Female alopecia: Why does my hair fall out?

Alopecia is not just a men’s thing, although it is more normalized in them. Hair loss, whether punctual or chronic, leads more and more women to consultation. It is estimated that 30% of women will suffer from some type of alopecia throughout their lives. “We don’t know if there is more female alopecia than in the 50s, what we do know is that there are many more women in consultation for this problem than ten years ago,” says Dr. David Saceda, dermatologist and trichologist at the Pedro Jaén Group and the Ramón y Cajal Hospital, and member of the Spanish Academy of Dermatology and Venereology (AEDV). A reality that has become even more visible after the 2022 Oscar gala, which will be remembered for the slap that Will Smith printed on Chris Rock’s face. The reason? The presenter joked at the awards show with actress Jada Pinkett Smith’s appearance, asking her if she was going to star in a sequel to ‘Lieutenant O’Neil’, the 90s film in which Demi Moore appeared bald. A joke in very bad taste, if we take into account that her look is not something voluntary. At the end of 2021, the actress acknowledged on her social networks that she is losing her hair and that she has decided to accept it: “This alopecia and I are going to be friends… period!” There are more than a hundred types, although in Jada’s case it seems to be alopecia areata, whose origin is autoimmune (the immune system mistakenly attacks and destroys healthy hair follicles), and in which circular areas without hair, which can lead to widespread loss. The most common alopecia in women is androgenic, of hormonal and genetic origin. In this case, those affected lose capillary density, the line becomes wider and the scalp is visible. Another type that especially affects them is frontal fibrosing, a form of scarring alopecia of autoimmune and hormonal origin in which the eyebrows are usually lost, and the hairline on the forehead and sideburns recedes. “It is an emerging disease that affects postmenopausal women of which we are seeing more and more cases,” says Dr. Juan Jiménez, dermatologist at the Ramón y Cajal Hospital in Madrid and member of the AEDV. These alopecias should not be confused with telogen effluvium, an intense but punctual hair loss caused by physical or emotional stress, which is reversible, since the hair will grow back after a few months. To have a correct diagnosis, it is essential to go to the dermatologist who will recommend the most appropriate treatment in each case. “If caught early, most alopecia can be stopped and prevented from progressing. Scars, such as the fibrosing frontal, do not have a cure as such for now, the objective is to stop the progression and stabilize it, “explains Dr. Jiménez. The areata, points out the expert, “when it is mild, it is reversible and heals. But total (whole head) or universal (whole body) alopecia areata is more complicated and takes a long time or does not recover, even if you treat it. It is unpredictable and capricious because it depends on the immune system. For the treatment of severe alopecia areata, Dr. Saceda is hopeful about a family of drugs that are currently being studied, JAK inhibitors: “It’s very promising and it’s going to change things a lot.” In androgenic alopecia or common baldness “it can be improved a lot if you act as soon as possible,” says Dr. Jiménez. It is progressive and gradually loses density due to the sensitivity of the hair to testosterone. That is why it is more common in men. “He needs long-term treatment. If left on, there is no rebound effect, but the rate of hair thinning returns to what it was before », he warns. Today, dermatologists have “a battery of treatments to stop this loss that did not exist twenty years ago,” says Dr. Saceda. Ahead of all the options is minoxidil, a drug approved for female alopecia, which works by increasing the blood flow around the follicle so that it thickens. It can be used topically or orally and its great advantage is that it has no hormonal interaction. To achieve a better and sustainable result, it is recommended to combine several therapies. “In the first consultation with the patient we look for an effective, safe and comfortable treatment that is very sustainable in the long term,” says the trichologist. In the dermatological arsenal to fight female alopecia there are also antiandrogens, oral or injected, which block hormones at the root of the hair. Or injections of platelet-rich plasma, which is extracted from the patient herself. What best suits the analytics, exploration and vital context of the woman is prescribed. “For example, there are very good treatments but they do not allow pregnancy,” warns Dr. Saceda. In any case, the expert recalls that pregnancy itself improves hair and is an excellent treatment for androgenic alopecia. But, if in any case, the expectant mother needed maintenance therapy at this stage, platelet-rich plasma injections could be used. Hair transplant, which has become so fashionable among men, is also possible in women, although in them the limitation is that alopecia is more diffuse and it is not always possible to improve the entire affected area. “The ideal context for a female transplant is a woman with a mild-moderate loss that has not improved with medical treatment,” concludes Dr. Saceda.