The midline part: An important physical clue to the clinical diagnosis of androgenetic alopecia in women☆,☆☆,★

Hirsutism, acne, and/or female pattern hair loss are common cutaneous manifestations of polycystic ovary syndrome (PCOS). However, while hirsutism is mainly related to androgen excess, both acne and female pattern hair loss may often depend on cutaneous alterations that are not linked to hyperandrogenism or increased androgen sensitivity. Because both acne and female pattern hair loss cannot be considered a sign of hyperandrogenism, neither should be included in the diagnostic process of PCOS without demonstration of increased levels of circulating androgens. In addition, in patients with androgen-dependent acne, the concomitant proliferation of Propionibacterium acnes in skin may determine lack of response to antiandrogen or estroprogestin therapy. Similarly, in hyperandrogenic female pattern hair loss, scalp inflammation and/or mineral or vitamin deficiencies often prevent hair regrowth. To successfully treat these patients, it is necessary that endocrinologists and reproductive endocrinologists have a good understanding of the mechanisms determining cutaneous manifestations of PCOS.

Focal atrichia is a common clinical finding in female pattern hair loss, the specificity and histologic findings of which need further clarification.

To determine the frequency of focal atrichia in various types of hair loss and its histologic characteristics in female pattern hair loss.

Part 1 of the study was a review of 250 consecutive female patients seen with hair loss for the presence of focal atrichia, and part 2 examined paired biopsy specimens from haired areas versus those from areas with focal atrichia in 18 subjects with female pattern hair loss.

Focal atrichia was seen in 46 of 104 of women with female pattern hair loss (44%), including 67% of those with the late-onset subtype versus 15% of those with the early-onset subtype, compared with in 3 of 146 of those with other hair disorders (2%). Biopsy findings of focal atrichia in female pattern hair loss showed primarily a more progressive miniaturization process than that of haired areas of the scalp.

Some women with female pattern hair loss may have had concomitant chronic telogen effluvium.

When present, focal atrichia is a clinical clue to the diagnosis of female pattern hair loss, particularly the late-onset subtype.

Female pattern hair loss (FPHL) is the most common form of alopecia in women. Affected women may experience psychological distress and impaired social functioning. Early diagnosis and initiation of treatment are desirable because treatments are more effective to avoid the progression of hair loss than stimulating regrowth. Typically, a diagnosis of FPHL can be confirmed by review of a patient's medical history and a physical examination alone. Testing a scalp biopsy is diagnostic but usually not required. In women with signs of hyperandrogenism, an investigation for ovarian or adrenal disorders should be performed. Treatment for FPHL is obscured by myths. The aim of FPHL treatment could be two-fold: Reverse or stabilize the process of hair follicle miniaturization. Mild-to-moderate FPHL in women can be treated with oral antiandrogen therapies (cyproterone acetate and spironolactone) and/or topical minoxidil with good results in many cases. If used correctly, available medical treatments arrest the progression of the disease and reverse miniaturization in most patients with mild-to-moderate FPHL. Hair systems and surgery may be considered for selected cases of severe FPHL.

Alopecia is a dermatologic condition that affects the pilosebaceous unit in both men and women. In addition to a thorough medical history and physical examination, a host of diagnostic tools may be warranted to differentiate nonscarring and scarring alopecias. Female pattern hair loss represents the most common form of hair loss experienced by up to 40% of women by a certain age. Although alopecia is a benign disorder, even the most negligible amount of hair loss can be devastating to a patient’s self-esteem, self-image, and overall quality of life. We present this comprehensive review of quality of life studies in women with alopecia to describe the multitude of feelings and emotions associated with the disorder and remind dermatologists of the psychological impact it can have on women.