Shapiro J. Clinical practice. Hair loss in women. N Engl J Med. 2007;357:1620-1630. Abstract
Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001;27:53-54. Abstract
Birch MP, Messenger JF, Messenger AG. Hair density, hair diameter and the prevalence of female pattern hair loss. Br J Dermatol. 2001;144:297-304. Abstract
Camacho-Martínez FM. Hair loss in women. Semin Cutan Med Surg. 2009;28:19-32. Abstract
Leavitt M. Understanding and management of female pattern alopecia. Facial Plast Surg. 2008;24:414-427. Abstract
Ramos PM, Miot HA. Female pattern hair loss: a clinical and pathophysiological review. An Bras Dermatol. 2015;90:529-543. Abstract
Gan DC, Sinclair RD. Prevalence of male and female pattern hair loss in Maryborough. J Investig Dermatol Symp Proc. 2005;10:184-189. Abstract
Paik JH, Yoon JB, Sim WY, Kim BS, Kim NI. The prevalence and types of androgenetic alopecia in Korean men and women. Br J Dermatol. 2001;145:95-99. Abstract
Vujovic A, Del Marmol V. The Female Pattern Hair Loss: Review of Etiopathogenesis and Diagnosis. BioMed Res Int. 2014;2014:767628.
Blume-Peytavi U, Blumeyer A, Tosti A, et al. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol. 2011;164:5-15. Abstract
Herskovitz I, Tosti A. Female pattern hair loss. Int J Endocrinol Metab. 2013;11:e9860.
Olsen EA. Current and novel methods for assessing efficacy of hair growth promoters in pattern hair loss. J Am Acad Dermatol. 2003;48:253-262. Abstract
Torres F, Tosti A. Female pattern alopecia and telogen effluvium: figuring out diffuse alopecia. Semin Cutan Med Surg. 2015;34:67-71. Abstract
Venning VA, Dawber RP. Patterned androgenic alopecia in women. J Am Acad Dermatol. 1988;18:1073-1077. Abstract
Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152:466-473. Abstract
Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977;97:247-254. Abstract
Olsen EA. Female pattern hair loss. In: Blume-Peytavi U, Tosti A, Whiting DA, Trueb R, eds. Hair Growth and Disorders. Berlin, Germany:Springer; 2008:171-183.
Torres F, Tosti A. Trichoscopy: an update. G Ital Dermatol Venereol. 2014;149:83-91. Abstract
Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Rudnicka L. Dermoscopy in female androgenic alopecia: method standardization and diagnostic criteria. Int J Trichology. 2009;1:123-130. Abstract
Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Women’s Health. 2013;5:541-556. Abstract
Tosti A, Piraccini BM, Iorizzo M, Misciali C. Frontal fibrosing alopecia in postmenopausal women. J Am Acad Dermatol. 2005;52:55-60. Abstract
Cotsarelis G, Millar SE. Towards a molecular understanding of hair loss and its treatment. Trends Mol Med. 2001;7:293-301. Abstract
Yazdan P. Update on the genetics of androgenetic alopecia, female pattern hair loss, and alopecia areata: implications for molecular diagnostic testing. Semin Cutan Med Surg. 2012;31:258-266. Abstract
Sawaya ME, Shalita AR. Androgen receptor polymorphisms (CAG repeat lengths) in androgenetic alopecia, hirsutism, and acne. J Cutan Med Surg. 1998;3:9-15. Abstract
Calvo RM, Asunción M, Sancho J, San Millán JL, Escobar-Morreale HF. The role of the CAG repeat polymorphism in the androgen receptor gene and of skewed X-chromosome inactivation, in the pathogenesis of hirsutism. J Clin Endocrinol Metab. 2000;85:1735-1740. Abstract
Yip L, Zaloumis S, Irwin D, Severi G, Hopper J, Giles G, et al. Gene-wide association study between the aromatase gene (CYP19A1) and female pattern hair loss. Br J Dermatol. 2009;161:289-294. Abstract
Redler S, Tazi-Ahnini R, Drichel D, Birch MP, Brockschmidt FF, Dobson K, et al. Selected variants of the steroid-5-alpha-reductase isoforms SRD5A1 and SRD5A2 and the sex steroid hormone receptors ESR1, ESR2 and PGR: no association with female pattern hair loss identified. Exp Dermatol. 2012;21:390-393. Abstract
Price VH. Androgenetic alopecia in adolescents. Cutis. 2003;71:115-121. Abstract
Sawaya ME, Price VH. Different levels of 5α-reductase type I and II, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia. J Invest Dermatol.1997;109:296-300. Abstract
Schmitt JV, Ribeiro CF, Souza FH, Siqueira EB, Bebber FR. Hair loss perception and symptoms of depression in female outpatients attending a general dermatology clinic. An Bras Dermatol. 2012;87:412-417. Abstract
Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol. 1999;141:398-405. Abstract
Camacho FM, García-Hernández M. Psychological features of androgenetic alopecia. J Eur Acad Dermatol Venereol. 2002;16:476-480. Abstract
Van der Donk EM, Hunfeld JA, Passchier J, Knegt-Junk KJ, Nieboer C.l. Quality of life and maladjustment associated with hair loss in women with alopecia androgenetica. Soc Scie Med. 1994;38:159-163.
