Hair: What Is New in Diagnosis and Management?

October 2012 in “ Dermatologic Clinics ”

Natasha Atanaskova Mesinkovska, Wilma F. Bergfeld

female pattern hair loss FPHL antiandrogen therapies 5-alpha reductase inhibitors minoxidil low-level laser therapy high-energy lasers biotin caffeine Rogaine

From the encyclopedia

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Biotin →

supplement to help with hair texture and quality

Caffeine →

the stimulant you know and love can be used topically to stimulate hair

Studysummary This review discusses treatment options for female pattern hair loss, emphasizing the importance of early intervention and the benefits of combined therapies, but reports no new clinical results.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

This document from 10 years ago discusses the diagnosis and management of female pattern hair loss (FPHL), which is the most common cause of hair loss in women. The diagnosis of FPHL is made clinically based on the appearance of the scalp, and biopsies are reserved only for situations when the diagnosis is uncertain. Treatment options for FPHL include antiandrogen therapies, 5-a reductase inhibitors, and minoxidil. Combination therapies tend to be more effective than single products. The document also explores various treatments, including low-level laser therapy, high-energy lasers, and adjuvant therapies such as biotin and caffeine. The authors suggest that FPHL may encompass different subtypes based on underlying cause, which can be treated with a better-targeted approach.

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Research cited in this study

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research Hormonal Changes in Menopause: Do They Contribute to a Midlife Hair Crisis in Women?

38 citations , December 2011 in “British Journal of Dermatology”

This review discusses the influence of menopausal status on hair parameters in women without alopecia, finding significant differences in hair growth rate, percentage anagen, and hair diameter distributions, particularly in the frontal scalp.

research The Effect of a 1550 Nm Fractional Erbium-Glass Laser in Female Pattern Hair Loss

47 citations , August 2011 in “Journal of The European Academy of Dermatology and Venereology”

This study found that treatment with a 1550 nm fractional erbium–glass laser increased hair density and thickness in women with female pattern hair loss, suggesting it may be an effective and safe option.

research The Latest Innovations in Hair Transplantation

32 citations , July 2011 in “Facial Plastic Surgery”

This review discusses recent surgical and medical advancements in hair restoration techniques but reports no new clinical results.

research Sex Hormone–Binding Globulin and Risk of Hyperglycemia in Patients With Androgenetic Alopecia

36 citations , April 2011 in “Journal of The American Academy of Dermatology”

People with hair loss have higher risk of high blood sugar and diabetes, and lower levels of a specific hormone.

research Prospective Cohort Study on the Effects and Tolerability of Flutamide in Patients with Female Pattern Hair Loss

42 citations , April 2011 in “Annals of Pharmacotherapy”

This study found that long-term flutamide treatment reduced hair loss in women with female pattern hair loss, but liver-related dropouts were minimized at a very low dose of 62.5 mg/day.

research Role of Genetics and Sex Steroid Hormones in Male Androgenetic Alopecia and Female Pattern Hair Loss: An Update

87 citations , March 2011 in “Australasian Journal of Dermatology”

This review explores the current understanding of genetic and hormonal influences on male androgenetic alopecia and female pattern hair loss, providing guidance for clinicians but reports no new results.

research Treatment of Female Pattern Hair Loss with the Androgen Receptor Antagonist Flutamide

30 citations , March 2011 in “Australasian Journal of Dermatology”

This case report found that a woman's hair loss, which progressed while using spironolactone and topical minoxidil, reversed after switching to flutamide therapy.

research Polymorphic CAG Repeat Numbers in the Androgen Receptor Gene of Female Pattern Hair Loss Patients

10 citations , November 2010 in “Journal of Dermatology”

In this study, the researchers reported that finasteride's efficacy in treating female pattern hair loss in Japanese patients was not predictable based on CAG repeat numbers in the androgen receptor gene.

research Treatment of Male Pattern Baldness with Botulinum Toxin: A Pilot Study

50 citations , November 2010 in “Plastic and Reconstructive Surgery”

This study suggests that Botox injections may increase hair count and reduce hair loss in men with androgenetic alopecia, potentially through increased blood flow and oxygen to the scalp.

research Androgenetic Alopecia and Cardiovascular Risk Factors in Men and Women: A Comparative Study

110 citations , July 2010 in “Journal of The American Academy of Dermatology”

Hair loss linked to higher heart disease risk in both men and women.

research Female Pattern Hair Loss in Complete Androgen Insensitivity Syndrome

54 citations , February 2010 in “British Journal of Dermatology”

This case report describes a patient with complete androgen insensitivity syndrome experiencing female pattern hair loss, suggesting that factors beyond direct androgen action may contribute to this condition in women.

research Evaluation of Androgen Receptor Gene as a Candidate Gene in Female Androgenetic Alopecia

23 citations , May 2009 in “International Journal of Dermatology”

In this study, no association was found between the AR gene and type II androgenetic alopecia in Egyptian women, suggesting it is not a useful biomarker for predisposition.

research Hair Loss in Women: Comprehensive Overview and Treatment Options

81 citations , March 2009 in “Seminars in Cutaneous Medicine and Surgery”

