Differential Diagnosis for Female Pattern Hair Loss

The patient's symptoms of a widening middle parting and potential bald patches at the vertex, as noted by her brother, boyfriend, and hairdresser, suggest a condition affecting hair density and distribution. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Female Pattern Hair Loss (FPHL): This condition, also known as female androgenetic alopecia, is characterized by a gradual thinning of hair, particularly over the top of the scalp, leading to a widening of the central parting. It is influenced by genetics, hormonal factors, and aging, making it a likely diagnosis given the familial observation and the specific pattern of hair loss described.

• Other Likely Diagnoses

  • Telogen Effluvium: A condition that can cause significant hair shedding, often after stressful events, major illness, or hormonal changes. It might present with a diffuse thinning of hair rather than a specific pattern but could be considered if the hair loss is more widespread than initially described.
  • Alopecia Areata: An autoimmune condition that can cause patchy hair loss. While it typically presents with well-defined bald patches, it's less likely given the description of a widening parting and vertex involvement without mention of distinct patches elsewhere.
  • Traction Alopecia: Hair loss due to constant pulling on the hair, such as from tight hairstyles. This could contribute to or exacerbate hair loss, especially if the patient frequently wears hairstyles that put tension on the hair at the vertex.

• Do Not Miss Diagnoses

  • Thyroid Disorders: Both hypothyroidism and hyperthyroidism can cause hair loss. It's crucial to rule out these conditions due to their potential impact on overall health and the fact that hair loss can be an early symptom.
  • Iron Deficiency Anemia: A common condition in women that can lead to hair loss. Identifying and treating iron deficiency is essential for overall health and may help alleviate hair loss symptoms.
  • Autoimmune Disorders (e.g., Lupus): Certain autoimmune diseases can cause hair loss as one of their many symptoms. While less common, these conditions are critical to diagnose due to their systemic implications.

• Rare Diagnoses

  • Frontal Fibrosing Alopecia: A condition characterized by hair loss and scarring, typically affecting the frontal scalp. It's less likely given the description of vertex involvement but could be considered if there are additional symptoms such as skin changes or loss of eyebrows.
  • Lichen Planopilaris: An inflammatory condition leading to hair loss, typically with scarring. It's rare and usually presents with additional symptoms like itching, redness, and skin lesions, making it less likely without such descriptions.
  • Hair loss due to skin conditions (e.g., discoid lupus, scleroderma): These conditions can cause hair loss but are rare and usually accompanied by other distinctive skin changes or systemic symptoms.