Clemens Esche

Clemens Esche

Pocono Medical Center

Title: Alopecia in Middle Aged Women: Diagnosis, Management, And Perspectives


Dr. Clemens Esche is a dermatologist in Allentown, Pennsylvania and is affiliated with Pocono Medical Center. He received his medical degree from Medizinische Fakultat: Startseite - Universitat zu Koln and has been in practice for 22 years. Dr. Esche accepts several types of health insurance, listed below. He is one of 2 doctors at Pocono Medical Center who specialize in Dermatology. He also speaks multiple languages, including German


Alopecia in middle aged women is discussed with a focus on female pattern baldness (FPB ), telogen effluvium (TE ), and hair shaft alterations due to hair care. Key to establishing the diagnosis is the clinical presentation along with a detailed history, including medication use, systemic illnesses, physical and emotional stress, endocrine dysfunction and hair-care practices. FPB is the most common cause of alopecia in women and presents with gradual thinning over the mid-frontal scalp. The hair pull test will be positive where the hair is thinning, but negative away from the thinning areas. Topical minoxidil 2% is FDA approved. In postmenopausal women with FPB, finasteride 1 mg/day taken for 12 months did not increase hair growth or slow the progression of hair thinning. Somewhat effective are antiandrogens (e.g. oral contraceptives, spironolactone, cypropterone, flutamide, dutasteride ), prostaglandin analogs (e.g. bimatoprost, latanoprost ), and ketoconazole. Hair transplantation can be considered in advanced FPB that is resistant to medical treatment. Concealment with a hairpiece, hair prosthesis such as extensions, or partial hairpieces can be useful. Weight loss improves FPB in hyperandrogenic women. The efficacy of laser and low-level light therapy remains to be established. TE presents with generalized hair loss with a positive hair pull test, indicating active hair shedding, particularly at the vertex and scalp margin. The modified wash test and dermoscopy can further assist, leaving the biopsy for difficult cases. Automated digital image analysis (TrichoScan ) is error-prone. Treatment of TE primarily involves correction of precipitating medical conditions. Conclusion: Despite its common occurrence, our understanding of the etiology of alopecia in middle aged women remains incomplete. Additional basic research followed by adequately powered randomized controlled trials investigating new treatment options are needed.