Postmenopausal Alopecia (Hair Loss)
A 62-year-old postmenopausal woman presents with a complaint of scalp hair loss. It has been present for several years, but worsened recently several months after a hospital admission for pneumonia, prompting the visit. She noticed an abrupt onset of hair
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Lynne J. Goldberg
Case Presentation A 62-year-old postmenopausal woman presents with a complaint of scalp hair loss. It has been present for several years, but worsened recently several months after a hospital admission for pneumonia, prompting the visit. She noticed an abrupt onset of hair shedding beginning 3 months after her hospitalization, and which lasted for almost 3 months. She reports that her shedding has since slowed and is back to baseline. She is otherwise healthy except for a history of recently diagnosed mild hypertension and osteoarthritis. Her medications include lisinopril, which she has been on for 6 months, and ibuprofen. She reports that her father became bald at a young age, but denies any hair loss complaint among women in her family. Her physical exam reveals short, dyed scalp hair. The frontal hairline is preserved with mild bitemporal recession and a mildly widened hair part on the crown of her scalp in comparison to the occiput. The hair loss was diffuse without bald patches. There is no erythema, scale, pustules, or atrophy. There is no loss of hair elsewhere on her body.
My Management . Counsel the patient on the causes of diffuse hair loss. A B. Explain the treatment options for female pattern hair loss, starting with proper use and side effects of minoxidil, the only Food and Drug Administration (FDA)-approved option. C. Discuss realistic treatment outcomes and expectations. L.J. Goldberg, MD Professor of Dermatology and Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA Director, Hair Clinic, Boston Medical Center, Boston, MA, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 L. Pal, R.A. Sayegh (eds.), Essentials of Menopause Management, DOI 10.1007/978-3-319-42451-4_11
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Fig. 11.1 Anagen hair follicle. The dark blue hair matrix gives rise to a light brown hair shaft. Several layers (inner and outer root sheaths) surround the hair shaft (Bhawan J, Sau P, Byers HR. Dermatopathology Interactive Atlas, http:// dermpathatlas.com/ used with permission)
HAIR CYCLE
CATAGEN (ARREST)
ANAGEN (GROWTH)
TELOGEN
Shed
Hair Growth and Loss: An Overview Postmenopausal hair loss is a prevalent, burdensome, and yet a poorly understood entity. This chapter aims at discussing the known mechanisms, differential diagnoses, and available management strategies and options to address scalp hair loss in postmenopausal women. Before one can understand hair loss, a brief review of hair anatomy, the hair cycle, and causes of hair loss, or alopecia, is in order. Hair follicles form during embryogenesis. The hair shaft itself is produced by hair matrix cells in the underlying hair follicle, which is located deep in the skin in the subcutaneous tissue (Fig. 11.1). Each follicle produces a hair shaft in a cyclic fashion in several phases, whose lengths are genetically determined (Table 11.1). Hair loss is divided into two broad types, scarring (cicatricial) or non-scarring. Scarring alopecias are due to inflam
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