Price VH, Roberts JL, Hordinsky M, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. 2000;43:768-776. Abstract
Rogaine® (minoxidil). Johnson & Johnson. New Brunswick, NJ. November 2015.
Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges. 2011;9:S1-S57.
Blume-Peytavi U, Hillmann K, Dietz E, Canfield D, Garcia Bartels N. A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women. J Am Acad Dermatol. 2011;65:1126-1134. Abstract
Propecia® (finasteride) Merck. Whitehouse Station, NJ. September 2013.
Iorizzo M, Vincenzi C, Voudouris S, et al. Finasteride treatment of female pattern hair loss. Arch Dermatol. 2006;142:298-302. Abstract
Kohler C, Tschumi K, Bodmer C, Schneiter M, Birkhaeuser M. Effect of finasteride 5 mg (Proscar) on acne and alopecia in female patients with normal serum levels of free testosterone. Gynecol Endocrinol. 2007;23:142-145. Abstract
Trueb RM. Finasteride treatment of patterned hair loss in normoandrogenic postmenopausal women. Dermatology. 2004;209:202-207. Abstract
Avodart ® (dutasteride) GlaxoSmithKline. Research Triangle Park, NC. September 2014.
Eun HC, Kwon OS, Yeon JH, et al. Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male patients with male pattern hair loss: a randomized, double-blind, placebo-controlled, phase III study. J Am Acad Dermatol. 2010;63:252-258. Abstract
Stough D. Dutasteride improves male pattern hair loss in a randomized study in identical twins. J Cosmet Dermatol. 2007;6:9-13. Abstract
Olsen EA, Hordinsky M, Whiting D, et al; Dutasteride Alopecia Research Team. The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride. J Am Acad Dermatol. 2006;55:1014-1023. Abstract
Moftah N, Abd-Elaziz G, Ahmed N, Hamed Y, Ghannam B, Ibrahim M. Mesotherapy using dutasteride-containing preparation in treatment of female pattern hair loss: photographic, morphometric and ultrustructural evaluation. J Eur Acad Dermatol Venereol. 2013;27:686-693. Abstract
Leyden J, Dunlap F, Miller B, et al. Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermatol. 1999;40:930-937. Abstract
Boychenko O, Bernstein RM, Schweiger ES. Finasteride in the treatment of female pattern (androgenic) alopecia: a case report and review of the literature. Cutis. 2012;90:73-76. Abstract
Adamopoulos DA, Karamertzanis M, Nicopoulou S, Gregoriou A. Beneficial effect of spironolactone on androgenic alopecia. Clin Endocrinol (Oxf). 1997;47:759-760. Abstract
Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152:466-473. Abstract
Aldactone® (spironolactone). Pfizer. New York, NY. November 2014.
Park JH, Moh US, Lee SY, You SH. Micropigmentation: camouflaging scalp alopecia and scars in Korean patients. Aesthetic Plast Surg. 2014;38:199-204. Abstract
Whiting DA, Jacobson C. Treatment of female androgenetic alopecia with minoxidil 2%. Int J Dermatol. 1992;31:800-804. Abstract
Jacobs JP, Szpunar CA, Warner ML. Use of topical minoxidil therapy for androgenetic alopecia in women. Int J Dermatol. 1993;32:758-762. 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;50:541-553. Abstract
van Zuuren EJ, Fedorowicz Z, Carter B, Andriolo RB, Schoones J. Interventions for female pattern hair loss. Cochrane Database Syst Rev. 2012;5:CD007628.
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;39:578-589. Abstract
Rathnayake D, Sinclair R. Innovative use of spironolactone as an antiandrogen in the treatment of female pattern hair loss. Dermatol Clin. 2010;28:611-618. Abstract
Rathnayake D, Sinclair R. Use of spironolactone in dermatology. Skinmed. 2010;8:328-332. Abstract
Katsambas AD, Dessinioti C. Hormonal therapy for acne: why not as first line therapy? Facts and controversies. Clin Dermatol. 2010;28:17-23. Abstract
Hairmax.com. Boca Raton: Lexington International LLC; 2001-2013. www.hairmax.com. Accessed February 4, 2016.
Leavitt M, Charles G, Heyman E, Michaels D. HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: a randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Invest. 2009;29:283-292.
Satino J. Markou M. Hair regrowth and increased hair tensile strength using the HairMax laser comb for low-level laser therapy. International Journal of Cosmetic Surgery and Aesthetic Dermatology. 2003;5:113-117.
Sharma P, Jain D, Maithani M, et al. Development and characterization of dutasteride bearing liposomal systems for topical use. Curr Drug Discov Technol. 2011;8:136-145. Abstract
Chandrasekar BS, Nandhini T, Vasanth V et al. Topical minoxidil fortified with finasteride: an account of maintenance of hair density after replacing oral finasteride. Indian Dermatol. Online J. 2015;1:17-20.

