What is Alopecia?
Alopecia, a term encompassing various forms of hair loss, usually presents with gradual hair thinning, scalp itching, and the emergence of bald spots (1). This can be triggered by factors such as emotional or physical trauma and medical treatments such as chemotherapy (1).
Female Pattern Hair Loss
As women age, female androgenetic alopecia (AGA), also known as female pattern hair loss (FPHL), becomes the leading cause of baldness (2). FPHL is distinguished by progressive hair thinning, especially at the top of the scalp (2). Though its exact cause remains unknown, several factors including genetics, hormones, and environmental influences are thought to contribute to its severity (3). Among these factors are a lack of physical activity and hypertension (3).
Links, Risk Factors, & Prevalence
FPHL is often associated with other health conditions, such as polycystic ovary syndrome (PCOS), metabolic syndrome, insulin resistance, as well as cardiovascular diseases like heart disease (2). The frequent coexistence of these conditions with FPHL suggests potential shared underlying factors and highlights the importance of comprehensive care.
As previously mentioned, alopecia becomes more prevalent as women age, particularly during menopause, when hormonal changes can promote hair follicle shrinkage and hair loss (1, 2). However, FPHL can also manifest in childhood and adolescence (2). This early onset can be distressing for young girls and their families and emphasizes the importance of awareness and early intervention. Research indicates that other possible risk factors for FPHL include long-term use of oral contraceptives and being exposed to the sun for more than 16 hours each week (2).
In terms of prevalence, FPHL varies across different ethnic groups, with Caucasian women typically experiencing higher rates compared to their Asian counterparts (2).
Emotional Impact & Treatment Avoidance
For many women, hair holds immense significance, beyond its physical appearance. Consequently, hair loss can negatively affect one's confidence and overall quality of life (4). Notably, the emotional distress which accompanies chemotherapy-induced alopecia, known as alopecia effluvium, may prompt cancer patients to avoid their potentially life-saving treatment (1, 5).
Current Clinical Treatment Options
Topical minoxidil, originally developed as a vasodilator for high blood pressure treatment, is an evidence-based therapy used to combat hair loss (3). Adherence to this treatment is crucial as results are typically seen after four to six months of continued use (3).
Additionally, oral minoxidil has demonstrated growing efficacy in treating FPHL, as evidenced by clinical trials showing improvements in hair density (3). However, the treatment carries the potential for adverse side effects such as tachycardia, edema, and scalp reactions, which need to be carefully considered (3).
In the realm of cancer treatment, scalp cooling systems have become increasingly popular for their role in minimizing chemotherapy-induced hair loss, with promising outcomes observed (5). These devices function by constricting the blood vessels below the scalp, thereby decreasing the flow of chemotherapy to the hair follicles and lowering the risk of hair loss (6).
Holistic Approach to Hair Loss
In conclusion, alopecia is a complex condition that can have significant impacts on women’s self-image and well-being. By recognizing and addressing the connections between FPHL and other health conditions, healthcare providers can provide more comprehensive care, promoting both the physical and emotional health of their patients.
References
Hair Loss in Women: Types, Causes, Treatments. (2018, December 19). Healthline. https://www.healthline.com/health/hair-loss-women#causes
Ramos, P. M., & Miot, H. A. (2015). Female Pattern Hair Loss: a clinical and pathophysiological review. Anais Brasileiros de Dermatologia, 90(4), 529–543. https://doi.org/10.1590/abd1806-4841.20153370
Müller Ramos, P., Melo, D. F., Radwanski, H., de Almeida, R. F. C., & Miot, H. A. (2023). Female pattern hair loss: therapeutic update. Anais Brasileiros de Dermatologia, 98(4). https://doi.org/10.1016/j.abd.2022.09.006
Shimizu, G. K. M., Wedy, G. F., Schaefer, L. V., Ramos, P. M., & Miot, H. A. (2018). Translation into Portuguese language (Brazil), transcultural adaptation and validation of the quality of life questionnaire in female pattern hair loss (WAA-QoL-BP). Anais Brasileiros de Dermatologia, 93(5), 701–706. https://doi.org/10.1590/abd1806-4841.20187452
Amarillo, D., de Boni, D., & Cuello, M. (2021). Alopecia, quimioterapia y gorras de frío o “scalp cooling system.” Actas Dermo-Sifiliográficas, 113(3). https://doi.org/10.1016/j.ad.2021.09.003
Uscher, J. (2024). Cold Caps and Scalp Cooling Systems. BreastCancer.Org. https://www.breastcancer.org/treatment-side-effects/hair-loss/cold-caps-scalp-cooling
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