Diagnosis
Hair loss in women, just like in men, can be attributed to common androgenetic alopecia or Female Pattern Hair Loss (FPHL), making it the most prevalent form of hair loss in females. However, unlike men, where about 90 percent of cases are caused by hereditary male pattern baldness, women’s hair loss can be triggered by various conditions and circumstances that may not be as straight forward.
When attempting to identify the trigger for hair loss in women, a battery of diagnostic tests should be conducted. While these tests may not always provide a specific cause, they can at least rule out certain disorders and aid in the diagnostic process. It is important to note that for many patients, these tests often return results within the normal range. Nevertheless, the proper diagnosis of female hair loss typically involves a process of elimination.
Diagnostic Tests:
Hormone Levels
DHEAs, testosterone, androstenedione, prolactin, follicular-stimulating hormone, and luteinizing hormone levels are checked to assess hormonal imbalances.
Serum Iron and Ferritin
These tests determine the levels of iron and ferritin in the bloodstream, which are vital for hair health.
Total Iron Binding Capacity (TIBC)
This test helps evaluate the body’s capacity to transport iron.
Thyroid Stimulating Hormone (T3, T4, TSH)
Thyroid function is examined since thyroid disorders can contribute to hair loss.
VDRL
This screening test detects the presence of syphilis, which can be linked to hair loss in some cases.
Complete Blood Count (CBC)
A comprehensive blood count assesses overall health and can reveal potential issues.
Scalp Biopsy
A small portion of the scalp, usually measuring around 4mm in diameter, is extracted and examined under a microscope to determine the underlying cause of hair loss. The sample should always be taken from areas of hair loss and usually from a site where the stitches and any small scar will be the most hidden.
It’s essential to keep in mind that while a biopsy is a valuable diagnostic tool, the patient’s personal history also holds significant diagnostic value. The intricate details of their story can sometimes carry more weight than the results of a biopsy.
Moreover, if a scalp biopsy is sent to a pathologist who lacks extensive experience in histological diagnosis of hair loss, it can occasionally lead to diagnostic challenges, potentially portraying the condition as less responsive to treatment.
Hair Pull Test
In this simple diagnostic test, the physician gently pulls a small amount of hair (approximately 100 strands simultaneously) to assess for excessive hair loss. Normally, one to three hairs per pull is within the expected range.
Densitometry
This handheld magnification device checks for hair shaft miniaturization, a characteristic of androgenetic alopecia.
Scalp Dermoscopy
Also known as trichoscopy, is a valuable, noninvasive technique for assessing hair loss. It provides magnified views of hair and scalp skin. This can be done using a manual dermoscope (×10 magnification) or a videodermoscope (up to ×1,000 magnification). Trichoscopy is especially effective for diagnosing various conditions like androgenetic alopecia, alopecia areata, telogen effluvium, trichotillomania, congenital triangular alopecia, scarring alopecia, tinea capitis, and hair shaft disorders.
Diagnosing hair loss in women requires a comprehensive approach, considering various factors and conducting appropriate tests to establish the most likely cause. Proper evaluation and understanding of the underlying reasons for hair loss can lead to better treatment and management strategies.