What are the treatment options for female hair loss?

Treatment Options for Female Hair Loss

For female pattern hair loss, topical minoxidil 5% foam applied once daily is the most effective first-line treatment with demonstrated efficacy in improving hair density and coverage. 1

Types of Female Hair Loss

Different types of female hair loss require different treatment approaches:

1. Female Pattern Hair Loss (FPHL):

   • Presents as diffuse thinning primarily on the crown with widening of the central part
   • Preserves the frontal hairline
   • Shows progressive miniaturization of hair follicles

2. Alopecia Areata:

   • Presents as well-defined patches of hair loss
   • May progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis)

Treatment Algorithm for Female Pattern Hair Loss

First-Line Treatment:

• Topical minoxidil 5% foam once daily 1
  • Must be continued indefinitely to maintain results
  • Discontinuation leads to reversal of gains within 3-6 months
  • Treatment efficacy may take 12-24 months to become fully apparent 2

Second-Line/Adjunctive Treatments:

• Platelet-Rich Plasma (PRP) therapy

  • Can be combined with minoxidil for superior results 1
  • Studies show PRP significantly increases hair growth when used alone or in combination with minoxidil 3
  • Treatment typically involves multiple sessions spaced 1 month apart

• Low-level laser therapy devices (655 nm)

  • Can be used 3 times weekly
  • Can be combined with topical treatments 1

• Anti-androgens (for cases with hyperandrogenism):

  • Spironolactone
  • Cyproterone acetate
  • Finasteride (particularly in postmenopausal women) 1, 4
  • Flutamide (shown to be more effective than spironolactone or cyproterone in one study) 5

Treatment Algorithm for Alopecia Areata

Limited Patchy Hair Loss:

• Intralesional corticosteroids (Strength of recommendation B) 3
  • Hydrocortisone acetate (25 mg/mL) or triamcinolone acetonide (5-10 mg/mL)
  • Injected just beneath the dermis in the upper subcutis

Extensive Patchy Hair Loss:

• Contact immunotherapy (Strength of recommendation B) 3
  • Best-documented treatment for severe alopecia areata
  • Stimulates cosmetically worthwhile hair regrowth in <50% of patients
  • May cause temporary local inflammation but serious side effects are rare

Alopecia Totalis/Universalis:

• Contact immunotherapy is the only treatment likely to be effective, though response rates are lower than for patchy loss 3

When Treatment Is Not Desired or Effective:

• Wigs or hairpieces are often the most effective solution 3
  • Acrylic wigs are cheaper and easier to maintain
  • Real hair wigs may provide a better fit for wider range of social activities

Important Considerations

• Early diagnosis and treatment initiation is crucial as treatments are more effective at arresting progression than stimulating regrowth 2

• Rule out underlying conditions through laboratory testing:

  • Thyroid function
  • Iron stores
  • Vitamin D levels 1

• Monitor treatment effectiveness using:

  • Trichoscopy
  • Global photography
  • Hair counts
  • Hair diameter measurements 1

Treatment Pitfalls to Avoid

1. Delayed treatment initiation - Early intervention is key to preventing further hair loss

2. Unrealistic expectations - Patients should understand that:

   • Treatment response often takes 12-24 months to become apparent 2
   • The goal is primarily to prevent further loss rather than complete regrowth
   • Treatment must be continued indefinitely to maintain results

3. Overlooking psychological impact - Hair loss can cause significant psychological distress and impaired social functioning 2

4. Ignoring hormonal factors - In cases with clinical signs of androgen excess, assessment of biochemical parameters is necessary 6

5. Discontinuing treatment prematurely - All treatments need to be continued long-term to maintain effect 2

Female hair loss is a chronic progressive condition requiring long-term management. While complete hair restoration may not always be possible, appropriate treatment can effectively slow progression and improve quality of life.