Female Hair Restoration
What is Female Pattern Hair Loss (FPHL)?
How does platelet rich plasma (PRP) help hair growth?
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Hair Restoration Solutions
Prescription Topicals and Oral Medicaion
Platelet Rich Plasma Injections
Transepidermal Drug Delivery (TED)
Alma TED’s proprietary technology with Impact Delivery™ offers a non-invasive, non-traumatic option to address the market’s growing hair loss concerns.
What is FPHL?
1) Fabbrocini, G., Cantelli, M., Masarà, A., Annunziata, M. C., Marasca, C., & Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International journal of women's dermatology, 4(4), 203-211.
Female pattern hair loss (FPHL) is the common term for androgenetic alopecia (AGA) in women. FPHL is the most common hair loss disorder in women. FPHL is characterized as a nonscarring diffuse hair loss that evolves from the progressive miniaturization of hair follicles and subsequent reduction in the number of hairs, especially in the central, frontal, and parietal scalp regions.
How common is FPHL?
1) Fabbrocini, G., Cantelli, M., Masarà, A., Annunziata, M. C., Marasca, C., & Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International journal of women's dermatology, 4(4), 203-211.
Among healthy women, approximately 6% to 38% experience some degree of female pattern hair loss (FPHL).
The age of onset for FPHL is during the reproductive years. 12% of women first develop clinically detectable FPHL by age 29 years, 25% by age 49 years, 41% by 69 years, and > 50% have some element of FPHL by 79 years.
What causes FPHL?
1) El Sayed, M. H., Abdallah, M. A., Aly, D. G., & Khater, N. H. (2016). Association of metabolic syndrome with female pattern hair loss in women: a case–control study. International journal of dermatology, 55(10), 1131-1137. 2) Arias-Santiago, S., Gutiérrez-Salmerón, M. T., Castellote-Caballero, L., Buendía-Eisman, A., & Naranjo-Sintes, R. (2010). Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study. Journal of the American Academy of Dermatology, 63(3), 420-429.
Hair loss in women is part genetic, and part multifactorial with the additional influence of environmental factors.
Unlike male pattern baldness, the role of androgens is less clear in FPHL and not always the culprit. Common medical conditions that contribute toward FPHL is polycystic ovarian syndrome and metabolic syndrome (obesity, insulin resistance, hypertension, elevated prolactin and aldosterone levels). It may be that carotid and coronary artery disease contribute to FPHL in some cases.
Whatever the underlying cause, something triggers progressive hair follicle miniaturization which leads to the production of shorter and finer hair shafts. Different from male pattern baldness, there are rarely complete areas of baldness.
Why treat FPHL?
Hair loss is substantially more distressing for women than it is for men. Women with hair loss possessed a more negative body image and a pattern of less adaptive functioning compared to control subjects.
1) Cash, T. F., Price, V. H., & Savin, R. C. (1993). Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects. Journal of the American Academy of Dermatology, 29(4), 568-575. 2) Mohamed, N. E., Soltan, M. R., Galal, S. A., El Sayed, H. S., Hassan, H. M., & Khatery, B. H. (2023). Female pattern hair loss and negative psychological impact: possible role of brain-derived neurotrophic factor (BDNF). Dermatology Practical & Conceptual, 13(3).
How can you treat FPHL?
1) Matilainen, V., Koskela, P., & Keinänen-Kiukaanniemi, S. (2000). Early androgenetic alopecia as a marker of insulin resistance. The Lancet, 356(9236), 1165-1166. 2) Morinaga, H., Mohri, Y., Grachtchouk, M., Asakawa, K., Matsumura, H., Oshima, M., Takayama, N., Kato, T., Nishimori, Y., Sorimachi, Y., Takubo, K., Suganami, T., Iwama, A., Iwakura, Y., Dlugosz, A. A., & Nishimura, E. K. (2021). Obesity accelerates hair thinning by stem cell-centric converging mechanisms. Nature, 595(7866), 266–271. 3) •Varothai, S., & Bergfeld, W. F. (2014). Androgenetic alopecia: an evidence-based treatment update. American journal of clinical dermatology, 15, 217-230. 4) •Yang, K., Tang, Y., Ma, Y., Liu, Q., Huang, Y., Zhang, Y., ... & Wu, W. (2021). Hair growth promoting effects of 650 nm red light stimulation on human hair follicles and study of its mechanisms via RNA sequencing transcriptome analysis. Annals of Dermatology, 33(6), 553. 5)
Since obesity is a risk factor for FPHL, losing weight can be an effective lifestyle measure to improve FPHL.
