Alopecia is (also) female? Dr. Michela Zazzaron


In recent years we are witnessing an increase in the number of requests for trichological pathologies by female patients.

Hair problems are increasingly affecting the female sex, with different clinical presentations depending on age.

Leaving aside the pictures of scarring alopecia that represent a separate chapter, in our clinical practice we identify 4 different clusters of female patients with hair problems.


Effluvium capillorum non-self-limiting and chronicizing

In this case, the patient experiences a loss of hundreds of hairs per day, with peaks of 300-400 hairs per wash, which lasts more than 3 months and does not stop.

This picture is very alarming and understandably so for the patient, who suffers a reduction in hair mass of up to 30-40%.

The treatment of the patient involves the execution of first level blood tests aimed at identifying ongoing inflammatory states, micronutrient deficiencies, thyroid pathologies or autoimmune/rheumatological disorders that are not known. The trichological examination should investigate the dietary habits and weight fluctuations, stress level, sleep cycle, menstrual cycle and lifestyle, as well as the use of any self-prescribed remedies. Iron or copper deficiency or subclinical thyroid disease is not uncommon. The therapy is absolutely personalized according to the findings of the examination, trichoscopy and blood tests and usually provides for the prescription of specific lotions to be applied at home, targeted integration by mouth and ad hoc outpatient therapy.


Early Female Alopecia in relation to Polycystic Ovary Syndrome

The typical patient is a girl who since young age has manifested a frontal thinning with thinning of the hair diameter and tendency to excess sebum in the scalp. Usually the patient is affected by Polycystic Ovary Syndrome even if she does not show frank signs of hyperandrogenism such as hirsutism (presence of hair in areas not typically feminine e.g. beard, hair on the back or chest) and frank acne.

In fact to make the diagnosis of Polycystic Ovary Syndrome is sufficient that 2 of the 3 following conditions are present:

  • Hyperandrogenism(defined both on the basis of clinical manifestations and by the detection of elevated blood values of androgenic hormones)
  • Oligo-amenorrhea (irregular cycles) with lack of ovulation
  • Presence of polycystic ovary on ultrasound examination

Very often this patient will develop by the age of 40 a dysthyroidism (hypothyroidism in most cases) and insulin resistance, i.e. a poor sugar metabolism that could predispose her to other systemic diseases.

The treatment of this patient should include a gynecological and endocrinological approach, but it should be emphasized that there are effective therapies to improve the trichological and general systemic situation beyond the systemic estroprogestinic therapy. There are many therapeutic alternatives without necessarily having to resort to the pill, such as the use of systemic non-pharmacological supplements with anti-androgenic function, the topical application of hormone-based lotions and mesotherapy with specific active ingredients and possibly autologous regenerative therapy (PRP or stem cells).


Patient in perimenopause/menopause who sees progressively changing the quality of her hair

The 50-year-olds of 2021 are decidedly more groomed, active and youthful than the 50-year-olds of a few decades ago. Consequently, facing the menopausal season with its inevitable changes, including hair changes, may not be easy.

From the clinical point of view, these patients report a reduction in the thickness of the hair, a change in the tightness of the fold and sometimes a change in the waviness and frizziness of the hair itself. Also in this case, the hormonal setting should be investigated and whether replacement therapy has been prescribed by the gynecologist. The trichological medical therapy is in this case aimed at improving the structure of the hair, support the growth phase and maintain a good trophism of the scalp; by way of example: applications of topical lotions, integration of Vit D3 and other micronutrients, carboxytherapy and microinjections of polydeoxyribonucleotides at the scalp level.


Senior patients with receding frontal hairline and visibility of the skin under the hair

The diagnosis and care of these patients is delicate because these pictures often go in differential diagnosis with chronic scarring pathologies, for which a thorough dermoscopy and possibly a biopsy are necessary.

Patients usually experience burning or discomfort on the scalp, which is often translucent, reactive and prone to redness. The trichoscopy during the trichological examination and the execution of first level blood tests allow a correct classification of patients and then prepare ad personam therapies. It is also necessary, as in all trichological pictures, to educate the patient to a proper cleansing and care of the hair, helping the patient to choose appropriate products and hygiene standards, involving also the hairdresser where possible.


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