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Rutgers, The State University of New Jersey, and Medscape, LLC, encourage Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Faculty

Antonella Tosti, MD

Activity Chair and Professor, Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida

Disclosures

Disclosure: Antonella Tosti, MD has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Aclaris Therapeutics, Inc., DS Laboratories, Incyte Corporation, Kythera Biopharmaceuticals, Polichem, Procter & Gamble

Dr Tosti does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Tosti does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Lakshi M. Aldrege, MSN, ANP-BC

Nurse Practitioner, Dermatology Service, VA Portland Health Care System, Portland, Oregon

Disclosures

Disclosure: Lakshi M. Aldrege, NP has disclosed the following relevant financial relationships:
Served as a speaker or a member of a speakers bureau for: AbbVie Inc., Celgene Corporation, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Pfizer, Inc.

Ms Aldrege does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Aldrege does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Amy J. McMichael, MD

Professor, Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina

Disclosures

Disclosure: Amy J. McMichael, MD has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Allergan, Covance Inc., eResearch Technology, Inc., Galderma Laboratories, LP, Guthey Renker, Incyte Corporation, Johnson & Johnson, KeraNetics LLC, Merck & Co., Inc., Merz Inc., Proctor & Gamble, Samumed, LLC
Received grants for clinical research from: Allergan, Proctor & Gamble, Samumed LLC
Other: Royalties from: Informa Healthcare, UpToDate

Dr McMichael does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr McMichael does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor

Shari J. Dermer, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Shari J. Dermer, PhD has disclosed no relevant financial relationships.

CE Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

Patrick Dwyer

Director, CME, Center for Continuing and Outreach Education at Rutgers Biomedical and Health Sciences

Disclosures

Disclosure: Patrick Dwyer has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed for relevance, accuracy of content, and balance of presentation by Robert A. Schwartz, MD, MPH, Professor & Head, Dermatology, Professor of Medicine and of Pediatrics, Rutgers New Jersey Medical School, Newark, NJ.

Disclosure: Robert A. Schwartz, MD, MPH has disclosed no relevant financial relationships.

Field Testers

This activity has been pilot-tested for time required for participation by Steven M. Draikiwicz, MD and Daniel Grabell, MD.

The field testers have disclosed no relevant financial relationships.

CME / CE

Update on Female Pattern Hair Loss: Advances in Diagnosis and Treatment

Authors: Antonella Tosti, MD; Lakshi M. Aldrege, MSN, ANP-BC; Amy J. McMichael, MD
CME / CE Released: 2/28/2016
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 2/28/2017, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for dermatologists, primary care providers, OB/GYNs, nurses, and pharmacists.

The goal of this activity is to provide clinicians with current perspectives on the identification and treatment of female pattern hair loss (FPHL) and communication strategies for patients with FPHL.

