Hair loss is physically, emotionally scarring
Managing hair disorders in women is a complex process that requires thorough evaluation and a comprehensive treatment algorithm.
F064 – Hair Loss in Women
3:30-5:30 p.m. | Sunday, March 29
Room 301
Female pattern hair loss (FPHL) is the leading source of hair loss in women, affecting about 30 million women in the United States alone. Nearly one in two women will have developed FPHL by the age of 50.
This common condition is multifaceted, with a wide range of symptoms, presentations, and root causes. In Sunday’s session, F064 – Hair Loss in Women, dermatologists will review challenges in treating FPHL and other hair disorders as well as the importance of a therapeutic algorithm.
Step one: Assess
“Hair loss in women is common and often quite emotionally devastating for those affected,” said session director Elise A. Olsen, MD, FAAD. “Correct diagnosis requires recognizing the combination of clinical, trichological, and pathological features unique for each type of hair loss.”
Dr. Olsen is a professor of dermatology and medicine at Duke University Medical Center as well as the founder and director of the Duke Hair Disorders Research and Treatment Center. Her presentation will focus on FPHL and cicatricial alopecias in the central scalp.
Scarring alopecias, she said, can be difficult to diagnose as they share similar pathological findings with each other and with FPHL. She recommends performing a scalp biopsy from the edge of the affected area, sectioned horizontally. This can provide the greatest information and chance of correct diagnosis. Dermatologists must also pay heed to medication-related changes, vitamin deficiencies, and endocrine disorders that may affect hair growth.
These are all critical considerations when diagnosing a patient and evaluating them for treatment, said David Saceda-Corralo, MD, PhD, a dermatologist in the Hair Disorders Unit of Hospital Ramón y Cajal and Grupo de Dermatología Pedro Jaen, in Madrid, Spain. Communicating with the patient to set realistic expectations is of equal importance, he said.
Mesotherapy and lasers are two minimally invasive, nonsurgical options for treating FPHL, said Dr. Saceda-Corralo. The process of delivering growth-promoting agents directly to the scalp can provide significant benefits but should be used in an adjunctive capacity.
“Evidence remains heterogenous and protocols are not standardized,” he said. “It should be framed as a complementary option after a correct diagnosis and first-line therapies like minoxidil.”
Step two: Articulate
There is an algorithm that dermatologists use to create a patient’s treatment plan. According to Dr. Olsen, therapeutic options may include FDA-approved treatments, off-label topical or systemic medications, lasers, procedures, or nontraditional dietary supplements.
Jerry Shapiro, MD, FAAD, professor and director of disorders of the hair and scalp in the Ronald O. Perelman Department of Dermatology at New York University’s Grossman School of Medicine in New York City, will present oral and topical applications of 5α-reductase inhibitors and androgen receptor blockers. Spironolactone, bicalutamide, and cyproterone acetate are androgen receptor blockers used in women with hair loss.
“Each has their own side effect profile and usually are of equal efficacy,” Dr. Shapiro said.
Drugs like finasteride and dutasteride are types of 5α-reductase inhibitors that are FDA-approved to treat specific male conditions but are sometimes used off-label for FPHL and androgenetic alopecia in men.
“They are oral medications usually,” said Dr. Shapiro, “but can be injected in the scalp as mesotherapy. Success rates vary for injections.”
Another approach to managing scarring alopecias is to use anti-inflammatory agents, said Amy J. McMichael, MD, FAAD, a professor in the department of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina.
“These can combat white blood cells that are causing inflammation of the hair follicle,” Dr. McMichael said. “To combat this inflammation, it is imperative to have an algorithm of medications that can decrease the inflammation that can lead to scarring hair loss.”
Immunosuppressants like tacrolimus and methotrexate have been shown to help reverse hair loss. Other choices include topical steroids, JAK inhibitors, and oral hydroxychloroquine.
“Anti-inflammatory agents can slow the inflammatory response and effectively rescue the hair follicles that still remain,” Dr. McMichael said. “This is the backbone of treatment and will be discussed in terms of how to choose the correct medication for the right patient and how to navigate escalation of medication appropriately.”
The session panel will also include Maria K. Hordinsky, MD, FAAD, and Rodney Daniel Sinclair, MD, IFAAD, who will discuss additional treatment alternatives, such as platelet-rich plasma (PRP) therapy and oral minoxidil.
