Occasionally, when a woman presents with female pattern hair loss, increased androgen production may be a contributing factor. The following signs and symptoms suggest that specific blood tests might be appropriate to rule out underlying sources of excess androgen:
- Irregular periods – for an extended period of time
- Cystic acne – severe acne which usually leaves scars
- Hirsuitism – increased body hair that doesn’t normally run in your family
- Virilization – appearance of secondary male sex characteristics such as a deepened voice
- Infertility – inability to become pregnant
- Galactorrahea – breast secretions when not pregnant (this is due to prolactin which is not actually an androgen)
It is important that when any of these symptoms are present, or these conditions are being considered, that you are under the care of a physician, to receive a proper evaluations and correct treatment if needed. Generally a gynecologist is the specialist most helpful for these problems.
Some of the tests that your doctor might order when considering androgen excess include:
- Total and Free Testosterone – the hormone that is mainly responsible for male secondary sex characteristics
- DHEA-Sulfate – a precursor to testosterone
- Prolactin – the hormone that enables the breast to secrete milk
Localised Hair Loss
Localized hair loss in women is distinct from the diffuse thinning seen in female pattern alopecia. The following are the more common causes of local alopecia. A dermatologist should be consulted if any of these conditions are suspected. Note: the term alopecia is synonymous with hair loss).
Alopecia areata is recognized by the sudden appearance of discrete, round patches that are completely devoid of hair. Occasionally, the entire scalp may be involved (alopecia totalis) and even the entire body hair including the eyebrows and eyelashes (alopecia universalis). When localized, the lesions respond well to injections of cortisone. Generalized alopecia is more difficult to treat. The prognosis is better the older the age of onset. Alopecia areata can occasionally be associated with other conditions such as thyroid disease.
Hairstyles that exert constant pull on the hair, such as “corn rows” or tightly woven braids produce a characteristic pattern called “Traction Alopecia” that can be identified by a rim of thinning or baldness along the frontal hairline and at the temples. This is easily prevented by changing one’s daily hair-care habits, but once the hair loss occurs, it may be permanent. Fortunately, this condition is easily amenable to surgery if the cause can be eliminated.
Trichotillomania is a condition seen more commonly in young females, where the person twists, tugs or pulls out her hair. This can be scalp hair, eyebrows or eyelashes. The diagnosis is made by observing short, broken hairs in the area of hair loss. The patient may deny having this habit.
Face-lift and brow-lift procedures can result in local hair loss in the vicinity of the incision. This may present as hair loss along the frontal hairline, in the temples, or adjacent to a surgical scar. If female patients do not have genetic hair loss, and have a good donor supply, they may make excellent candidates for a hair transplant.
Tinea Capitis is a fungal infection of the scalp. It presents as irregular, red and scaly patches and/or small bald patches with broken hairs. The diagnosis is made by scraping a small piece of scale from the scalp and obtaining a bit of hair for testing. The specimens are sent for special fungal stains and cultures.
Pseudopalade is a non-specific scarring alopecia that generally starts on the top of the scalp and extends into the surrounding hair bearing areas with finger-like extensions. The areas look smooth and white due to the scarring and loss of hair follicles.
Lichen Plano-pilaris is an inflammatory condition of the scalp that presents with redness, scale and localized areas of hair loss. There is a characteristic scaling at the edge of each balding patch.
Discoid Lupus Erythematosus (DLE) is the localized form of Systemic Lupus Erythematosus (SLE), a potentially serious autoimmune disease. The localized form presents with red, scaly, pigmented patches of scarred skin. The localized form of the disease is mostly a cosmetic problem, but patients must be evaluated for the systemic disease as well with specific blood tests such as an ANA. SLE can cause diffuse (generalized) hair loss and both the local and systemic forms of the disease may cause sensitivity to the sun.
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