Upon completion of this activity, participants should be better able to:

Describe the prevalence, pathogenesis, diagnosis, and clinical presentation of female pattern hair loss
Outline the psychological and quality-of-life effects of hair loss in women and how these effects inform management strategies
Review the available treatments for female pattern hair loss

Disclosures

Faculty

Antonella Tosti, MD

Activity Chair and Professor, Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida

Disclosures

Disclosure: Antonella Tosti, MD has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Aclaris Therapeutics, Inc., DS Laboratories, Incyte Corporation, Kythera Biopharmaceuticals, Polichem, Procter & Gamble

Dr Tosti does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Tosti does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Lakshi M. Aldrege, MSN, ANP-BC

Nurse Practitioner, Dermatology Service, VA Portland Health Care System, Portland, Oregon

Disclosures

Disclosure: Lakshi M. Aldrege, NP has disclosed the following relevant financial relationships:
Served as a speaker or a member of a speakers bureau for: AbbVie Inc., Celgene Corporation, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Pfizer, Inc.

Ms Aldrege does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Aldrege does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Amy J. McMichael, MD

Professor, Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina

Disclosures

Disclosure: Amy J. McMichael, MD has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Allergan, Covance Inc., eResearch Technology, Inc., Galderma Laboratories, LP, Guthey Renker, Incyte Corporation, Johnson & Johnson, KeraNetics LLC, Merck & Co., Inc., Merz Inc., Proctor & Gamble, Samumed, LLC
Received grants for clinical research from: Allergan, Proctor & Gamble, Samumed LLC
Other: Royalties from: Informa Healthcare, UpToDate

Dr McMichael does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr McMichael does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor

Shari J. Dermer, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Shari J. Dermer, PhD has disclosed no relevant financial relationships.

CE Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

Patrick Dwyer

Director, CME, Center for Continuing and Outreach Education at Rutgers Biomedical and Health Sciences

Disclosures

Disclosure: Patrick Dwyer has disclosed no relevant financial relationships.

Peer Reviewer

Field Testers

This activity has been pilot-tested for time required for participation by Steven M. Draikiwicz, MD and Daniel Grabell, MD.

The field testers have disclosed no relevant financial relationships.

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From Medscape Education Dermatology

CME / CE

Update on Female Pattern Hair Loss: Advances in Diagnosis and Treatment

Authors: Antonella Tosti, MD; Lakshi M. Aldrege, MSN, ANP-BC; Amy J. McMichael, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / CE Released: 2/28/2016

Valid for credit through: 2/28/2017, 11:59 PM EST

processing....

Contents of This CME Activity

All sections of this activity are required for credit.

Section 1. A Primer on Female Pattern Hair Loss: Pathophysiology, Diagnosis, and Treatment

The basics on hair loss in women.
Antonella Tosti, MD

Section 2. Management of Female Pattern Hair Loss

Demystifying female pattern hair loss.
Lakshi M. Aldrege, NP

Section 3. Improving Patient Outcomes in Female Pattern Hair Loss Through Communication

Case-based insights on managing female pattern hair loss.
Amy J. McMichael, MD

Page 1 of 4

A Primer on Female Pattern Hair Loss: Pathophysiology

CME / CE Information Download Slides

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This CME/CE certified enduring material is provided by Rutgers, The State University of New Jersey, and Medscape, LLC.

Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Faculty

Antonella Tosti, MD

Lakshi M. Aldrege, MSN, ANP-BC

Amy J. McMichael, MD

Editor

Shari J. Dermer, PhD

CE Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Patrick Dwyer

Peer Reviewer

Field Testers

CME / CE

Update on Female Pattern Hair Loss: Advances in Diagnosis and Treatment

Target Audience and Goal Statement

Disclosures

Faculty

Antonella Tosti, MD

Lakshi M. Aldrege, MSN, ANP-BC

Amy J. McMichael, MD

Editor

Shari J. Dermer, PhD

CE Reviewer/Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Patrick Dwyer

Peer Reviewer

Field Testers

Accreditation Statements

For Physicians

For Nurses

For Pharmacists

Instructions for Participation and Credit

Update on Female Pattern Hair Loss: Advances in Diagnosis and Treatment

Contents of This CME Activity

Section 1. A Primer on Female Pattern Hair Loss: Pathophysiology, Diagnosis, and Treatment

Section 2. Management of Female Pattern Hair Loss

Section 3. Improving Patient Outcomes in Female Pattern Hair Loss Through Communication