Female pattern hair loss (androgenetic alopecia in women): Pathogenesis, clinical features, and diagnosis
- Amy McMichael, MD
Amy McMichael, MD
- Professor of Dermatology
- Wake Forest University Baptist Medical Center
Female pattern hair loss (FPHL) is a common form of nonscarring hair loss that primarily occurs in adult women. The condition is characterized by the progressive loss of terminal hairs over the frontal and vertex regions of the scalp, resulting in a visible reduction in hair density (picture 1A-C). Unlike many cases of androgenetic alopecia in men (male pattern hair loss), the loss of terminal hairs in affected areas is usually incomplete and the frontal hairline is often spared.
The pathogenesis, clinical manifestations, and diagnosis of FPHL will be reviewed here. Other forms of nonscarring hair loss and the treatment of FPHL are discussed separately. (See "Evaluation and diagnosis of hair loss" and "Androgenetic alopecia in men: Pathogenesis, clinical features, and diagnosis" and "Clinical manifestations and diagnosis of alopecia areata" and "Chemotherapy-induced alopecia" and "Telogen effluvium" and "Traction alopecia" and "Female pattern hair loss (androgenetic alopecia in women): Treatment and prognosis".)
In the past, the term "androgenetic alopecia" was the primary term used to refer to the appearance of the common, progressive loss of terminal hair on the frontal scalp and/or vertex of the scalp in both men and women. The term "andro" signified a hormonal etiology and "genetic" signified a contribution of heredity to the clinical phenotype.
Over the years, as more work on hair loss was published, "female pattern hair loss" became the preferred term for this form of hair loss in women. This newer terminology helps to distinguish the different clinical features of this process in women versus men and reflects the lack of evidence to support a hormonal contribution in all cases of the condition.
Further, some authors use the terms "androgen-dependent FPHL" and "androgen-independent FPHL" to separate women with FPHL due to androgen excess from women with FPHL and normal androgen levels . The term "female pattern alopecia" has also been used in place of FPHL.
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- ETIOLOGY AND PATHOGENESIS
- CLINICAL MANIFESTATIONS
- ASSOCIATED DISORDERS
- Psychosocial dysfunction
- Associated medical conditions
- Patient history
- Physical examination
- - Dermoscopy
- Scalp biopsy
- Laboratory tests
- Adjunctive tests
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS