From the Guidelines
The medical workup for female hair loss should begin with a thorough history and physical examination to determine the pattern and progression of hair loss, followed by initial laboratory tests including complete blood count, thyroid function tests, iron studies, vitamin D level, and hormone panel to rule out common causes such as telogen effluvium, anagen effluvium, and systemic lupus erythematosus 1. The diagnosis of alopecia areata, which can present as diffuse hair loss, may require a biopsy to confirm the diagnosis, especially when the clinical course is unclear. Key considerations in the medical workup include:
- Differentiating between scarring and non-scarring alopecia
- Ruling out conditions that may mimic alopecia areata, such as trichotillomania, tinea capitis, and secondary syphilis 1
- Identifying underlying nutritional deficiencies or hormonal imbalances that may be contributing to hair loss
- Considering the potential for coexisting conditions, such as polycystic ovary syndrome, which may require additional testing and treatment. Initial treatment options may include topical minoxidil, oral minoxidil, spironolactone, and topical or intralesional corticosteroids, depending on the underlying cause of hair loss. It is essential to address the underlying trigger for telogen effluvium and correct any nutritional deficiencies, while also considering the use of JAK inhibitors for severe cases of alopecia areata. Early intervention is crucial, as treatment outcomes are generally better when started promptly, and patients should understand that visible improvement typically takes at least 3-6 months of consistent therapy.
From the Research
Medical Workup for Alopecia and Hair Loss in Females
The medical workup for alopecia and hair loss in females typically involves a thorough history and a focused physical examination 2, 3, 4.
- History Taking: A systematic approach to history taking is essential in evaluating hair loss in women, including disturbances of the hair cycle, damage to the hair shaft, and disorders affecting the follicle 4.
- Physical Examination: A focused physical examination can help diagnose the underlying cause of hair loss, such as androgenetic alopecia, alopecia areata, telogen effluvium, or cicatricial alopecia 2, 3.
- Laboratory Tests: Selected laboratory tests, such as hormone level tests, may be necessary to diagnose underlying endocrine disorders that may be contributing to hair loss 5.
- Punch Biopsy: A punch biopsy may be necessary in some cases to diagnose scarring alopecia or other conditions that require a tissue sample for diagnosis 2, 3.
Common Causes of Hair Loss in Females
The common causes of hair loss in females include:
- Androgenetic Alopecia: The most common cause of hair loss in women, characterized by progressive replacement of slow cycling terminal hair follicles by miniaturized, rapidly cycling vellus hair follicles 2, 3, 6.
- Alopecia Areata: An autoimmune condition that causes patchy hair loss, often treated with corticosteroids and other agents 2, 3.
- Telogen Effluvium: A nonscarring, noninflammatory alopecia of relatively sudden onset caused by physiologic or emotional stress, often self-limited 2, 3.
- Cicatricial Alopecia: A scarring form of hair loss that requires evaluation by a dermatologist 3.
Treatment Options
Treatment options for hair loss in females include:
- Minoxidil: A topical treatment labeled for the treatment of androgenetic alopecia in women, which can promote hair regrowth 2, 3, 6.
- Corticosteroids: Used to treat alopecia areata and other inflammatory conditions that cause hair loss 2, 3.
- Hormonal Therapies: Such as 5-alpha-reductase inhibitors, spironolactone, and estrogens, which may be used to treat hair loss caused by hormonal imbalances 5.