A 55-year-old woman comes to the office due to hair loss. She has had gradual thinning of hair at the vertex and center of the scalp since experiencing menopause 4 years ago. There is no associated pain or itching. Medical history is notable for hypothyroidism. Current medications include levothyroxine and a daily multivitamin supplement. The patient does not use tobacco, alcohol, or illicit drugs.
Vital signs are normal. Examination shows thinning of hair as shown in the exhibit.
Which of the following is the most likely cause of this patient's hair loss?

Question

A 55-year-old woman comes to the office due to hair loss.  She has had gradual thinning of hair at the vertex and center of the scalp since experiencing menopause 4 years ago.  There is no associated pain or itching.  Medical history is notable for hypothyroidism.  Current medications include levothyroxine and a daily multivitamin supplement.  The patient does not use tobacco, alcohol, or illicit drugs.
Vital signs are normal.  Examination shows thinning of hair as shown in the exhibit.
Which of the following is the most likely cause of this patient's hair loss?

Quizplus · Accepted Answer

11ec193a_9794_9f3a_853d_07e88bc92b43_MD0002_00 This patient has typical features of androgenetic alopecia (female pattern baldness). As the name implies, the hair loss is driven by both hormonal (eg, circulating androgens) and genetic factors, and patients often have a family history of similar hair loss. The pattern and severity vary between men and women. In men, the hair loss usually occurs at the temporal areas, anterior hairline, and vertex; in women, it affects the vertex and center of the scalp with sparing of the hairline. hair loss Androgenetic alopecia is the most common cause of hair loss, with a lifetime incidence of up to 80% in men and 50% in women. The diagnosis is based on clinical findings, and testing (eg, biopsy) is needed only if other possible causes are likely. Topical minoxidil is the usual first-line treatment in both men and women. 5-alpha-reductase inhibitors (eg, finasteride) can be considered in men but are not approved for use in women. (Choice A) Alopecia areata is characterized by smooth, circular areas of complete hair loss, rather than large areas of thinning, as in this patient. Alopecia areata (Choice C) Telogen effluvium is a common cause of hair thinning, but generally occurs diffusely across the scalp. Also, telogen effluvium usually has an acute onset, and symptoms generally resolve within a year. This patient's chronic hair thinning affecting the center of the scalp is more consistent with androgenetic alopecia. (Choice D) Tinea capitis is characterized by scaly, erythematous patches of hair loss, often with pruritus, tender lymphadenopathy, and scarring. (Choice E) Trichotillomania is due to compulsive plucking of hair, leading to an irregular pattern of broken hair strands of varying lengths. It predominantly affects the front and sides of the scalp, as well as the eyebrows and lashes. Educational objective: Androgenetic alopecia causes chronic thinning of hair. In men, it primarily affects the temples, anterior hairline, and vertex; in women, it primarily affects the vertex and center of the scalp with sparing of the hairline. Treatment options include topical minoxidil for men and women and finasteride for men. __________ References: Hair loss: common causes and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/28925637) The effectiveness of treatments for androgenetic alopecia: a systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/28396101)

A 55-Year-Old Woman Comes to the Office Due to Hair