September 2019 | Case of the month

The diagnoses are male pattern and female pattern alopecia.

For thorough notes on management refer to the relevant chapter, some of the key points are as follows:

• If uncertain as to whether it is female pattern or generalised alopecia check FBC, ferritin and TFT
• Refer to the condition as alopecia rather than baldness
• Provide patients information leaflets and give details for Alopecia UK (on the chapter linked above)
• Hair products containing nanofibres can help stick hair together to give an appearance of thicker hair
• Assess levels of psychological distress - always important when considering treatment, including the potential costs to the patient when not all patients will benefit
• Minoxidil 
  • Is a topical treatment that can be used for mild-moderate alopecia
  • Upto 40% of patients may benefit 
  • Minoxidil does not alter the natural history of hair loss, but rather it can thicken / increase the density of remaining hair
  • The 5% formula is recommended BD for men and OD for women
  • Minoxidil comes as a solution or foam - the easiest way to measure the correct amount is to use a large tangerine-sized blob of the foam
  • The response to treatment should be assessed at six months - if beneficial treatment needs to be continued to maintain efficacy
  • Patients should not be referred for this treatment
• Other medical treatments:
  • Men: Finesteride is used by some men (refer to the linked chapter)
  • Women: if there is associated hyperandrogenism patients can be considered for treatment with anti-androgens, although evidence for a satisfactory response is lacking - refer to the related chapter on Hyperandrogenism
• ​Wigs
  • ​Can be considered for patients with moderate to severe alopecia
  • Patients can be referred (normally to local dermatology departments) for the provision of wigs, which are of sufficient quality to normally make for a good cosmetic appearance
• Surgery
  • ​Can be performed in both male and female patients, although the outcomes appear better for men
  • Patients need to have sufficient donor hair - the best site is from the neck region of the scalp
  • Outcomes are variable, and depend to a large extent on the skill / experience of the surgeon
  • Treatments are very expensive and patients need to give considerable thought before having such a procedure performed