Female Patturn Baldness in afya

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Female androgenetic alopecia
from top of scalp - usually just general loss / widened parting - no broken hairs, Normal scalp, usually hairs miniaturise to thinner finer and so to vellus hairs (non-pigmented thin fine short hairs)
never on occiput, seldom from sides - think hypothyroid or Iron
deficiency (diffuse)
different patturn to males - although Male patturn may occur in females - check androgens but usually normal
generally slow progressive - rarely start in adolescence
complex inheritance
may relate to depression

Mx
Finasteride (5a red inhibit - stops Testos to dihydroT) - works for men, pre-men women - avoid as teratogenic, post-men - not effective
Steroids / Ketoconazole - doesn't work
Laser - little evidense
2% Minoxidil - some evidense (60% effective), not on NHS, use for 4-6 /12 if effective
will need to continue to maintain, if not effective by 6/12 abandon
or may respond to Anti-androgens .... (dec miniaturisation)
Cyproterone acetate - need contraception
Spironolactone

SE cyproterone
irregular menses, loss libido, fatigue, wt change, breast tender, hepatotoxic, depression

SE Spironolactone
Hyperkalaemia (avoid in renal failure)
feminisation of male fetus

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