Women’s hair loss: pathophysiological, diagnostic and therapeutic aspects

Abstract

The article presents a review of modern ukrainian and foreign publications on the pathogenesis, clinical manifestations and diagnostics of female pattern hair loss (FPHL), which is a common type of hair loss and its frequency increases with age. The questions of terminology, disease prevalence, and risk factors of hair loss are considered. It is emphasized that FPHL is a clinical problem and that it is advisable to clarify the comorbid profile of female patients and to screen for metabolic disorders. There is still no complete understanding of the pathophysiology of FPHL. There is evidence that hormonal, genetic, and environmental factors are involved in the process of hair loss in women. Current data concerning systemic hormonal disturbances in ovarian and adrenal gland diseases in women as well as the importance of disorders of androgen-dependent mechanisms of regulation of the hair follicle growth cycle are presented.The attention is drawn to genetic abnormalities in the case of FPHL. The role of growth factors, cytokines, microinflammation, iron deficiency, perifollicular fibrosis, oxidative stress in regression of the hair follicle is considered. FPHL is characterized as non-scarring alopecia, which develops due to progressive miniaturization of hair follicles and further hair reduction, especially in the central (frontal and parietal) scalp, gradual replacement of long terminal hair by short pubic (vellus) hair. Three models of female hair loss, modern classification according to the stages of progression used in practice, possible causes of clinical differences in alopecia in men and women are presented. The main directions of diagnostics (history, clinical and laboratory examination, special dermatological tests) are outlined, the possibilities of modern noninvasive diagnostic method of dermoscopy are emphasized. Pharmacotherapy, recommended on the basis of evidence-based medicine, is limited to two drugs – topical minoxidil and systemic finasteride. The necessity of interdisciplinary approach to the management of patients with FPHL has been proved.