Is Your Hair Taking a Break?

BOSTON -- For many women, their hair is one of their most defining characteristics. From short and sassy bobs to long, cascading curls, the right hairstyle can make any woman look more pulled together and can even take years off of her appearance. That's why hair loss can be particularly devastating for women, and dermatologists advise that it should be addressed at the first noticeable signs of a problem.

At the American Academy of Dermatology's Summer Academy Meeting 2009 in Boston, dermatologist Amy J. McMichael, MD, FAAD, associate professor of dermatology at Wake Forest University School of Medicine in Winston-Salem, N.C., discussed the different types of hair loss women experience and the current treatment options.

"Hair loss is a very misunderstood condition, both in terms of how people see their own hair loss and how physicians who are not dermatologists approach hair loss," said Dr. McMichael. "It is important for women to be evaluated by a dermatologist, who specializes in hair loss, at the first signs of a problem -- whether she notices that her ponytail is smaller than it used to be, she sees more hair in the shower, or if her part is widening. Determining the cause of the hair loss is the first step in treating it and preventing future hair loss."

Female-Pattern Hair Loss
The most common form of hair loss in women is female-pattern hair loss, which is a hereditary condition also referred to as androgenetic alopecia. While pattern hair loss affects both men and women, it is very different in women and does not display the classic receding hairline or bald spot on top of the scalp as it does in men. In women, the frontal hairline is usually maintained, but there is visible thinning over the crown. Dr. McMichael explained that in both male- and female-pattern hair loss, the hair stays on the head for a shorter time due to a short growth phase, resulting in baby fine hairs that do not reach their full length or diameter.

Fortunately, several treatment options are effective for women with hair loss. Minoxidil 2% is the only topical medication approved by the U.S. Food and Drug Administration (FDA) for female-pattern hair loss. Minoxidil 5% is only FDA-approved for male-pattern hair loss, but it has been shown to be very effective in women as well. Both the 2% and 5% solutions are available over-the-counter. While minoxidil does not grow new hair, it works by prolonging the growth phase of hair -- providing more time for hair to grow out to its full density.

"Minoxidil is a wonderful option for women with thinning hair, as it only treats the hair you want to keep that is not reaching its maximum growth and is an easy way to fill in hair density," said Dr. McMichael. "Although minoxidil is an over-the-counter treatment, women should consult their dermatologist who is experienced with the product and can explain how it works and off-set any known side effects -- such as irritation or fine facial hair that could develop along the cheeks and jaw line."

In some cases, other medications may be used off-label to treat female hair loss, including finasteride (which is FDA-approved for male-pattern hair loss) for women of non-childbearing age only, and the anti-androgens spironolactone and flutamide that work by blocking the male hormone testosterone at the cellular level of the hair follicle. These oral medications also may be an option for women who may not want to spend time applying minoxidil every day. Dr. McMichael also noted that hair transplantation is an extremely effective procedure for women who want to fully restore their lost hair and works best in conjunction with topical or oral medications to prevent further hair loss.