Female Androgenetic Alopecia: An Update on Diagnosis and Management

Michela Starace; Gloria Orlando; Aurora Alessandrini; Bianca Maria Piraccini


Am J Clin Dermatol. 2020;21(1):69-84. 

In This Article


FAGA is a common form of non-scarring alopecia in women. Clinically it is characterized by hair thinning in the central scalp and histologically by miniaturization of hair follicles and by an increased number of telogen hairs in the involved area.

Recently, the following cicatricial alopecias with hair loss in a FAGA distribution have been described: FAPD, CPHL, CCCA and FFA. In order to rule out the presence of a cicatricial alopecia, trichoscopical examination should always evaluate the frontal hairline and the crown area in patients complaining of hair thinning, especially if associated with itching or pain. In doubtful cases, a trichoscopy-guided biopsy can be decisive.

The predilection of FAGA, FAPD, CPHL, CCCA and FFA for postmenopausal women, the effectiveness of androgen-modulating treatments and the histological finding of perifollicular inflammation involving mainly the miniaturized hair follicles suggest an overlap or a progression between these diseases.

More studies are necessary to further elucidate the relationship between these diseases and therefore determine the correct management and treatments.