O#16   Treatment of female hair loss

Maria Hordinsky. Dept of Dermatology, University of Minnesota Academic Health Center, Minneapolis, Minnesota, USA.

Only until recently were the patterns of female hair loss believed to represent either 1) a pattern similar to male pattern baldness or 2) a progressive loss of hair density and widening of the part width with preservation of the frontal hair line. In both cases, androgens were implicated. Unfortunately, the presentation of female pattern loss is not that straightforward as most women do not have any signs or symptoms of hyperandrogenemia. It has recently been suggested female pattern hair loss be classified into one of the following categories: (1) Female pattern hair loss with or without androgen excess and (2) Late onset/postmenopausal with or without androgen excess. For those women with documented androgen excess, improvement in hair density may occur once the source of androgen excess is found and addressed. These women can also be treated with combination therapy involving anti-androgens and topical minoxidil solution. For those women who do not have easily defined androgen excess, the application of minoxidil solution may be effective. Two and five per cent minoxidil solution is now approved in 79 and 30 countries respectively for the treatment of women with female pattern hair loss. Topical minoxidil solution is viewed by many as being a biologic response modifier and a product which can support anagen differentiation. Therefore, it has been found to be effective clinically not only in the management of female pattern hair loss but also other hair disorders where the hair follicle may be producing a thinner, finer fiber, one that the patient perceives as abnormal. Side effects of applying topical minoxidil solution include initial exacerbation of hair loss, pruritus, scale, dryness, skin irritation, and hypertrichosis. Some of these adverse experiences can be addressed by reviewing drug application, consideration of a vehicle other than propylene glycol, and modifying drug application. Topical minoxidil solution has shown itself to be a powerful tool in the management of hair loss in women. Its use has also been successfully extended in clinical practice to both younger and older women with non-scarring hair loss.