AgingSkinNet Spotlight Article
Best Rx Options for Hair Loss in Women
Dermatologists Say First Find the Cause

When a woman starts losing her hair, it is often unexpected and frightening. Not wanting to tell a soul, many women cope by hiding hair loss with a new hairstyle. Some experiment with products that guarantee hair re-growth. Dermatologists understand the appeal of these options but caution that getting to the root of hair loss is essential.

Cause Determines Treatment
Hair loss occurs for many reasons. Two of the most common reasons women see thinning locks are stress and hereditary hair loss. An underlying medical condition such as lupus, thyroid disease, or polycystic ovary syndrome also can cause hair loss. Even what you do to your hair — including bleaching, permanent waving, and certain hairstyles — can result in noticeable hair loss. Each cause requires a different approach to re-grow hair.

Stress-induced Hair Loss
Women can lose a noticeable amount of hair after a particularly stressful event, such as childbirth, illness, surgery, or passing of a loved one. Prolonged stress can force too many hairs into what is called the “resting phase.” (Hair goes through 3 phases: growing, resting, and shedding.) When stress pushes too many hairs into the resting phase, the hairs remain on the head for about 3 months. Then all of these hairs enter the shedding phase together, causing noticeable hair loss.

Treatment: The good news is that stress-induced hair loss usually does not require treatment. The phases tend to return to normal, and hair re-grows on its own.

Hereditary Hair Loss
Many women are surprised to learn that like men, they, too, can have hereditary hair loss. In men, this condition typically causes a receding hairline or a balding patch. Women, however, tend to have gradual overall thinning. An early sign of hereditary hair loss in women is noticeable hair loss in the center part. If parting hair down the center reveals a Christmas-tree pattern on the bare scalp, the cause is usually hereditary hair loss. Another sign of hereditary hair loss is thinning right behind the front hairline.
 

Hereditary hair loss can be especially troubling for women because it tends to worsen — often in an unpredictable way. A woman may notice significantly more hairs in the tub or on her brush for 2 or 3 months, and then the excessive shedding stops. For the next 3 to 12 months, hair loss seems normal. Then suddenly and unexpectedly, the excessive hair loss returns. This unpredictably can leave a woman feeling anxious and uncertain about what to do.

Treatment: Early treatment offers the best chance for hair re-growth and preventing further loss. When hereditary hair loss develops, the growing phase shortens. This causes hair to thin until growth stops completely. The sooner treatment begins, the better the chance that hair will re-grow.

There are a number of treatment options for hereditary hair loss in women. Over-the-counter minoxidil is a common treatment. The U.S. Food and Drug Administration (FDA) approved the 2% minoxidil solution for women who have hereditary hair loss. Studies show that it stimulates re-growth in about 60% of women with hereditary hair loss.

To see re-growth, minoxidil should be applied twice daily every day. It takes about 4 months to notice any growth. To continue seeing growth, minoxidil must be used indefinitely. Once stopped, hair re-growth tends to stop and the hair that grew usually falls out.

Patients often dislike the inconvenience of applying minoxidil twice daily. Some dermatologists compare using minoxidil to brushing your teeth. Done twice daily, both help prevent loss. Brushing helps prevent tooth loss. Applying minoxidil twice daily can help stop hair loss. Minoxidil also helps many women to re-grow their hair.

In some cases, dermatologists will prescribe a different — or additional — medication to treat hereditary hair loss. Spironolactone and flutamide can be effective for some women. As these medications carry the risk of birth defects, women should not take these medications if they are pregnant or plan to become pregnant. Women who can get pregnant must use an oral contraceptive when taking these medications.

Cortisone medication in topical (applied to the skin) or injectable form can help some women re-grow their hair.

A procedure called “hair transplantation” may be an option. This procedure involves taking hair from a healthy area and moving it to an area(s) that has thinning. Rest assured, this procedure has improved dramatically since the days of the hair plug. Today, hair transplantation produces natural-looking results. It can be effective for women with early or mid-stage hereditary hair loss.

