Clinical Characteristics of Female Patterned Hair Loss in Patients Attending Hair Clinic in Thailand

Objective: To study the clinical features and associated factors of female pattern hair loss (FPHL) in premenopausal and menopausal women patients. Materials and Methods: This is a retrospective chart review of FPHL patients visited hair clinic, Siriraj Hospital from June 2012 to May 2015. Demographic data, family history and history of hair loss were evaluated. Factors associated with FPHL were analysed. Results: There were 267 patients (180 premenopausal women and 87 menopausal women) in this study. The mean age of onset of patients was 35.5±12 years (premenopausal FPHL) and 60.5±7 years (menopausal FPHL). Positive family history of androgenetic alopecia (AGA) was 48.3%, mainly in first-degree relatives. The data showed an increased incidence of FPHL with advancing age. The most common presentation is Ludwig grade I. The study showed that patients also have dyslipidemia (16.9%), hypertension (16.5%), diabetes mellitus (10.9%), hypothyroidism (4.9%), anemia (3.7%), and hyperthyroidism (2.9%). In multivariate analysis, significant associations were found between low ferritin level < 70 µg/L and premenopausal FPHL (OR 5.51, 95% CI 2.26-15.14, P = 0.01). Conclusion: Maternal family history of AGA seems to have a greater influence on premenopausal FPHL. Low serum ferritin levels < 70 µg/L were significantly associated with FPHL in premenopausal women.

Female pattern hair loss among Saudi women and hematological changes associated with it - case controlled study

<p class="abstract"><strong>Background:</strong> Female pattern hair loss is a problematic condition. The availability of a rapid indicator is crucial. The current study compared female pattern hair loss patients with healthy controls regarding hematological parameters and vitamin D levels.</p><p class="abstract"><strong>Methods:</strong> We included 78 females with female pattern hair loss and 50 healthy subjects in the control group. We collected a detailed medical history and performed a systematic clinical examination. Blood samples were collected including complete blood count, serum ferritin, and vitamin D.<strong></strong></p><p class="abstract"><strong>Results:</strong> A significant increase in positive family history and acne among the study than the control group. Most patients had mild disease (55.1%). Female pattern hair loss was significantly associated with a reduction in red blood cell count, hemoglobin, hematocrit, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration, red cell distribution width, serum ferritin and serum vitamin D. Among the patient’s group, the disease severity was positively correlated with disease duration and patient age. The correlation with duration was moderate (r=0.366). The disease duration was positively correlated with body mass index and negatively correlated with red blood cell count, hemoglobin concentration, hematocrit, red cell indices, ferritin and vitamin D. Disease duration was also inversely correlated with vitamin D levels.</p><p class="abstract"><strong>Conclusions:</strong> Family history, body mass index, acne, hirsutism and irregular period were high among Saudi women. The disease was moderately severe. FPHL was associated with a significant reduction in hematological parameters and lower serum ferritin that indicated iron deficiency could play a crucial role in the development or progression of the disease. As a preventable etiology, restoring iron stores may provide at least an adjunct therapeutic option.</p>

Clinicopathological, trichoscopic and biochemical parameters in females with patterned hair loss

<p class="abstract"><strong>Background:</strong> Hair has no vital functions in humans but its loss from the scalp can create a sense of negative body image and anxiety. The term ‘female pattern hair loss’ is explained by decrease in hair fiber production and their eventual miniaturization. To evaluate the clinicopathological, trichoscopic and biochemical parameters in females with patterned hair loss.</p><p class="abstract"><strong>Methods: </strong>37 females in age group of 18-45 years complaining of reduction in hair volume with diffuse thinning over the crown were included in our study after applying inclusion and exclusion criteria. Detailed history was taken and clinical examination was done. Written consent and ethical clearance from Institutional Ethical Committee was taken. Ludwig grading, evaluation of other clinical signs of hyperandrogenism and trichoscopy was done. These females then underwent histopathological examination. 10 ml blood was withdrawn to assess anemic, thyroid and hormonal profile in these females.</p><p class="abstract"><strong>Results: </strong>Out of 37 females examined majority of the females had Ludwig grade 1 hair loss. Serum levels of testosterone were found significantly related to clinical signs of hyperandrogenism. Hair diameter variability and peri pilar sign formed the majority in trichoscopy (62.2% each). The most common histopathological finding was perifollicular infiltrate (70.3%).</p><p class="abstract"><strong>Conclusions:</strong> FPHL can contribute to severe psychological distress. Despite its high prevalence, its diagnosis and treatment still impose several difficulties in clinical practice. Although hormonal factors are believed to contribute, its pathogenesis still remains elusive.</p>

Is Every Patient of Hair Loss a Candidate for Hair Transplant?—Deciding Surgical Candidacy in Pattern Hair Loss

Patterned hair loss which includes both male pattern hair loss (MPHL) or androgenic alopecia (AGA) and female pattern hair loss (FPHL) is the most common indication for hair transplant surgery. However, not all such patients are candidates for hair transplants. There are eight conditions that cause patients to not be appropriate candidates. These are: diffuse unpatterned alopecia (DUPA), cicatricial alopecia (CA), patients with unstable hair loss, patients with insufficient hair loss, very young patients, patients with unrealistic expectations, patients with psychologic disorders such as body dysmorphic disorder (BDD) and trichotillomania, and patients who are medically unfit. In addition, there are patients who are poor candidates and who should undergo hair transplantation only if they understand and accept limited results. The key to identifying these patients involves performing careful and detailed history and examination at the time of consultation.

Trichoscopy for the Hair Transplant Surgeon—Assessing for Mimickers of Androgenetic Alopecia and Preoperative Evaluation of Donor Site Area

Preoperative diagnostic confidence and donor site assessment are important for all hair transplant surgery patients. While the majority of patients seek hair transplantation for male or female pattern hair loss (androgenetic alopecia [AGA]), there are mimickers that must be differentiated from patterned hair loss, as they alter the candidacy of the patient for transplantation. They are termed mimickers as they also can present with patterned hair loss. The use of trichoscopy has become increasingly popular for such use. Patterned hair loss mimickers, which include the underappreciated alopecia areata incognita (AAI) and fibrosing alopecia in patterned distribution (FAPD), can be identified clinically with key trichoscopic findings such as yellow dots and peripilar casts, respectively, that correlate with their histologic diagnosis. Donor hair density and putative hair pathology of the safe donor area can also by assessed via trichoscopy. This article discusses the use of trichoscopy, particularly for diagnosing mimickers of patterned hair loss as well as preoperative donor site assessment.