Female pattern hair loss: clinico-laboratory findings and trichoscopy depending on disease severity

Female pattern hair loss (FPHL) is a progressive hair loss disorder with unclear triggering and supporting factors. Trichoscopic features of each stage of FPHL have not been specifically elaborated previously.

To analyze characteristics and investigate associations of clinico-laboratory and trichoscopic features of female patients in regard to the severity of hair loss in FPHL and to facilitate its diagnosis using noninvasive scalp dermoscopy (trichoscopy) in Fitzpatrick skin type III patients.

Clinico-laboratory and trichoscopic data from 60 patients with FPHL were analyzed using Spearman's correlation test.

Patients had mean age of 34.4±10.6 years and mean duration of hair loss of 4.49±3.76 years. Of all, 45% (27/60) had a family history of pattern hair loss (PHL) and had an earlier onset of hair loss. Stage of hair loss positively correlated with duration and age at presentation. No association was found between the severity of FPHL and laboratory values including anemic and gonadal hormone profiles. Characteristic trichoscopic features (at 10-fold magnification) of FPHL were peripilar signs (PPS) (brown, BPPS and white, WPPS), white dots, scalp pigmentation, and focal atrichia. WPPS, scalp pigmentation, and focal atrichia positively correlated with the stage and duration of hair loss.

Family history of PHL causes an earlier onset of hair loss but does not influence its course or severity. The latter is also not affected by abnormal anemic profile or hormonal levels. PPS, scalp pigmentation, focal atrichia, and white dots are characteristic of PHL. WPPS, scalp pigmentation, and focal atrichia reflect advanced PHL.