Evaluating hair loss in women

Dr. Linkov

Hair restoration makes up a significant part of Gary Linkov, M.D.’s, NYC-based facial plastic surgery practice. It’s not unusual for his female patients to complain of hair loss and thinning, says Dr. Linkov who presented “Women’s Hair Loss Evaluation,” at this year’s Global Aesthetics conference in Miami, Fla.

“Women who come in with complaints of [their] hair falling out [or] thinning and losing hair, really want to be heard,” he says.

They also want to walk away with a specific diagnosis, according to Dr. Linkov.

“Consultation takes time to figure out all the different causes of what might be contributing to the hair loss,” he says. “Knowing the various types of alopecia or hair loss conditions is very important.”

The most common type of alopecia in women is androgenic alopecia, or female pattern hair loss.

Other forms include anagen effluvium, telogen effluvium, alopecia areata and traction alopecia.

“Women with increased hair shedding but little or no reduction in hair volume over the mid-frontal scalp could be suffering from several diseases and acute and chronic telogen effluvium (TE),” according to a study published in the International Journal of Women’s Dermatology. “Anamnesis and a physical examination are needed to get the right diagnosis.”

Physical examinations can be used to quantify hair loss and to determine whether the hair is shedding at the scalp or distal hair shaft. Pull tests can be performed to evaluate the number of hairs that shed. The trichogram method can be used for hair root and cycle evaluation. Standardized wash tests can also be used, according to the study.

Importantly, “Early diagnosis and initiation of treatment are desirable because treatments are more effective to avoid the progression of hair loss than stimulating regrowth,” write the study authors.

In a recent Dermatology Times article, Valerie Callender, M.D., explains that if you can determine the root of the cause in nonscarring alopecias, most patients can achieve regrowth.

“I usually perform the [hair pull] test at the vertex, two parietal sides and the occipital area of the scalp,” she says. “It is best to select 15 or more hairs from each section and pull. I look to see if the hair is shedding or coming out from the scalp, or if there are broken hairs that correlate with hair breakage.”

As for cicatricial or scarring alopecia, this type of hair loss could be the result of other health issues, such as infection, and it is important to do a thorough health history to identify the cause.

"Hair loss can be a sign of an internal or systemic problem. That's why the workup is important," Dr. Callender says.

And once you have a diagnosis, the next step is to create a treatment plan.

“Having a comprehensive treatment plan is very important for properly treating women with hair loss …whether it’s medical therapies such as vitamins, different other medications or injections, or surgical treatments that may include hair transplant or hairline lowering,” says Dr. Linkov.

References:

Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol. 2018;4(4):203-211.