Diffuse Hair Loss
The most communal type of hair loss in women happens in a diffuse pattern. Diffuse hair loss is most often inherited, but it can also be caused by underlying medical conditions, medications, and other factors.
Common or “hereditary” baldness in women, also called female pattern alopecia, is genetic and can come both the mother’s or father’s side of the family. It is caused by the activities of two enzymes; aromatase (which is establish mainly in women) and 5-a reductase (which is initiate in both women and men).
Women have partial the amount of 5-a reductase paralleled to men, but have greater levels of the enzyme aromatase, particularly at their frontal hairline. Aromatase is responsible for the development of the female hormones estrone and estradiol. It also falls the formation of DHT. Its existence in women may help to clarify why the presentation of female hair loss is so different than in males, principally with respect to the salvation of the frontal hairline. It may also explain why women have a poor reply to the drug finasteride (Propecia), a medication widely used to treat hair loss in men that works by blocking the formation of DHT.
Women’s hair looks to be particularly complex to underlying medical conditions. Since “systemic” problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed hair loss, be correctly assessed.
Medical conditions that can cause diffuse hair loss in women:
- Obstetric and gynecologic disorders such as post-partum and post-menopausal states or ovarian tumors
- Anemia – iron deficiency
- Thyroid disease
- Connective tissue diseases such as Lupus
- Nutritional – crash diets, bulimia, protein/calorie deficiency, essential fatty acid or zinc deficiency, malabsorbtion, hypervitaminosis A
- Stress – surgical procedures, general anesthesia, and severe emotional problems
A pretty large number of drugs can cause “telogen effluvium,” a condition where hair is shifted into a resting stage and then several months later shed. Luckily, this shedding is revocable if the medication is stopped, but the response 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 broad, but often reversible when the medication is stopped.
Drugs that can cause diffuse hair loss in women:
- 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 progestins
- Misc. – diet pills, high doses of Vitamin A, street drugs (cocaine)
Localized Hair Loss
Although there are a mass of dermatologic conditions that cause hair loss, they create a pattern that is different from the diffuse pattern of genetic hair loss usually seen in women and are easily differentiated from it by a dermatologist.
Localized female hair loss that happens around the hairline after face-lift surgery may be permanent. Traction Alopecia, the hair loss that happens with constant pulling 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.
Classification of Hair Loss in Women
As argued in the section on the causes of hair loss in women, women’s hair loss can be categorized into diffuse hair loss, localized hair loss, or patterned hair loss. It can also be divided into scarring and non-scarring types. Since the diffuse, non-scarring female hair loss caused by genetic is so common, it has its own special classification that is based upon the degree of thinning called the Ludwig classification.
The Ludwig Classification uses three phases to describe female pattern genetic hair loss:
- Type I (mild)
- Type II (moderate)
- Type III (extensive)
In all three Ludwig stages, there is hair loss on the front and top of the scalp with relative protection of the frontal hairline. The back and sides may or may not be convoluted. Irrespective of the extent of hair loss, only women with stable hair on the back and sides of the scalp are candidates for hair transplant surgery.
Type I: Early thinning that can be easily camouflaged with proper grooming. Type I patients have too little hair loss to consider surgical hair restoration.
Type II: Significant widening of the midline part and noticeably decreased volume. Hair transplantation may be indicated if the donor area in the back and sides of the scalp is stable.
Type III: A thin, see-through look on the top of the scalp. This is often associated with generalized thinning.
It is important for all women suffering hair loss that a correct diagnosis is made. This is particularly true when the hair loss is diffuse, as underlying medical conditions may be a contributing factor.