From the Guidelines
Clobetasol is not recommended for treating female pattern hair loss (FPHL) due to its limited effectiveness and potential side effects, such as folliculitis, as noted in the British Association of Dermatologists' guidelines 1. When considering treatment options for FPHL, it's essential to prioritize evidence-based therapies that address the underlying causes of the condition.
- Topical minoxidil 5% solution or foam applied twice daily is a well-established first-line treatment for FPHL.
- Oral minoxidil at low doses (0.25-2.5 mg daily) may be considered as an alternative for patients who cannot tolerate or do not respond to topical minoxidil.
- For women with hormonal influences, oral anti-androgens like spironolactone (50-200 mg daily) or finasteride (2.5-5 mg daily) might be beneficial, especially if there are signs of androgen excess. The use of clobetasol, a super-potent topical corticosteroid, is primarily reserved for inflammatory scalp conditions like psoriasis or severe seborrheic dermatitis, not for genetic hair loss patterns like FPHL, as its mechanism involves follicular miniaturization due to androgen sensitivity, not inflammation 1.
- Long-term use of potent topical steroids on the scalp can cause skin atrophy, telangiectasia, and paradoxically may worsen hair loss. It is crucial to consult with a dermatologist for proper diagnosis and treatment recommendations tailored to the specific condition, as they can provide guidance on the most effective and safe treatment options, including those supported by the most recent and highest quality evidence, such as the British Association of Dermatologists' guidelines 1.
From the Research
Female Pattern Hair Loss
- Female pattern hair loss (FPHL) is a common condition that can be cosmetically disrupting, and prompt diagnosis and treatment are essential for obtaining optimal outcomes 2.
- FPHL is characterized by diffuse thinning of the crown region with preservation of the frontal hairline, and it is not associated with elevated androgens in most cases 2.
Treatment Options
- The only approved treatment for FPHL is 2% topical Minoxidil, which should be applied at a dosage of 1ml twice a day for a minimum period of 12 months 2.
- Off-label alternative modalities of treatment include 5-alfa reductase inhibitors, antiandrogens, estrogens, prostaglandin analogs, lasers, light treatments, and hair transplantation 2.
- Oral antiandrogen therapies, such as cyproterone acetate and spironolactone, and/or topical minoxidil can be used to treat mild-to-moderate FPHL in women with good results in many cases 3.
- Low-level light therapy (LLLT) is an effective and safe tool with comparable results to minoxidil 5% in the treatment of FPHL, and combination therapy with both LLLT and minoxidil 5% can hasten hair regrowth 4.