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Female Pattern Hair Loss — SCE Dermatology MCQ

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ModerateHair DisordersFemale Pattern Hair LossSCE Dermatology

A 19-year-old woman presents with gradually progressive hair thinning over the vertex with a 'Christmas tree' pattern of widening along the central parting. She has been on the combined oral contraceptive pill for 3 years. Ferritin is 18 mcg/L. Thyroid function is normal. What is the most important modifiable factor to address?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Iron supplementation to optimise ferritin >70 mcg/L

Although this patient has female pattern hair loss, the low ferritin (18 mcg/L) is a modifiable contributing factor. While the exact threshold is debated, many trichologists recommend optimising ferritin to >70 mcg/L in women with hair loss, as iron deficiency can both cause and exacerbate hair shedding. The Christmas tree pattern (widening of the central parting with frontal preservation) is described by Olsen and is characteristic of female pattern hair loss. After addressing iron, topical Minoxidil 5% and/or anti-androgen therapy (Spironolactone off-label) can be considered as ongoing management.

Reference: BAD 2022 Female Pattern Hair Loss; BJD Trichology Review