Androgenetic alopecia and to a lesser extent Telogen effluvium are the two most frequent causes of hair loss in women.
To make the diagnosis:
-General examination of the scalp
- evaluate the distribution of the hair loss
- are hair follicles present?
- traction (does the hair go away easily?)
- evaluate the quantity of the hair loss (trichogram)
- éventually, do a biopsy (always in the direction of the hair follicle)
-Specific clinical evaluation in the case of androgenetic alopecia
- Distribution of the alopecia: male pattern according to Hamilton (I to VII) or female pattern according to Ludwig (I to III).
- Severity: is the scalp visible. If yes, more than 50% of the total hair has been lost.
- Exclude a Telogen effluvium: traction test (to evaluate if the hair falls off on all the scalp), loss of more than 100 hairs per day? (trichogram)
One word on Telogen effluvium
- deficiency in iron
- dysfunction thyroid gland
- Chronic disease
- Etiology of a deficiency in iron (ferritin less than 30 micrograms per ml):
- decreased intake
- increase of needs (pregnancy…)
- blood losses (menses, internal bleeding).
- Treatment of a deficiency in iron:
- oral intake of 200mg per day. Control ferritin after 3 months. If it is higher than 40micrograms per ml, treatment can be stopped. If levels of ferritin remain low for two tests, it is advisable to investigate for an internal bleeding etiology.
- Clinical diagnosis (see specific clinical evaluation)
- look for a hyperandrogenic state: early beginning, rapid start, hyperandrogenic state signs (hirstutism), history of polycystic disease…
- hormonal blood tests: Testosterone, Dehydroepiandrostenedions (DHEA).
- topical: minoxidil 2%, topical estrogens, sprays to increase the volume of the hair (TopSecret, Mathis-Lucerne).
- systemic: sprironolactone 50-100mg, cyproterone acetate.
This advice is for informational purposes only and does not replace therapeutic judgement done by a skin doctor.
Source of information: Harms, “Trchologie” (french), Geneva University Hospital, 2010
Source of information: here