There are several therapeutic measures to address FPHL. There are topical and oral medications that can be quite effective. There is some evidence that combining topical and oral medication is more effective than either one by itself (see table).
Low-level laser (red light) light therapy has been FDA approved for in-home treatment of male pattern baldness.
Platelet Rich Plasma (PRP) is an emerging therapy for FPHL that is proving to be successful. It can be administered by injection or through transepidermal drug delivery (TED). We specialize in these two PRP treatment options and feel that a combination of evidence based treatments (oral, topical, red light therapy, and PRP) would likely result in the best treatment.
How does PRP help hair growth?
1) Yano, K., Brown, L. F., & Detmar, M. (2001). Control of hair growth and follicle size by VEGF-mediated angiogenesis. The Journal of clinical investigation, 107(4), 409-417. 2) Weger, N., & Schlake, T. (2005). Igf-I signalling controls the hair growth cycle and the differentiation of hair shafts. Journal of Investigative Dermatology, 125(5), 873-882. 3) Panchaprateep, R., & Asawanonda, P. (2014). Insulin‐like growth factor‐1: roles in androgenetic alopecia. Experimental dermatology, 23(3), 216-218. 4) Ota, Y., Saitoh, Y., Suzuki, S., Ozawa, K., Kawano, M., & Imamura, T. (2002). Fibroblast growth factor 5 inhibits hair growth by blocking dermal papilla cell activation. Biochemical and biophysical research communications, 290(1), 169-176.
Platelet rich plasma (PRP) contains more than 1100 different proteins. Importantly, they are a storage site for the seven main growth factors found in blood. Two of those growth factors are vital to hair growth.
A 2001 study identified “endothelial growth factor (EGF) as a major mediator of hair follicle growth and cycling and provide the first direct evidence that improved follicle vascularization promotes hair growth and increases hair follicle and hair size.”1
Another study demonstrates that “insulin-like growth factor-1 (ILGF-1) … has an essential role in hair cycle control as well as hair shaft differentiation during the development of hair follicles.”2,3
Interestingly, not every growth factor is helpful for hair growth. Fibroblast growth factor 5 (FGF-5) has been shown to inhibit hair growth.4
Does PRP really help FPHL?
1) Tawfik, A. A., & Osman, M. A. R. (2018). The effect of autologous activated platelet‐rich plasma injection on female pattern hair loss: a randomized placebo‐controlled study. Journal of cosmetic dermatology, 17(1), 47-53. 2) Dervishi, G., Liu, H., Peternel, S., Labeit, A., & Peinemann, F. (2020). Autologous platelet‐rich plasma therapy for pattern hair loss: A systematic review. Journal of cosmetic dermatology, 19(4), 827-835. 3) Puig, C. J., Reese, R., & Peters, M. (2016). Double-blind, placebo-controlled pilot study on the use of platelet-rich plasma in women with female androgenetic alopecia. Dermatologic Surgery, 42(11), 1243-1247.
There are several randomized controlled trials that demonstrate the benefit of PRP on FPHL. There are also studies which fail to show any benefit of PRP or FPHL. Cumulatively, there are more studies that show results than do not. Due to differences in individual physiology, it is impossible to predict how a person might respond to PRP for FPHL. The following are excerpts from different studies showing the efficacy of PRP for FPHL or lack thereof.
“There was a statistical significant difference between PRP and placebo areas (P<.005) regarding both hair density and hair thickness as measured by a folliscope. Global pictures showed a significant improvement in hair volume and quality together with a high overall patient satisfaction in PRP-injected sites, and these results were maintained during the 6-month follow- up.”1
"The pooled results of seven randomized controlled trials ndicated that autologous platelet-rich plasma could increase hair density in males and females when compared to placebo or no treatment. We did not identify serious short-term treatment-related adverse events."2
“13.3% of the treatment subjects (vs 0% of the placebo subjects) experienced substantial improvement in hair loss, rate of hair loss, hair thickness, and ease of managing/styling hair, and 26.7% (vs 18.2% of the placebo group) reported that their hair felt coarser or heavier after the treatment.” However, there was no improvement in hair mass index, which looks at number of hair fibers and hair diameter.3