Successful Treatment of Female-Pattern Hair Loss with Spironolactone in a 9-Year-Old Girl

This case report describes the successful treatment of female-pattern hair loss (FPHL) in a 9-year-old girl with spironolactone. FPHL is a common disorder affecting 30% of Australian women, but rare in prepubescent children. The patient had a 6-month history of increasing hair shedding and generalized hair thinning, with a midline clinical grade of 2. After 6 months of treatment with spironolactone at a dose of 100 mg orally per day, the patient had a noticeable narrowing of the midline part consistent with a midline clinical grade of 1. Spironolactone is an aldosterone antagonist used in the treatment of hypertension, but it also possesses anti-androgenic properties, acting as an androgen receptor antagonist and reducing the levels of cytochrome P450-dependent enzymes 173-hydroxylase and desmolase, which are both required for androgen synthesis. Spironolactone has been shown to be safe and effective in the treatment of FPHL in adults and well tolerated at a dose of 200 mg orally per day. The authors suggest that this treatment should be considered in other cases of prepubertal FPHL.