Summary
Definition
History and exam
Key diagnostic factors
- family history of baldness
- gradual receding of frontal hairline, central, and crown (vertex)
- diffuse thinning of the central scalp with preservation of frontotemporal hairline
Risk factors
- family history of baldness
- advancing age
- polycystic ovary syndrome in women
- white ethnicity
- insulin resistance
- prostate cancer
Diagnostic tests
1st tests to order
- hair-pull test
- thyroid function test
- serum ferritin
Tests to consider
- CBC with differential
- comprehensive metabolic panel
- antinuclear antibodies
- rapid plasma reagin
- free testosterone
- serum dehydroepiandrosterone (DHEA)-sulfate
- sex hormone-binding globulin
- dermatoscopy/trichoscopy
- scalp biopsy
Treatment algorithm
men who opt for conservative management
men who opt for medical management
women who opt for conservative management
women who opt for medical management
failed medical treatment
Contributors
Authors
Carolyn Goh, MD
Associate Clinical Professor
Department of Medicine
Division of Dermatology
UCLA Medical Center
Los Angeles
CA
Disclosures
CG has spoken for the International Society of Hair Restoration Surgeons, the American Academy of Dermatology, the Pacific Dermatologic Association, the California Society of Dermatology and Dermatologic Surgery, and has had manuscripts published in a variety of journals. CG has also participated in advisory boards for Pelage Pharmaceuticals and Pfizer, Inc.
Acknowledgements
Dr Carolyn Goh would like to gratefully acknowledge Dr Robert Haber, Dr Christiane Querfeld, and Dr Christopher R. Shea, previous contributors to this topic. RH has an ownership interest in a company that manufactures light-based hair growth devices and receives royalties for the sales of a surgical device used in hair restoration surgery. CQ and CRS declare that they have no competing interests.
Peer reviewers
Marcelo G. Horenstein, MD
Director of Dermatopathology
The Dermatology Group
Verona
NJ
Disclosures
MGH declares that he has no competing interests.
Alvin R. Solomon, MD
Professor of Dermatology
Emory University School of Medicine
Atlanta
GA
Disclosures
ARS declares that he has no competing interests.
David Whiting, MD, FACP
Medical Director
The Baylor Hair and Skin Research and Treatment Center
Dallas
TX
Disclosures
DW is an author of a number of references cited in this topic. We have since been made aware that Dr David Whiting is deceased.
References
Key articles
Starace M, Orlando G, Alessandrini A, et al. Female androgenetic alopecia: an update on diagnosis and management. Am J Clin Dermatol. 2020 Feb;21(1):69-84. Abstract
European Dermatology Forum. S3 - European Dermatology Forum guideline for the treatment of androgenetic alopecia in women and in men. 2017 [internet publication].Full text
Olsen EA, Messenger AG, Shapiro J, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005 Feb;52(2):301-11. Abstract
Olsen EA, Whiting D, Bergfeld W, et al. A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2007 Nov;57(5):767-74. Abstract
Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578-89. Abstract
Lucky AW, Piacquadio DJ, Ditre CM, et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol. 2004 Apr;50(4):541-53. Abstract
Olsen EA, Hordinsky MK, Price VH, et al. Alopecia areata investigational assessment guidelines: part II. National Alopecia Areata Foundation. J Am Acad Dermatol. 2004;51:440-7. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Diffuse alopecia areata
- Acute telogen effluvium
- Chronic telogen effluvium
More DifferentialsGuidelines
- S3 - European dermatology forum guideline for the treatment of androgenetic alopecia in women and in men
- Medical guidelines for clinical practice for diagnosis and treatment of hyperandrogenic disorders
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