LS2 MANAGEMENT OF DIFFUSE HAIR LOSS IN WOMEN.

D. Hugh Rushton, School of Pharmacy, University of Portsmouth, Portsmouth, Hants, UK.

Diffuse hair loss in women is neither serious nor life threatening in the vast majority of cases, however it does cause a great deal of distress, which can adversely affect an individual’s quality of life.

Diagnosing hair problems often causes difficulties, exacerbated by different initiating signals producing the same physiological response. This can result in lack of understanding, with patients often being dismissed and made to feel guilty for wasting the physician’s time. This highlights the difficulties involved in unravelling and monitoring hair loss in women.

While three fundamental variables (hair density, diameter, and % anagen) can assess hair quality in terms of a physical change, widening of the hair parting is usually the first sign of diffuse thinning as the number of hairs per cm² declines. For many the onset is insipid but some women become aware of seeing more scalp after an episode of increased hair shedding. Matters are further complicated as grey begins to appear, which may give the impression of a wider parting.

Where hair density remains unaffected, a change in hair volume can occur as a result of persistent increased hair shedding (chronic telogen effluvium; CTE). CTE results in hair being shed diffusely over the entire scalp reducing the overall amount of hair present. In some women however, it can also affect the frontal area similar to hair loss seen after childbirth. Often the termed ‘diffuse hair loss’ is applied to CTE when perhaps it should be reserved for conditions where a reduction in hair density occurs. The associated temporal changes are often mistakenly viewed as a sign of androgenetic alopecia. As 72% of women with androgenetic alopecia also exhibit CTE, there can be confusion in diagnosis.

These issues will be addressed to provide the clinician with guidelines for diagnosis following which, appropriate therapy can be considered.