Scalp Specialist – Female Hair Loss

As part of our ongoing feature on Female Hair Loss Tania had continued her journey towards a possible solution by visiting top Consultant Dermatologist and hair and scalp specialist, Dr Martin Wade B.Med Sci, MB BS, FACD at his clinic in London.  She has previously seen specialist Hair Surgeon Dr Greg Williams and wanted to explore all of the options open to her prior to making a decision.

Dr Wade consults from The London Skin and Hair Clinic on all general Dermatology and hair loss and scalp disorders as well as acne and he is experienced in diagnosing and treating skin cancer through his time with major Australian melanoma units. His special interests include cosmetic Dermatology. His NHS post is with Queens Hospital where he is the Clinical Lead for Dermatology and the skin cancer MDT Lead.

Dr Wade specialises in hair and scalp conditions including male pattern baldness, female hair loss,  alopecia areata, androgenetic alopecia, scarring alopecia including lichen planopilaris, as well seborrhoeic dermatitis and scalp psoriasis. Dr Wade uses clinical hair photography for monitoring of treatment.

Hair and Scalp Specialists are able to diagnose and treat many conditions of the hair and scalp in both health and disease sometimes referred to as a Trichologists. It is important for each individual patient to find a Practitioner who best suits their needs as we have found it is an extremely private and very emotive subject for our case studies.

Tania has told us on a few occasions that forcing herself to tackle her hair problems head on, the series of diagnosis and options can often be very overwhelming emotionally.  But she does want to explore every avenue and we were asked to get a  long list of blood tests done prior to the consultation with Dr Wade to allow a thorough asessment.  Patients can go to their GP for bloods however be warned that not all GP’s see hair loss as a valid problem and will often refuse blaming losses on ‘the change’!

Tania said “I never did have a really thick head of hair. While I was pregnant the thickness and condition improved greatly. My last child was born when I was 40.  After I stopped breastfeeding him things changed. It got much thinner. By the time I was in my late 40’s it was significantly thinner. During that time I did have a lot of sad things happen and anxiety … By then I had sought medical help, spent a fortune on Nourkrin supplements and also Regaine lotion.”

The Appointment

Tania was keen to explore the subject of hair loss in women in more detail and arrived at her appointment armed with her blood test results and these questions for Dr Wade.

hair and scalp our-visit-to-a-scalp-specialistQ: What is Female Pattern Hair Loss

Female pattern hair loss (FPHL) is also known as female androgenetic alopecia and is the most common form of hair loss in women. Sometimes this condition is referred to as alopecia, although that is not technically correct – alopecia simply means hair-loss, it is not a condition. The hair thins on the scalp either by increased hair shedding or a reduction in hair volume, or both. Female pattern hair loss can result not just in the physical appearance of thinning hair but also emotional effects such as anxiety, depression, frustration and low self-esteem. Thankfully, there are treatment options available to help slow down and even reverse female pattern hair loss.

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Q: What causes Female Pattern Hair Loss

The reason a woman’s hair gets thin when she suffers from androgenetic alopecia is due to the process of miniaturisation. Each time the hair follicle goes through the hair cycle it becomes smaller and smaller and thus produces a smaller hair shaft. Eventually the hair shaft is so small that it does not protrude above the level of the skin in the scalp.

Q: What are the symptoms of Female Pattern Hair Loss

Unlike men, women usually begin to lose their hair by going diffusely thin on the vertex (the top of the scalp). Sometimes, temporal recession is also seen (loss of hair at the corners of the frontal hair line). Women rarely tend to go completely bald.

There are a few hair conditions that can result in generalised thinning of hair on the top of the scalp. It is therefore extremely important that the correct diagnosis is made before embarking on treatment for hair loss in women and Tania knows to her cost.

hair and scalp our-visit-to-a-scalp-specialist-2 Scalp SpecialistQ: How do you treat Female Pattern Hair Loss?

There is now good treatment for female pattern hair loss which is aimed at reversing the process and promoting regrowth. In recent peer reviewed research 88% of women with this form of hair loss attained a positive outcome with treatment. Products which inhibit DHT or work against the androgen process, are considered the best treatments for addressing the underlying cause of this type of hair loss. Though since the cause of the hair loss could be a multitude of things, a Dermatologist may also recommend growth stimulants such as topical minoxidil as well as  prescribing the DHT Inhibitors or Anti Androgens.   Topical minoxidil is currently the only licensed product for female androgenetic alopecia in the United Kingdom.

Q: Can I do anything to slow hair loss down?

It is important that women maintain a healthy diet high in iron and healthy fats, and so supplementation with a ferritin supplement may be necessary to promote healthy hair growth. There are now some hair supplements available in the market that are showing good clinical results.

Q: How do you measure the success of treatments?

It is important that good quality clinical photographs are taken prior to starting any treatment, in order to monitor the scalp and responses to treatment. We use the Canfield stereotactic device system in our clinic which is the  global gold standard for clinical hair photography.

The Diagnosis 

Diagnosis:           Mild patterned hair loss/androgenetic alopecia

 Investigations:    Clinical hair photography

                               Testosterone 1.3

Treatment:          Continue with Minoxidil 5% Foam or Lotion topical daily

                              Add Finasteride 2.5 mgs oral daily

Review:               Six months

On examination there was patterned hair loss with the part in the vertex being wider than the occiput.  There was mild bi-temporal recession and miniaturisation was seen on dermoscopy.  The scalp was non-inflamed and the hair pull test was negative.

Tania has female pattern hair loss and due to the early onset and strong family history would be considered androgenetic alopecia.  Her blood work has shown that her testosterone level is at the upper level of normal at 1.3, however all her other bloods were normal.  I have recommended Tania continue using topical Minoxidil but have also suggested that she add Finasteride 2.5 mgs oral daily to try to stop the miniaturisation process and encourage regrowth.

We will be watching this space and Tania will be back!

You can get in touch with Dr Wade at The London Skin and Hair Clinic based at 96 Harley Street, London, W1G 7HY by calling 020 7183 4565  or emailing doctor@LSAH.co.uk  the clinic is open Monday to Saturday.

See the findings of our Surgical Consultation HERE

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