Without early treatment, hereditary hair loss in women tends to progress, eventually causing visible thinning across the scalp. In the later stages, treatment may not lead to hair re-growth.

Underlying Medical Condition
An undiagnosed medical condition can cause noticeable hair loss.

Treatment: Treating the underlying medical condition may stop excessive hair loss and allow the hair to re-grow.

How Dermatologists Diagnose Hair Loss
To diagnose the cause of hair loss, a dermatologist generally does the following:

• Takes a thorough medical history. Be sure to tell your dermatologist about all medications, vitamins, and food supplements that you are taking and have recently taken. It also is important for the dermatologist to know if you have been dieting. You also will be asked about your menstruation history, pregnancies, and menopause.
  
  If you have been using any hair re-growth products, be sure to tell your dermatologist. This includes shampoos, laser combs, vitamins, and food supplements.
   

• Examines the hair and scalp. This typically involves a visual exam of the hair and scalp. To learn about the health of the roots, a dermatologist will gently tug on your hair. The doctor also may need to look at the hair over the rest of your body. This tells the doctor if there is too little or too much hair, which can be helpful in diagnosing the cause of hair loss.
  
  If an underlying medical condition is suspected, you may need blood work or other testing. Sometimes the dermatologist performs a scalp biopsy to determine the exact cause of the hair loss. This simple procedure can be quickly and safely performed in the dermatologist’s office.

Benefits of Seeing a Dermatologist
With so many causes, it can take a bit of detective work to uncover the reason for hair loss. Sometimes, more than one cause is responsible. And as we age, one cause may follow another.

Dermatologists receive specialized medical training that gives them expertise in diagnosing and treating conditions that affect the skin, nails, and hair. These doctors are best able to diagnose the underlying cause — or causes — of hair loss. An accurate diagnosis and early treatment offer the best chance for successful re-growth.

References:
American Academy of Dermatology. “Hair Loss.” Available at: www.aad.org/media/background/factsheets/fact_hair_loss.html. Last accessed July 23, 2009.

American Academy of Dermatology. “Don’t Let Hair Loss Tangle You Up – Dermatologists Can Identify Common Hair Disorders,” News release issued February 3, 2008. Available at www.aad.org/media/background/news/Releases/Dont_Let_Hair_Loss_Tangle_You_Up__Dermatologists_C1/. Last accessed July 23, 2009.

American Academy of Dermatology. “Hair Loss in Women: More than Meets the Eye.” News release issued March 2, 2006. Available at www.aad.org/media/background/news/Releases/Hair_Loss_in_Women_More_Than_Meets_the_Eye/. Last accessed July 23, 2009.

American Academy of Dermatology. “Hair Disorders: Dermatologists Identify the Top 3 Causes of Tress Distress.” News release issued February 6, 2004. Available at: www.aad.org/media/background/news/Releases/Hair_Disorders_Dermatologists_Identify_the_Top_3_C/. Last accessed July 23, 2009. 

Dinh QQ, Sinclair R. “Female pattern hair loss: current treatment concepts.” Clin Interv Aging 2007; 2: 189-99.

Iorizzo M, Vincenzi C, Voudouris S et al. “Finasteride treatment of female pattern hair loss.” Arch Dermatol 2006; 142: 298-302.

McMichael, AJ. “How to Approach Hair Loss in Women.” Presented during symposium S001 “What’s Hot: Women’s Dermatology” at the Summer Academy Meeting of the American Academy of Dermatology, July 2009: Boston.

Olsen EA. “The midline part: an important physical clue to the clinical diagnosis of androgenetic alopecia in women.” J Am Acad Dermatol 1999; 40: 106-9.

Rogers NE, Avram MR. “Medical treatments for male and female pattern hair loss.” J Am Acad Dermatol 2008; 59: 547-66; quiz 67-8.

All content solely developed by the American Academy of Dermatology