The currently preferred treatment for androgenetic alopecia is topically administered 2 percent minoxidil. Advanced androgenetic alopecia, however, may not respond to treatment, because the inflammation that surrounds the bulge area of the follicle may irreparably damage the follicular stem cell. 6īecause the hair loss in androgenetic alopecia is an aberration of the normal hair cycle, it is theoretically reversible.
#MY HAIR HAS TAKEN 7 YEARS TO GROW FREE#
In this situation, total testosterone, free testosterone, dehydroepiandrosterone sulfate, and prolactin levels should be obtained. If a woman has irregular menses, abrupt hair loss, hirsutism, or acne recurrence, an endocrine evaluation is appropriate. Therefore, an extensive hormonal work-up is unnecessary. Most women with androgenetic alopecia have normal menses, normal fertility, and normal endocrine function, including gender-appropriate levels of circulating androgens. However, they have been found to have higher levels of 5α-reductase (which converts testosterone to dihydrotestosterone), more androgen receptors, and lower levels of cytochrome P450 (which converts testosterone to estrogen). Women with androgenetic alopecia do not have higher levels of circulating androgens. The remaining hair configuration may resemble a monk's haircut. Even persons with severe androgenetic alopecia almost always have a thin fringe of hair frontally. In women, the thinning is diffuse, but more marked in the frontal and parietal regions. With successive anagen cycles, the follicles become smaller (leading to shorter, finer hair), and nonpigmented vellus hairs replace pigmented terminal hairs. In the presence of androgens, genes that shorten the anagen phase are activated, and hair follicles shrink or become miniaturized. Hair follicles contain androgen receptors. A stepwise approach to the diagnosis of hair loss is provided in Figure 1. If the diagnosis is not clear based on the history and physical examination, selected laboratory tests and, occasionally, punch biopsy may be indicated. Patients should not shampoo their hair 24 hours before the test is performed. A negative test (six or fewer hairs obtained) indicates normal shedding, whereas a positive test (more than six hairs obtained) indicates a process of active hair shedding. The hairs are then gently but firmly pulled. Approximately 60 hairs are grasped between the thumb and the index and middle fingers.
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The “pull test” is an easy technique for assessing hair loss. Third, the hair shaft is examined for caliber, length, shape, and fragility. Second, the density and distribution of hair are assessed. Follicular units are apparent in nonscarring alopecias but absent in scarring types. First, the scalp is examined for evidence of erythema, scaling, or inflammation. The physical examination has three parts.
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The patient's diet, medications, present and past medical conditions, and family history of alopecia are other important factors. Crucial factors include the duration and pattern of hair loss, whether the hair is broken or shed at the roots, and whether shedding or thinning has increased. 1, 2Ī careful history often suggests the underlying cause of alopecia.
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Alopecia in women has been found to have significantly deleterious effects on self-esteem, psychologic well-being, and body image.
#MY HAIR HAS TAKEN 7 YEARS TO GROW PATCH#
Hair loss can range from a small bare patch that is easily masked by hairstyling to a more diffuse and obvious pattern. Because alopecia can be devastating to women, management should include an assessment for psychologic effects.Īlthough alopecia can occur anywhere on the body, it is most distressing when it affects the scalp. Telogen effluvium is often a self-limited disorder. Corticosteroids and other agents are typically used in women with alopecia areata. Topically administered minoxidil is labeled for the treatment of androgenetic alopecia in women. In some patients, selected laboratory tests or punch biopsy may be necessary.
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The diagnosis is usually based on a thorough history and a focused physical examination. Other disorders include alopecia areata, telogen effluvium, cicatricial alopecia, and traumatic alopecias. Androgenetic alopecia is the most common cause of hair loss in women. Alopecia can be divided into disorders in which the hair follicle is normal but the cycling of hair growth is abnormal and disorders in which the hair follicle is damaged.