This review discusses the classifications, diagnostic methods, and treatment strategies for female pattern hair loss, but reports no clinical results.

research Androgen Dependence of Hirsutism, Acne, and Alopecia in Women

105 citations , January 2009 in “Medicine”

This study found that ethinylestradiol and high-dose cyproterone acetate significantly reduced hirsutism scores and were effective for treating acne and alopecia in women with hyperandrogenism.

research Comparing the Therapeutic Effects of Finasteride Gel and Tablet in Treatment of Androgenetic Alopecia

57 citations , January 2009 in “Indian Journal of Dermatology, Venereology and Leprology”

This study found that both topical and oral finasteride had similar therapeutic effects in treating male androgenic alopecia, with no significant differences in hair thickness, counts, or bald area size.

research HairMax LaserComb Laser Phototherapy Device in the Treatment of Male Androgenetic Alopecia

160 citations , January 2009 in “Clinical Drug Investigation”

This study found that the HairMax LaserComb® significantly increased hair density and was safe and well tolerated for treating androgenetic alopecia in men compared to a sham device.

research Biotin And Biotinidase Deficiency

166 citations , November 2008 in “Expert Review of Endocrinology & Metabolism”

This review discusses biotin and biotinidase deficiencies, their symptoms, and methods of medical management, without presenting new clinical findings.

research Medical Treatments for Male and Female Pattern Hair Loss

212 citations , September 2008 in “Journal of The American Academy of Dermatology”

This review discusses the various treatment options for male and female pattern hair loss and provides no new clinical results; the authors outline the most effective strategies based on existing evidence.

A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

research A Multicenter, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of a Novel Formulation of 5% Minoxidil Topical Foam Versus Placebo in the Treatment of Androgenetic Alopecia in Men

142 citations , August 2007 in “Journal of The American Academy of Dermatology”

This study found that a new 5% minoxidil foam formulation significantly increased hair counts and improved hair loss condition in men with androgenetic alopecia over 16 weeks compared to placebo.

research Effect of Caffeine and Testosterone on the Proliferation of Human Hair Follicles In Vitro

114 citations , January 2007 in “International Journal of Dermatology”

This study found that caffeine can stimulate hair growth in vitro and counteract testosterone-induced growth suppression in hair follicles from male AGA patients.

research The Current Role of Laser and Light Sources in the Treatment of Male and Female Pattern Hair Loss

68 citations , January 2007 in “Journal of Cosmetic and Laser Therapy”

This review discusses laser/light treatments for pattern hair loss and reports no clinical validation of current devices; experts recommend physician evaluation to exclude other medical conditions.

research Effect of Finasteride 5 mg (Proscar) on Acne and Alopecia in Female Patients with Normal Serum Levels of Free Testosterone

43 citations , January 2007 in “Gynecological Endocrinology”

This study found that 9 out of 12 women with acne or alopecia showed subjective improvement with finasteride treatment despite having normal free testosterone levels, suggesting a potential role of 5alpha-reductase activity.

research Reversal of Androgenetic Alopecia by Topical Ketoconazole: Relevance of Anti-Androgenic Activity

38 citations , September 2006 in “Journal of Dermatological Science”

This study evaluated the effect of 2% ketoconazole lotion for androgenetic alopecia, but the results regarding its effectiveness on clinical appearance remained unclear.

research Diagnosis and Management of the Dermatologic Manifestations of Polycystic Ovary Syndrome

97 citations , July 2006 in “Dermatologic therapy”

This article reviews the diagnosis and treatment approaches for cutaneous manifestations of PCOS, reporting on various treatment options without presenting new clinical results.

research Histopathologic Evaluation of Alopecias

90 citations , June 2006 in “The American Journal of Dermatopathology”

This review outlines the classification, histopathologic presentation, and pathogenetic concepts of scarring and nonscarring alopecias, reporting no new clinical results and emphasizing the need for clinicopathologic correlation.

research The Diagnosis and Treatment of Iron Deficiency and Its Potential Relationship to Hair Loss

207 citations , April 2006 in “Journal of The American Academy of Dermatology”

This review discusses the complexities of diagnosing and treating iron deficiency related to nutritional anemia and hair loss, concluding that routine screening and supplementation for hair loss are not yet supported by sufficient evidence.

research Finasteride Treatment of Female Pattern Hair Loss

108 citations , March 2006 in “Archives of Dermatology”

This study observed that 62% of premenopausal women with female pattern hair loss reported improvement when treated with oral finasteride and an oral contraceptive containing drospirenone and ethinyl estradiol.

research Physiological and Biological Skin Changes in Pregnancy

71 citations , February 2006 in “Clinics in Dermatology”

This review discusses the physiological skin changes during pregnancy and reports no new clinical results, emphasizing the importance of distinguishing these changes from pathological conditions.

research Effectiveness of Finasteride on Patients with Male Pattern Baldness Who Have Different Androgen Receptor Gene Polymorphism

23 citations , November 2005 in “Journal of Investigative Dermatology Symposium Proceedings”

