useful in clinical practice. International multicenter studies are still highly needed to improve the quality of available evidence and consequently the strength of future recommendations.

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Female Pattern Hair Loss in Female and Male: A Quantitative Trichoscopic Analysis in Chinese Han Patients

Frontiers in Medicine ◽

10.3389/fmed.2021.649392 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xi Chen ◽

Xiangqian Li ◽

Baifu Chen ◽

Yue Yin ◽

Jianzhong Zhang ◽

...

Keyword(s):

Hair Follicle ◽

Hair Loss ◽

Hair Shaft ◽

Occipital Area ◽

Chinese Han ◽

Hair Density ◽

Single Hair ◽

Shaft Diameter ◽

Female Pattern Hair Loss ◽

Normal Controls

Objectives: To investigate the trichoscopic features of female pattern hair loss (FPHL) in Chinese Han patients and analyze the difference between male and female patients with FPHL.Materials and Methods: Trichoscopic images were taken in four different scalp areas, including right frontal hairline, vertex, right parietal and occipital areas. Hair density, hair shaft diameter, vellus hair ratio and single hair follicle unit ratio were counted manually and analyzed.Results: Seventy-three subjects were enrolled in this study, including 38 patients with FPHL (28 females and 10 males) and 35 normal controls without hair loss. The hair density and hair shaft diameter of FPHL patients reduced in the whole scalp. Vellus hair ratio and single hair follicle unit ratio were both increased in FPHL compared to normal controls. The vertex was the most affected area and the hair shaft diameter showed the most significant difference. Parietal and occipital area were also affected in FPHL. The reduction or increase was correlated with the severity of Ludwig staging. Very few gender differences were detected in male and female FPHL patients.Conclusion: FPHL patients showed decreased hair density and hair shaft diameter, accompanied by increased vellus hair ratio and single hair follicle unit ratio. Parietal and occipital area can be also affected in FPHL, though not as severe as in vertex area. FPHL in male basically has the same characteristic as those in female patients.Limitation: The main limitation of the study is the small sample size which only enrolled 10 male FPHL patients, in comparison to the female cases. The findings could not be representative of the normal population with the limited sample size.

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Evaluation of Automated Measurement of Hair Density Using Deep Neural Networks

Sensors ◽

10.3390/s22020650 ◽

2022 ◽

Vol 22 (2) ◽

pp. 650

Author(s):

Minki Kim ◽

Sunwon Kang ◽

Byoung-Dai Lee

Keyword(s):

Deep Learning ◽

Object Detection ◽

Hair Loss ◽

Medical Image Analysis ◽

Density Measurement ◽

Hair Follicles ◽

Learning Technologies ◽

Tissue Imaging ◽

Learning Technology ◽

Hair Density

Recently, deep learning has been employed in medical image analysis for several clinical imaging methods, such as X-ray, computed tomography, magnetic resonance imaging, and pathological tissue imaging, and excellent performance has been reported. With the development of these methods, deep learning technologies have rapidly evolved in the healthcare industry related to hair loss. Hair density measurement (HDM) is a process used for detecting the severity of hair loss by counting the number of hairs present in the occipital donor region for transplantation. HDM is a typical object detection and classification problem that could benefit from deep learning. This study analyzed the accuracy of HDM by applying deep learning technology for object detection and reports the feasibility of automating HDM. The dataset for training and evaluation comprised 4492 enlarged hair scalp RGB images obtained from male hair-loss patients and the corresponding annotation data that contained the location information of the hair follicles present in the image and follicle-type information according to the number of hairs. EfficientDet, YOLOv4, and DetectoRS were used as object detection algorithms for performance comparison. The experimental results indicated that YOLOv4 had the best performance, with a mean average precision of 58.67.

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