Treatment Modalities of Female Pattern Hair Loss

Background: Hair loss (HL) is a major concern among people of different ages, race, and gender. Female pattern HL (FPHL) is an important issue for females since it relates to their beauty. Females around the world seek treatment to restore hair growth or to thicken scalp hair. To guide the management of FPHL, an understanding of the causes and the treatment modalities of FPHL is required. Therefore, this review assessed current treatment modalities available for FPHL.

Objectives: The aim of this study was to undertake a literature review of the treatment modalities available for FPHL. The study also sought to compare the treatments and identify their advantages and disadvantage in terms of their effectiveness and safety.

Materials and Method: The study design was the evidence-based systemic literature review. Inclusion and exclusion criteria were set, search terms were generated, searches were undertaken, and relevant articles (in English) on the medical and surgical modalities for FPHL were identified and retrieved from several databases. Articles published before 2000 were excluded. The appraisal of the selected articles was conducted using Parahoo and the Heuter Model.

Results: The study found a strong correlation between FPHL and race and ethnicity. The prevalence of FPHL was greater among those aged 60 and over. This suggested that ethnic or racial groups in Asia are less vulnerable to FPHL compared to their counterparts in the USA, the UK, and Australia. The review shows that minoxidil 5% is safe and effective and should be applied for about six months for noticeable improvement and a decrease in the shedding of hair. Side effects of minoxidil included urticaria, hypotension, and facial hypertrichosis. A combination of minoxidil and spironolactone proved to be safe and effective for FPHL. On the other hand, some studies concluded that finasteride neither promoted hair growth nor slowed down the progression of thinning of the hair, and more research was needed on the effectiveness of finasteride for FPHL. However, it was shown that finasteride 5 mg is useful and safe for FPHL among postmenopausal women. However, cyproterone acetate was more effective for high-BMI patients who have symptoms of hyperandrogenism, hypermenorrhoea, and menstrual cycle modifications. Stem cell therapy is a promising treatment for FPHL, but more studies are needed to establish its effectiveness.

Conclusion: Minoxidil seems to be the most suitable treatment available for females of all ages. However, it carries the risk of side effects. None of the medications has proved to be safe enough to be prescribed on a case-based strategy. Follicular unit extraction is a suitable surgical option for females and has better outcomes and fewer side effects. Stem cell therapy, PRP and mesotherapy are all promising treatments for managing HL, but more comprehensive studies are needed.

Key words: female alopecia, female pattern hair loss, hair regrowth, treatment modalitiesAcknowledgements

I am grateful to the course leader, Professor Simon Myers, who organized an extraordinarily successful international Aesthetic Medicine course with his team, and to the course instructor, Dr. Ali Mahmoud Ghanem, who gave his support and advice to clarify any doubts or issues.

I am also grateful to my supervisor, Dr. Haider Hassan, for his continuous support, for taking the time to read my work, for guiding me in the right direction, enabling me to make the right decisions, and improving my skills during the dissertation phase. I am also grateful to Dr. Frank Joseph, who provided excellent administrative support throughout this course.

I would also like to thank my consultant, Dr. Talal Al-Hitmi for constant inspiration, endless help and support. My thanks also go to my friend, Nurse Khulood Abdalsalam Kassem, for help, advice, time and support during the two years of the master’s degree, and to my colleague, Dr. Saif Badran, for his assistance and guidance during the dissertation.

Finally, I am very thankful to my eldest sister Alia, who I consider to be my second mother, for her continuous social support, for providing the best study environment, and for always being there when needed.