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When Do You do Bloodwork in Women with Female Pattern Hair Loss?

January 23, 2021

This is a common situation where a woman comes into our office presenting with female pattern hair loss. It is often a question as to whether or not bloodwork is necessary to see if androgen excess is responsible for the hair loss.

A recent review article in the Journal of the American Academy of Dermatology 2021 looked at androgen-mediated skin disease and came up with an algorithm for when bloodwork or ovarian ultrasounds are necessary when investigating women with androgen mediated skin disorders.

The authors indicated if the woman presents with female pattern hair loss (FPHL) alone then no further bloodwork or investigation is required. However, if the woman has more than 1 androgen-mediated skin disorder (e.g. acne, FPHL, hirsutism) or has FPHL and menstrual irregularities or evidence of virilization, then bloodwork is recommended to rule out an underlying problem.

This algorithm clarifies the situations in which further investigation is necessary in the evaluation of FPHL.

Reference:

Androgens in women: Androgen-mediated skin disease and patient evaluation. Bienenfeld A, Azarchi S, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR. J Am Acad Dermatol. 2019 Jun;80(6):1497-1506.

Alopeca Areata Consensus of Experts Study (ACE)

January 19, 2021

A recent article published in the Journal of the American Academy of Dermatology outlined some of the world experts consensus opinions of therapeutic options for alopecia areata. Topical and intralesional corticosteroids were the most common treatments used for this problem, although other topicals such as calcineurin inhibitors, prostaglandin analogues like Latisse, minoxidil, and DPC were acknowledged to be useful in some situations.

With respect to systemic therapy, oral corticosteroids can sometimes be used although steroid-sparing agents would probably be preferred for chronic alopecia areata. If used, oral steroids generally require a taper over more than 12 weeks. Some of the steroid sparing agents mentioned include cyclosporine and methotrexate, as well as JAK inhibitors.

Reference for alopecia areata consensus:

The Alopecia Areata Consensus of Experts (ACE) Study PART II: Results of an International Expert Opinion on Diagnosis and Laboratory Evaluation for Alopecia Areata. Meah N, Wall D, York K, Bhoyrul B, Bokhari L, Sigall DA, Bergfeld WF, Betz RC, Blume-Peytavi U, Callender V, Chitreddy V, Combalia A, Cotsarelis G, Craiglow B, Donovan J, Eisman S, Farrant P, Green J, Grimalt R, Harries M, Hordinsky M, Irvine AD, Itami S, Jolliffe V, King B, Lee WS, McMichael A, Messenger A, Mirmirani P, Olsen E, Orlow SJ, Piraccini BM, Rakowska A, Reygagne P, Roberts JL, Rudnicka L, Shapiro J, Sharma P, Tosti A, Vogt A, Wade M, Yip L, Zlotogorski A, Sinclair RD. J Am Acad Dermatol. 2020 Sep 11:S0190-9622(20)32614-1.

Study comparing PRP to minoxidil for female pattern hair loss

January 3, 2021

The main problem with platelet rich plasma (PRP) studies is that there are so many different ways of preparing PRP that it is difficult to assess the effectiveness of PRP as a whole. One practitioner may prepare the PRP differently from another or the method of injecting may be different from one another.

Despite this, this study is important because it provides further real evidence that PRP for androgenic alopecia in women is helpful. This study was performed by the Mayo Clinic and was published in Dermatologic Surgery 2020.

This was a randomized, controlled pilot study and patients were treated with either PRP followed by minoxidil after an 8 week washout period, or with minoxidil followed by PRP. The hair was analyzed using a TrichoScan device and looked at hair count, vellus hair density, terminal hair density, and cumulative thickness. The patients were also asked how they felt about the benefit or lack of benefit from treatment with minoxidil and PRP.

The study showed there was a definite improvement from PRP, although the study also suggests that minoxidil may have been slightly more effective in these patients. Interestingly, the patient’s subjective opinions about PRP vs. minoxidil was that PRP was more effective than minoxidil. Lastly, the authors noted there may be a combination effect from the two treatments.

Further studies are needed but this provides more objective evidence that PRP is effective for female pattern hair loss.

Reference:

A Randomized, Controlled Pilot Trial Comparing PlateletRich Plasma to Topical Minoxidil Foam for Treatment of Androgenic Alopecia in Women. Bruce AJ, Pincelli TP, Heckman MG, Desmond CM, Arthurs JR, Diehl NN, Douglass EJ, Bruce CJ, Shapiro SA. Dermatol Surg. 2020 Jun;46(6):826-832