Understanding Hair loss in Women
There are many myths about hair loss In women especially in our population- Just an example- After child birth when a child starts recognizing her mother, the mother begins to lose her hair. This is not true but matter of fact is that this is the stage when the mother who has delivered a baby runs short of nutritional reserves and that leads to sudden loss of hair, which we commonly see in our practice. They not only lose a few shafts but big chunks and not unusually we see the patients bringing bags full of hair.
The above mentioned entity is quite common and is known as Telogen Effluvium (TE). This condition follows any mild to moderate traumatic insult to our body. By trauma I mean anything ranging from stress, infections, nutritional depletion, any surgeries in the recent past or any medications a patient has been recently put on. This type of hair loss needs thorough scalp examination, few blood tests like Iron studies, Zinc levels or more depending on what your treating dermatologist feels necessary. Identifying the insult is key to the treatment and replenishing the stores leads to successful treatment, however, treatment can take a few months to act. But I personally reassure all such patients that this type of hair loss is completely reversible.
Another type of hair loss which we encounter in our day to day practice is Female Pattern Hair loss.
which is not actually described by our patients as hair loss but reduced density of hair primarily in the central scalp and most pronounced near the hairline. This type of hair loss is completely different from the one mentioned previously and this type is commonly associated with hormonal dysfunction and most common of which is PCOS (Polycystic Ovarian Syndrome). There is an increased levels of serum testosterone in this condition and increased LH/FSH ratio which needs to be corrected. So the patient who has early onset, post puberty, in early 20s for example, they are much more likely to have elevated androgens or other androgen-related processes, like hirsutism and acne vulgaris.
The postmenopausal or perimenopausal women are less likely to have these problems but can happen due to reduced estrogen levels and hence increased sensitivity of hair follicles to androgens. These patients usually benefit with topical or oral minoxdil, which should be used only under strict medical supervision. With the use of low dose oral minoxidil many patients have benefitted and grown their hair back. Another treatment modality that we use in such condition is oral finasteride and dutasteride and of course not in child bearing age as these drugs can have teratogenic effects. Platelet rich plasma (PRP) has been used extensively and I call it as ‘Adjunctive treatment’, same is true with recently added exosomes and Low level Laser light therapy. Dutasteride Mesotherapy is another treatment option that we currently offer to our patients. So currently we have a menu of options that can be given and discussed with our patients and adjustments can be done. And in those cases who present very late for treatment and have lost hair to the extent of visible baldness can be taken up for hair transplant if they have required donor area for such procedure.
Going further ahead, what we frequently see in our practice is Alopecia areata. This is an autoimmune condition and in patients it can lead to Alopecia totalis which means complete loss of scalp hair, eyebrows and eyelashes or Alopecia Universalis in which there is complete loss of body hair. Fortunately, we recently got approval of certain drugs known as JAK inhibitors for this condition. These medications have proven to be game changers for this condition. However, it should always be taken after consulting your treating Dermatologist.
There is another subset of patients which we see commonly in our practice known as Scarring Alopecia like Frontal Fibrosing Alopecia, Central Cicatricial Centrifugal Alopecia and many more. In these conditions there is complete destruction of hair follicles and once destroyed they can’t be grown back with any currently known medications. These conditions should be diagnosed as early as possible and treatment started to prevent further. Once the condition is stabilized for 1 year or more patient can be taken for hair transplantation.
Besides these we have infections like Tinea Capitis/ fungal infection which is usually seen in paediatric population and should receive treatment with oral anti fungals.
The above mentioned conditions also coexist- like TE can occur in association with Female pattern hair loss and scarring alopecia can also coexist with female pattern hair loss.
We can also have Seborrheic Dermatitis associated with any of these conditions which should also be treated as persistent seborrheic dermatitis can make scalp inflamed, itchy and less amenable to treatments.
Tailpiece: Hair loss in women can have several reasons and a detailed history, clinical examination, lab work up and appropriate treatment should help the patient suffering from hair loss. There are excellent treatment options available right now and many more are in trial phases which can be exciting treatments for hair loss.
Author is working as Assistant Professor in Department of Dermatology GMC Anantnag and is Fellow American Academy of Dermatology
