In a randomized clinical trial comparing treatments of female-pattern hair loss, 1 mg of oral minoxidil daily was as effective as a daily 5% topical solution applied daily. Hypertrichosis occurred in about 15% of patients, and peripheral edema in roughly 1%. The incidence of pericardial effusion at low doses remained unknown, and both symptomatic and asymptomatic cases were reported. The review recommended initiating oral minoxidil at or below 1.25 mg per day and gradual increases as tolerated.
Other therapeutic options included 5α-reductase inhibitors and antiandrogens. In a randomized trial of 137 postmenopausal patients, finasteride at 1 mg day did not differ significantly compared with placebo. Nonrandomized studies reported improvement in more than 60% of patients taking doses of 2.5 to 5 mg daily. Dutasteride data in women were limited. Neither drug was approved for women, and contraception was advised for patients of childbearing potential.
Topical minoxidil remains the only hair loss treatment approved by the US Food and Drug Administration for women. The 2% solution was applied twice daily, and the 5% foam once daily. Both increased hair density, although some patients experienced transient shedding, scalp irritation, or facial hypertrichosis. Adjunctive procedures such as microneedling, platelet-rich plasma injections, low-level light therapy, and nonablative fractional laser treatments showed potential benefits, though most evidence came from small or uncontrolled studies.
Female-pattern hair loss was characterized by gradual thinning of the frontal or central scalp with preserved follicular openings and variable hair shaft diameters. Diagnosis is typically clinical, aided by dermoscopy; scalp biopsy may confirm follicular miniaturization or rule out other causes.
“Standardized photographs of the central scalp with a midline part are a simple and effective measure to help both the physician and the patient determine the efficacy of treatment,” said Elise A. Olsen, MD, of Duke University Medical Center, and colleagues.
The review synthesized evidence from randomized controlled trials, observational studies, and case reports. Topical and oral minoxidil had the strongest data supporting efficacy, while other therapies were less well studied. The authors advised starting with topical or oral minoxidil, monitoring response for several months, and then considering additional agents or procedures as needed.
Limitations included small sample sizes, short study durations, and few placebo-controlled trial data. Variations in study design and outcome reporting impeded direct comparisons. Long-term safety data for combined or procedural treatments remained sparse.
The review concluded that successful management of female-pattern hair loss depended on individualized treatment plans that balanced efficacy, safety, and patient preference. Continuous follow-up was recommended to monitor progress, minimize adverse events, and adjust therapy as needed. Early diagnosis and patient education were emphasized to preserve follicular function and improve long-term outcomes.
The author reported no potential conflicts of interest relevant to this article. No external funding supported the preparation of the review .
