The Ludwig Classification uses three stages to describe female pattern genetic hair loss:
- Type I (mild)
- Type II (moderate)
- Type III (extensive)
||Type I: Early thinning can be noticed which is easily camouflaged with proper grooming. In patients suffering from Type l there is too little hair loss to consider surgical restoration.|
|Type II: It is characterized by significant widening of the midline part and noticeably decreased volume. The hair transplant might be considered if the donor area in the back and sides of the scalp is stable.|
|Type III: This type is marked by a thin, see-through look on the top of the scalp. This is often indicative of generalized thinning..|
The most common type of hair loss in women occurs in a diffuse pattern. Diffuse hair loss is most often hereditary. It can also be caused by underlying medical conditions, medication, and other factors. Common or hereditary baldness in women, also called female pattern alopecia, is genetic and can come from either the mother or father’s side of the family. It is caused by the actions of two enzymes; aromatase (which is found predominantly in women) and 5-a reductase (which is found in both women and men.)
Medical conditions that can cause hair loss in women:
- Obstretic and gynecologic conditions such as postpartum and post-menopausal states or ovarian tumors
- Anemia – iron deficiency
- Thyroid disease
- Nutritional – crash diets, bulimia, protein/calorie deficiency, essential fatty acid or zinc deficiency, malabsorption, hypervitaminosis A
- Stress – surgical procedures, severe emotional problems
- Connective tissue diseases such as Lupus
A relatively large number of drugs can cause “telogen effluvium,” a condition where hair is shifted into a resting stage and then several months later, it sheds. Fortunately, this shedding is reversible if the medication is stopped, but the reaction can be confused with genetic female hair loss if not properly diagnosed. Chemotherapy causes a diffuse type of hair loss called “anagen effluvium” that can be very extensive, but often reversible when the medication is stopped. Drugs that can cause diffuse hair loss in women are:
- Blood thinners (anti-coagulants,) such as warfarin and heparin
- Seizure medication, most commonly dilantin
- Medication for gout, colchicines and alopurinol (Xyloprim)
- Blood pressure medication, particularly the B-Blockers (such as Inderal) or diuretics
- Anti-inflammatory drugs such as prednisone
- Medications that lower cholesterol and other lipids
- Mood-altering drugs – lithium, tri-cyclics, Elavil, Prozac
- Thyroid medications
- Oral contraceptive agents, particularly those high in progestin
- Misc.: Diet pills, high doses of Vitamin A, street drugs (cocaine)
Localized Hair Loss
Although there are a host of dermatologic conditions that cause hair loss, they produce a pattern that is different from the diffuse pattern of genetic hair loss commonly seen in women and are easily differentiated from it by a dermatologist. Localized hair loss in women may be sub-divided into scarring and non-scarring types. Alopecia Areata is a genetic, autoimmune disease that typifies the non-scarring type. It manifests with the sudden onset of discrete, round patches of hair loss associated with normal skin. It can be treated with local injections of steroids or ACell+PRP. Scarring Alopecia can be caused by a variety of medical or dermatologic conditions such as Lupus, Lichen Planus or local radiation therapy. Hair loss from injuries or from local medical problems that have been cured, are usually amenable to hair transplantation. Radiotherapy can cause both scarring and non-scarring localized hair loss and it also can be treated with surgical hair restoration if the area is not too large. Localized female hair loss that occurs around the hairline after face-lift surgery may be permanent. Traction Alopecia, the hair loss that occurs with constant tugging on the follicles, can also be permanent if the habit persists for a long period of time. Both of these conditions can be treated with hair transplantation.
Patterned Hair Loss
Women with this type of hair loss have a pattern similar to what we observe in men. In other words, they have thinning in the front or on the top of their scalp with preservation of the hair in the permanent zone around the back and sides of scalp. Thus, the balding is in a characteristic “pattern” rather than generalized. Women with patterned hair loss and a stable donor area may be excellent candidates for surgical hair restoration.
Treatment for androgentic alopecia can be difficult for women
Androgenetic alopecia is not an easy experience for women and can be detrimental to one’s self-esteem. While many drugs may work to some degree for certain women, doctors hesitate to prescribe them. What’s more, drug companies aren’t falling over themselves to test drugs specifically for their ability to prevent and treat female pattern baldness. Physicians are reluctant to prescribe systemic treatments because they can tamper with your body’s own androgen levels. The doctor will first want to confirm that the hair loss is due to an excess of androgen in the system or a sensitized “over-response” to normal amounts of androgen. Therefore, physicians often choose topical treatments, which are applied directly to the scalp.
Beginning treatment as soon as possible after the hair loss begins gives the best results, because prolonged androgenetic alopecia may destroy many of the hair follicles. The use of anti-androgens after prolonged hair loss will help prevent further damage and encourage some hair regrowth from follicles that have been dormant but are still viable. Stopping treatment will result in the hair loss resuming if the androgens aren’t kept in check in some other way. Maintaining your vitamin and mineral levels helps while you’re on anti-androgen medications.