Finasteride works better for baldness in people with shorter gene repeats.

research Zinc as an Ambivalent but Potent Modulator of Murine Hair Growth In Vivo: Preliminary Observations

60 citations , October 2005 in “Experimental Dermatology”

This study found that high-dose oral zinc significantly influences hair growth in mice, showing both inhibition and promotion effects depending on the timing and duration of administration.

research Prevalence of Male and Female Pattern Hair Loss in Maryborough

193 citations , August 2005 in “Journal of Investigative Dermatology Symposium Proceedings”

This study found that the prevalence of androgenetic alopecia increases with age among both men and women in Maryborough, Australia, with 57% of women and 73.5% of men aged 80 and over affected.

research Genetic Variation in the Human Androgen Receptor Gene Is the Major Determinant of Common Early-Onset Androgenetic Alopecia

195 citations , June 2005 in “American Journal of Human Genetics”

Genetic variation in the androgen receptor gene mainly causes early-onset hair loss, with maternal inheritance playing a key role.

research Treatment of Female Pattern Hair Loss With Oral Antiandrogens

179 citations , March 2005 in “British Journal of Dermatology”

This study found that 88% of women with female pattern hair loss who received oral antiandrogens saw no progression or improvement in their condition.

research Evaluation and Treatment of Male and Female Pattern Hair Loss

203 citations , December 2004 in “Journal of The American Academy of Dermatology”

This article reviews the historical developments in understanding and treating male pattern hair loss, emphasizing the role of dihydrotestosterone and 5α-reductase inhibitors, but reports no new clinical findings.

research Marked Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual 5α-Reductase Inhibitor

408 citations , May 2004 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study found that dutasteride more effectively reduced serum dihydrotestosterone levels than finasteride in patients with benign prostatic hyperplasia.

research A Randomized, Placebo-Controlled Trial of 5% and 2% Topical Minoxidil Solutions in the Treatment of Female Pattern Hair Loss

219 citations , March 2004 in “Journal of The American Academy of Dermatology”

In this 48-week trial, 5% topical minoxidil was more effective than both 2% minoxidil and placebo in promoting hair growth in women with female pattern hair loss, with notable improvements in nonvellus hair count and hair growth assessments.

Melatonin Increases Anagen Hair Rate in Women With Androgenetic Alopecia or Diffuse Alopecia: Results of a Pilot Randomized Controlled Trial

research Melatonin Increases Anagen Hair Rate in Women With Androgenetic Alopecia or Diffuse Alopecia: Results of a Pilot Randomized Controlled Trial

78 citations , February 2004 in “British Journal of Dermatology”

This article reviews the potential impact of melatonin on hair growth, noting its benefits observed in animals, but reports no clinical results in humans to date.

research Topical Estrogen Accelerates Hair Regrowth in Mice After Chemotherapy-Induced Alopecia by Favoring the Dystrophic Catagen Response Pathway to Damage

76 citations , January 2004 in “Journal of Investigative Dermatology”

research Topical Estrogen Therapy for Androgenetic Alopecia in Menopausal Females

22 citations , January 2004 in “Dermatology”

This article discusses the use of topical estrogen therapy for androgenetic alopecia in menopausal females and reports no new clinical results.

research Ketoconazole as an Adjunct to Finasteride in the Treatment of Androgenetic Alopecia in Men

28 citations , December 2003 in “Medical Hypotheses”

This paper suggests that ketoconazole 2% shampoo may enhance finasteride's effectiveness in treating androgenetic alopecia by more completely inhibiting the dihydrotestosterone pathway.

research Decreased Serum Ferritin Is Associated With Alopecia in Women

163 citations , November 2003 in “Journal of Investigative Dermatology”

This study found that women with androgenetic alopecia or alopecia areata have significantly lower serum ferritin levels than those without hair loss, suggesting a potential link between these types of alopecia and decreased iron stores.

research Hair Transplanting: An Important but Often Forgotten Treatment for Female Pattern Hair Loss

43 citations , October 2003 in “Journal of The American Academy of Dermatology”

This article explains why modern hair transplant techniques can be effective for women with pattern hair loss, despite this being underrecognized.

research The Effects of Minoxidil, 1% Pyrithione Zinc, and a Combination of Both on Hair Density: A Randomized Controlled Trial

57 citations , August 2003 in “British Journal of Dermatology”

This study found that daily use of 1% pyrithione zinc shampoo modestly improved hair growth over 26 weeks, although these effects were less than those of 5% minoxidil.

research Hair Loss in Women with Hyperandrogenism: Four Cases Responding to Finasteride

92 citations , October 2002 in “Journal of The American Academy of Dermatology”

This study reports that oral finasteride improved or stabilized hair loss in women with hyperandrogenism but not in postmenopausal women with female pattern hair loss.

research Female Pattern Hair Loss

226 citations , September 2001 in “Journal of The American Academy of Dermatology”

Hair loss in women is genetic, diagnosed by examination and biopsy, and treated with minoxidil, finasteride, or transplantation.

Lack of Efficacy of Finasteride in Postmenopausal Women with Androgenetic Alopecia