Hair loss is a universal problem in all men and women. Though it is not life threatening condition, most women finds it worrisome and leads to stress and emotional disturbance that can adversely affect the quality of life.
Several conditions contributes to hair loss in women that may include stress, metabolic conditions, drug intake, environmental conditions, mechanical trauma, hair disorders and genetic factors. The most common cause that accounts for almost 90% of hair loss in women are due to disturbance in hair growth cycle (Acute or Chronic Telogen effluvium ) and due to disorder of hair follicle (female androgenetic alopecia or female pattern baldness) . While both conditions are treatable, several months of therapy may be required for effective results.
Acute or Chronic Telogen effluvium: It may occur at any age but is not common in childhood. It may be characterized by persistent shedding of hair that runs a fluctuating course over several months or years. It result from shift of large number of anagen (Growth phase) hair into telogen or resting phase, which will usually shed off 3 months after the shift.
This may be due to several underlying triggering factors. Most common factors are listed below:
- History physical or emotional stress
- Sustained high fever
- Low protein diet
- Chronic iron deficiency
- Heavy metals such as arsenic or selenium
- Systemic diseases
- Inflammatory scalp disease (eg. seborrheic dermatitis, erythroderma)
- Severe infection
- Drug (Anticoagulants, retinoids, beta- blockers, cholesterol lowering drugs)
Post partum telogen effluvium: It occurs due to hormonal changes which causes sudden shift of hair cycle from anagen phage to telogen phage. This condition usually subsides after 4-6 months with regrowth of hair spontaneously.
Acute cases of Telogen effluvium is usually self-limiting and resolves with in few months of avoiding or treating the triggering factors. Although in case of chronic telogen effluvium, complete recovery may not be possible but good cosmetic outcome can be achieved with proper treatment. The most important factor in treatment in to find out the contributing factor and treat accordingly. In case of low protein or iron deficiency adequate protein intake and iron supplements should be taken. Surgical treatment like hair transplant is not effective in case of telogen effluvium.
Female Pattern Baldness: Female pattern baldness is a genetically mediated biological process determined by sensitivity to androgens. It results in gradual and progressive thinning, depigmentation and decrease in volume of hair which permits the scalp to be seen. It usually presents as diffuse thinning of hair on the crown. Unlike male pattern hair loss, women pattern hair loss never reaches to complete baldness.
Female pattern baldness is a multifactorial condition which may be due to aging, changes in level of hormones and family history of male or female pattern baldness.
Although several treatment options have been tried for female pattern hair loss, 2%-5% Minoxidil is the only drug approved by FDA for treatment of female pattern hair loss. Other options that have been considered are:
- Oral anti-androgens (cyproterone acetate, spironolactone)
- Topical 17?-estradiol
- Hair transplant surgery
Treatment with either of the medications or procedure is expensive because you must continue the medication for at-least 6 months to see the effectiveness and hair transplant is expensive. Hair loss may start again after you stop using the medication. If you are comfortable with the hair loss you can use some cheap measure to deal with it like change hair styles, use hair wigs or any other visual deception methods.
1.Fitzpatrick’s Dermatology in General Medicine
2.Rook’s textbook of dermatology