Treatment of female pattern alopecia/androgenic alopecia in women

Pharmacological treatment options include:

• topical minoxidil
  • minoxidil is a safe treatment
  • not recommended for patients under the age of 18 years of over 65 years (2)
  • evidence of hair growth may be seen after four months of treatment (with twice-daily applications) (2)
  • some patients complain that it leaves unsightly deposits on the hair
  • occasionally it causes scalp irritation which may be severe enough to cause a temporary increase in hair shedding and patients should be warned about this
  • hypertrichosis on the face and on more remote sites has been reported, particularly when higher concentrations of minoxidil are used
    • resolves in 1 year with continuous use or within one to six months if treatment is stopped (3)
  • should be used for at least 1 year, before an accurate assessment of efficacy can be made (4)
• antiandrogens
  • contraindicated in women who are pregnant (4)
  • spironolactone is an aldosterone antagonist used in the treatment of hypertension and has also been used in the treatment of FPHL
    • spironolactone also possesses antiandrogenic properties, acting as an androgen receptor antagonist and reducing the levels of cytochrome P450-dependent enzymes 17beta-hydroxylase and desmolase, which are both required for androgen synthesis
    • spironolactone has been shown to be safe and effective in the treatment of female pattern hair loss (FPHL) in adults
  • cyproteron acetate
    • the androgen receptor blocker cyproterone acetate has been widely used in Europe to treat female pattern hair loss (1)
  • like minoxidil, anti androgens should be used for at least 1 year before an accurate assessment of efficacy can be made (4)

Other treatment options include:

• cosmetic aids e.g - hair styling techniques, camouflage products, hair replacements, hair accessories
• surgical treatment e.g. – hair transplant

Psychological distress resulting from FPHL should also be addressed during management (4).

Notes:

• women with polycystic ovary syndrome may have signs of some degree of androgenic alopecia. However they will also suffer from acne, hirsutism and irregular periods. Those with hormonal disturbance may benefit from treatment with cyproterone acetate 50-100mg daily with oestrogen e.g. in the contraceptive pill Dianette (R).

Reference:

• (1) Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br. J. Dermatol. 2005; 152: 466-73.
• (2) ABPI Medicines Compendium 2010. Summary of product characteristics for Boots hair loss treatment regular strength
• (3) Thiedke CC. Alopecia in women. Am Fam Physician. 2003;67(5):1007-14
• (4) Dinh QQ. Sinclair R. Female pattern hair loss: current treatment concepts. Clin Interv Aging. 2007;2(2):189-99.