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Female Androgenetic Alopecia: An Update on Diagnosis and Management

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Abstract

Female androgenetic alopecia (FAGA) is a common cause of non-scarring alopecia in women. The onset may be at any age following puberty and the frequency increases with age. Clinically, it shows a diffuse hair thinning over the central scalp, while the frontal hairline is usually retained. FAGA can have a significant psychological impact, leading to anxiety and depression. For this reason, early diagnosis is very important to stop the progression of the disease. The sex hormonal milieu is the main pathogenetic mechanism studied in FAGA. The role of androgens is not clearly defined and only one-third of women with FAGA show abnormal androgen levels. Endocrinological diseases with hyperandrogenism associated with FAGA comprise polycystic ovarian syndrome (PCOS), hyperprolactinemia, adrenal hyperplasia and, rarely, ovarian and adrenal tumours. Usually the diagnosis of FAGA is made clinically. A complete clinical examination and a blood examination can reveal other signs of hyperandrogenism. Trichoscopy shows the typical hair miniaturization. A scalp biopsy can be useful when the clinical evaluation does not provide a definitive diagnosis or when cicatricial alopecias with hair loss in the distribution of FAGA or alopecia areata are suspected. FAGA is a slowly progressive disease. The goal of therapy is to stop the progression and to induce a cosmetically acceptable hair regrowth. The most important drugs are topical minoxidil and oral anti-androgens. The purpose of this review is to provide an update on FAGA and to create a guideline on diagnosis and management of this frequent hair disease, not always easily recognizable from cicatricial alopecias with a similar distribution.

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  1. Michela Starace and Gloria Orlando equally contributed to this article.

Authors and Affiliations

  1. Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, V. Massarenti 1, 40138, Bologna, Italy

    Michela Starace, Aurora Alessandrini & Bianca Maria Piraccini

  2. Unit of Dermatology, Department of Medicine-DIMED, University of Padova, Padua, Italy

    Gloria Orlando

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Correspondence to Bianca Maria Piraccini.

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Michela Starace, Gloria Orlando, Aurora Alessandrini, and Bianca Maria Piraccini have no conflicts of interest to declare.

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Starace, M., Orlando, G., Alessandrini, A. et al. Female Androgenetic Alopecia: An Update on Diagnosis and Management. Am J Clin Dermatol 21, 69–84 (2020). https://doi.org/10.1007/s40257-019-00479-x

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