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FEMALE PATTERN HAIR LOSS
Female pattern hair loss is also term has androgenetic alopecia in women due to the uncertain relationship between androgens. . FPHL is the commonly seen hair loss disorder in females. Initial symptoms may develop during the teenage and lead to progressive hair loss with a characteristic pattern distribution. . It is characterized as a nonscarring diffuse alopecia with progressive diminishment of hair follicles and subsequent decrease in the number of hairs, mostly in the central, frontal, and parietal scalp regions.
Clinically Female pattern hair loss has three main features.The primary feature is the diffuse thinning of the upper biparietal and vertex regions and preservation of the anterior hair implantation. There are many hair loss scales which attempt to categorize hair loss percent. Second manifestation is the thinning of the upper bimporal region and vertex with frontal accentuation that configures as a triangular form with loss of hair in a triangular shape in the front vertical area. A third indication is a deep recession of the frontaltemporal hairline and true vertex balding, this type of balding is seen in men but occasionally occurs in women which is uncommon.
Female pattern baldness and male pattern baldness has common features that causes follicular miniature but current knowledge suggests that the cause is not same in both sexes. . In women with FPHL with no elevated androgen levels, a genetic predisposition may be a complication. This genetic nature will allow normal levels of circulating androgen to act on follicular target cells, which are specially sensitized by binding to specific intracellular androgen receptors.
Hair loss in women is multifactorial and polygenic with the added influence of environmental factors. These types of follicles have a reduced hair cycle because of a minimization in the anagen phase, that leads to the production of fine and short hair shafts. Unlike in men, the reduction is not uniform and intense in women; Therefore, there is no complete area of baldness except in very rare cases.
Women with increased hair loss but little or no reduction in hair volume over the midfrontal scalp could be suffering from chronic telogen effluvium (TE), acute and several diseases and particularly should be considered. Physical examination and anamnesis are needed to get the correct diagnosis. Anamnesis should aim on when the hair loss was started, whether the loss is gradual/ involved handful of hair along with any physical, mental, or emotional stress that may have been faced within the previous 3 to 6 months. A history and physical examination should focus at detecting signs of hyperandrogenism such as ovarian abnormalities, hirsutism, acne, menstrual irregularities, and infertility. Laboratory test results are rarely considered in women who suffer from FPHL with no signs of hyperandrogenism.
Moreover, hair loss may occur in patients who are on oral contraceptive medications that contain progesterone with a high androgenic potential such as norethindrone or with the discontinuation of an estrogenic oral contraceptive medication that was taken for long. A physical the examination should include all aspects of the scalp and especially evaluate the involvement of the occipital area, which will show a strenthening of the central part with a diffuse reduction in density of hair than the frontal scalp. Although these areas show the most marked reduction in density of hair, evidence