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Female Hair Loss

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Hair fall in females is a common problem. It is not actually a "problem" but a normal phenomenon in most cases where there is less than 100 hair shed in a day. Hair grows in cycles ie growing phase, resting phase and shedding phase. We have around 1lakh hair follicles in scalp out of which 0.1% will be in a shedding phase in a given day. Hence, fall of 100 strands a day is considered normal.

Females tend to notice hair fall more because the length of hair is longer. Hence even a few strands of hair looks like a lot when it folds on itself. When there is significant hair fall with diffuse thinning of hair or bald patches, then it is of concern and requires prompt evaluation and treatment.

Types of hair loss:

  • Telogen effluvium: This is the most common cause of hair fall in females. It is due to a disturbance in hair cycle wherein a large number of hair are in resting phase. It occurs after a period of stress, fever, due to a nutritional deficiency, pregnancy, after delivery or after intake of a drug. It is usually self limiting and resolves in a matter of 6 months.

    It is of two types:

    o   Acute telogen effluvium: It occurs after 2-3 months of a triggering event such as high fever, major surgery, crash dieting and sudden weight loss. If it is at a slow rate then no balding is noticed. But, if a larger number of hair are shed then there is diffuse thinning of hair. There is complete spontaneous regrowth after 3-6 months.

    o   Chronic telogen hair loss: It occurs when the insult is present for a long time or when there are repeated triggering events. It is seen in thyroid disorders, iron deficiency anemia and other nutritional deficiencies. Drug induced hair loss usually starts after 1 and a half to 3 months of drug intake and progresses till drug is continued. Regrowth occurs after stopping drugs.

  • Androgenetic alopecia (Female pattern hair loss): The age of onset, pattern and progression is different as compared to males. There is diffuse thinning of hair with prominent thinning and see through scalp on the front and top parts. The hairline is preserved leaving a fringe of hair. Mild recession of the lateral hairline is seen. It is genetically determined condition and seen mostly in post menopausal women. It is a difficult disease to treat.

Grade of hair loss

Ludwig’s grading system is sued to grade female pattern hair loss.

Evaluation

A complete examination and history is important to elucidate the cause for hair loss in females. If the offending factor continues to exist then the condition may progress. A serum ferrtin and TSH level test help in detection of anemia and thyroid disorders respectively.

Treatment

Medical therapy: This can halt the progression of baldness as well as thicken the calibre of hair present in this area.

Platelet rich plasma therapy: This therapy causes thickening of existing hair.It should be taken monthly for 3 months followed by a maintenance session once every 6 months.

Light therapy: Low level light therapy has shown to improve hair growth by moving the hair in to the growth phase (anagen phase). It also improves blood supply to hair roots and makes hair thicker.

Hair transplantation: When there is thinning of hair in a small area in the front or top aspect of scalp, transplantation of upto 1000 grafts (depending upon area and density desired) is a viable treatment option to cover the scalp. We can harvest larger number of grafts depends on the density of hair in back of scalp (occipital area).