Hair Loss in Women
The Ludwig Classification System
While women too can experience baldness in a typical male pattern the more common type of female hair loss can be classified by the Ludwig system. Divided into 3 types of stages, female hair loss is marked by a progressive increase in diffuse hair loss from the top of the scalp, with the frontal temporal hair line remaining intact.
Type I
Perceptible thinning of hair on the central scalp (top of the head)
Type II
Continued thinning of hair in central scalp with increased patches of greater scalp loss.
Type III
Represents the minimal extent of hair loss considered sufficient to represent baldness. Scalps have deep frontal temporal recessions, which are usually symmetrical and are either bare or sparsely covered.
Hair Loss
While there are several possible causes for female hair loss, the most common type of hair loss in women is female adrogenetic alopecia (AGA) or female pattern baldness, occuring in approximately 20% of American women. And while it is a common occurence, the effects of hair loss for a woman can be more devastating than for a man as social pressures and self-awareness levels in women can be much more intense and anxiety ridden. Women experience a much greater emphasis on beauty based on hair.
Female pattern hair loss can begin at any age from teen ages up through middle ages. There may not be an obvious hereditary association; whereas a man with AGA usually has close male relatives with AGA. Regardless, androgenetic alopecia is hereditary, caused by the production of hormones that affect hair follicles.Though it is the same cause as androgentic alopecia in men, it's effects in women differ. Because women have fewer androgen receptors along the frontal hairline, most women retain the frontal hairline that is so commonly lost among men. Overall women experience a more widespread and generalized thinning and hair loss throughout the scalp.
Female androgenetic alopecia can be quite extensive, however, unlike male pattern alopecia, female pattern alopecia is much more responsive to treatments and hair regrowth is generally more likely, although there is no guarantee of complete hair recovery.
Unlike male pattern alopecia, where areas of skin may become completely deviod of hair, female pattern alopecia most often involves a diffuse thinning and production of finer hair fiber. There is less total destruction of hair follicles in specific regions of skin. This means that regenerating a satisfactory hair covering is much more readily achievable for women than for men.
While such generalized hair loss makes it more difficult to treat via hair transplantation, there are many female patients who are excellent candidates for hair restoration surgery. It is important to meet with a doctor personally to discuss your medical history to determine the cause of hair loss as well as see if you are a candidate for hair transplant surgery.
The choice of treatment for hair loss in women often depends on the age of the patient as well as the extent of hair loss. Milder cases often see a greater improvement with treatment than those that are more severe. To date the only drug approved for promoting hair growth in women is Minoxidil.
Other Causes of Hair Loss
While AGA is the most common cause of permanent hair loss in women, it is by no means the only one and can be the effect of a number of different causes. Stress, hormonal problems, pregnancy, and certain medications can all cause hair loss and most often is temporary.
Other causes of hair loss, some of which are more permanent, include:
Alopecia areata - autoimmune disorder that causes patchy hair loss ranging from diffuse thinning to extensive areas of baldness with islands of retained hair.
Scarring alopecia - hair loss due to scarring of the scalp. A common cause of scarring alopecia is persistent tight braiding or corn-rowing of scalp hair. Over a period of time scarring may destroy hair follicles and result in permanent hair loss. More severe scarring alopecia may be caused by physical cutting-ripping-tearing injury to scalp skin or burn injury.
Telogen effluvium - a relatively common type of hair loss caused when a large percentage of scalp hair follicles are shifted into "shedding" phase. An underlying cause may be hormonal, nutritional, or drug-associated.
Loose-anagen syndrome - a condition that occurs primarily in fair-haired persons. Scalp hair sits loosely in hair follicles and is easily extracted by normal combing or brushing. In some cases the condition appears during childhood and improves in later life.
Triangular alopecia - a loss of hair in the frontal area of the scalp that sometimes begins in childhood. Hair loss may be complete in the frontal area or a few hairs may remain. The frontal hair loss can look similar to early-stage AGA. The cause of triangular alopecia is not known but it can be successfully treated.
Trichotillomania - compulsive hair plucking. The condition ranges from idly plucking hair while reading or watching TV to ritualistic plucking of hair in specific patterns. Over time, trichotillomania can cause scarring alopecia and permanent hair loss. Hair loss due to trichotillomania usually cannot be successfully treated until underlying psychological or emotional conditions are treated successfully.
Scalp infections - bacteria, fungi and viruses can invade and damage hair follicles, causing hair loss. The infection must be diagnosed and treated before any hair restoration can be undertaken.
Anorexia- unhealthy pressures and unrealistic weight goals have resulted in an increase of eating disorders, such as anorexia, the abstaining or loss of appetite for food. Prolonged anorexia can result in hair loss due to malnutrition. Those suffering from anorexia should seek counseling immediately.
* Excerpts taken from the International Society of Hair Restoration Surgery, www.ishrs.org, © 2004