Hair loss is a topic of daily talk even among the elderly, especially for women, as population aging is a trend worldwide. Hair loss in the elderly has its distinctive features and an early treatment is essential for an optimal cosmetic effect. Greying of hair is usually the first manifestation of hair aging, while the number of hair follicles and the properties of hair shaft show only slight changes. More studies are needed to explore the mechanism behind hair aging, in terms of aging of hair follicular stem cells. Senescent alopecia, androgenetic alopecia, acute or chronic telogen effluvium, and alopecia areata are the most common forms of hair loss in the elderly women. Concurrence of them is not uncommon and differentiation can sometimes be difficult. It is important to check hyperandrogenemic status and search for androgen-producing tumors in the elderly women with rapid progression or sudden exacerbation of diffuse hair loss. Tinea capitis should be considered in female patients with pruritic and scaling changes of the scalp. There are currently few treatment options for advanced androgenetic alopecia and the results are overall unsatisfactory. Among scarring alopecia, important differential diagnoses in the elderly women are lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, erosive pustular dermatosis and giant cell arteritis. Association with other coexisting skin or systemic diseases should be excluded or otherwise treated. An early active treatment to eliminate the inflammation is crucial for best hair regrowth. Alopecia neoplastica due to tumor metastasis especially from breast carcinoma is infrequent but serious for elderly women. Hair loss, both scarring and nonscarring, can be observed in patients undergoing targeted cancer therapies such as epidermal growth factor receptor inhibitors.
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