What are the treatment options for female hair loss?

Treatment Options for Female Hair Loss

For female pattern hair loss (FPHL), topical 5% minoxidil foam applied once daily is the first-line treatment, which should be continued for at least 12 months to properly evaluate response, with maintenance therapy required indefinitely to sustain results. 1

Types of Female Hair Loss

There are two main types of hair loss affecting women:

1. Female Pattern Hair Loss (FPHL) - Most common type

   • Progressive thinning of hair, especially in frontal, central, and parietal scalp
   • May or may not have elevated androgen levels
   • Characterized by follicular miniaturization

2. Alopecia Areata - Patchy hair loss

   • Limited patches: Often resolves spontaneously
   • Extensive/total/universal: More difficult to treat

Treatment Algorithm for FPHL

First-line Treatment:

• Topical 5% minoxidil foam once daily 1
  • Continue for minimum 6 months before evaluating initial response
  • Full evaluation at 12 months
  • Must be continued indefinitely to maintain results

Second-line/Alternative Options:

• Low-dose oral combination therapy 1

  • Minoxidil 0.25 mg + spironolactone 25 mg once daily
  • Particularly useful for women with signs of androgen excess

• Platelet-rich plasma (PRP) therapy 1

  • Initial phase: 3 sessions at 4-6 week intervals
  • Maintenance: Sessions every 6 months
  • Can be used alone or as adjunct to minoxidil

• Low-level laser therapy 1

  • Used 3 times weekly
  • Minimal side effects
  • Can increase total hair count

• Spironolactone (25-200 mg daily) 1, 2

  • Particularly effective when FPHL is associated with hyperandrogenism
  • Acts as an androgen receptor antagonist

For Severe or Treatment-Resistant Cases:

• Finasteride (1-2.5 mg daily) 1, 2

  • May be effective in postmenopausal women
  • Contraindicated in women of childbearing potential due to teratogenicity
  • Warning: Pregnant women should not handle tablets

• Hair transplantation 1

  • For advanced FPHL resistant to medical treatments
  • Requires well-preserved donor hair at the occipital region

Treatment for Alopecia Areata

Limited Patchy Hair Loss:

• Intralesional corticosteroids 3, 1
  • Triamcinolone acetonide (5-10 mg/mL)
  • Best for fewer than five patches of <3 cm diameter

Extensive Alopecia Areata:

• Contact immunotherapy 3, 1
  • Diphenylcyclopropenone (DPCP)
  • 50-60% of patients achieve worthwhile response
  • Requires multiple hospital visits over several months
  • Store solutions in the dark; patients should wear hat/wig for 24h after application

Monitoring Treatment Response

• 3-month mark: Early signs of improvement may be visible
• 6-month mark: Critical evaluation point; significant improvements should be noticeable
• 12-month mark: Comprehensive evaluation of treatment efficacy
• Evaluation methods: Standardized clinical photography, trichoscopy, hair counts, patient self-assessment 1

Important Considerations and Pitfalls

• Don't discontinue treatment prematurely - Results take 6-12 months to become apparent 1
• Rule out underlying conditions - Check thyroid function, iron stores, vitamin D levels 1
• Set realistic expectations - Treatments are better at preventing progression than stimulating regrowth 4
• Consider psychological impact - Hair loss can cause significant psychological distress in women 4, 5
• For cosmetic improvement - Wigs, hairpieces, and cosmetic camouflage can be helpful while awaiting treatment response 3, 1

Treatment Efficacy Evidence

• Minoxidil shows moderate to marked increase in hair regrowth compared to placebo, with an important increase in total hair count 6
• Low-level laser therapy shows improvement in total hair count compared to sham devices 6
• Finasteride 1mg has shown limited efficacy in premenopausal women but may be effective at higher doses (2.5mg) in postmenopausal women 2, 6
• All treatments need to be continued to maintain effect, as FPHL is a chronic progressive condition 4