Department of Health Sciences and Mother and Child Care, University of Palermo, Palermo, Italy.
Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, New York.
J Clin Endocrinol Metab. 2019 Jul 1;104(7):2875-2891. doi: 10.1210/jc.2018-02548.
To determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female pattern hair loss (FPHL), a common form of hair loss in women that is characterized by the reduction of hair density in the central area of the scalp, whereas the frontal hairline is generally well conserved.
An expert task force appointed by the Androgen Excess and PCOS Society, which included specialists from dermatology, endocrinology, and reproductive endocrinology.
Levels of evidence were assessed and graded from A to D. Peer-reviewed studies evaluating FPHL published through December 2017 were reviewed. Criteria for inclusion/exclusion of the published papers were agreed on by at least two reviewers in each area and arbitrated by a third when necessary.
(i) The term "female pattern hair loss" should be used, avoiding the previous terms of alopecia or androgenetic alopecia. (ii) The two typical patterns of hair loss in FPHL are centrifugal expansion in the mid scalp, and a frontal accentuation or Christmas tree pattern. (iii) Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal. (iv) The assessment of patients with FPHL is primarily clinical. (v) In all patients with FPHL, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron, zinc, thyroid hormones, and prolactin are optional but recommended. (vi) Treatment of FPHL should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.
确定当前的知识状态，并提供循证建议，这些建议可能对所有治疗女性型脱发（FPHL）的专家都有效，FPHL 是女性常见的脱发形式，其特征是头皮中央区域的头发密度减少，而额发线通常保持良好。
雄激素过多和多囊卵巢综合征学会任命的一个专家工作组，包括皮肤科、内分泌学和生殖内分泌学方面的专家。
评估并将证据等级从 A 到 D 分级。对截至 2017 年 12 月发表的评估 FPHL 的同行评审研究进行了综述。在每个领域，至少有两名评审员同意纳入/排除发表论文的标准，必要时由第三名评审员进行仲裁。
（i）应使用“女性型脱发”一词，避免使用以前的脱发或雄激素性脱发术语。（ii）FPHL 中两种典型的脱发模式是头皮中部的离心性扩张，以及额部加重或圣诞树模式。（iii）当雄激素水平正常时，孤立的 FPHL 不应被视为高雄激素血症的迹象。（iv）FPHL 患者的评估主要是临床评估。（v）所有 FPHL 患者均应评估是否存在潜在的雄激素过多。维生素 D、铁、锌、甲状腺激素和催乳素的测量是可选的，但推荐进行。（vi）FPHL 的治疗应从米诺地尔（5%）开始，如果脱发严重或存在高雄激素血症，可加用 5α-还原酶抑制剂或抗雄激素。
