Content area
Full text
Figure 1. Ludwig scale. Reproduced with permission from [3].
(Figure omitted. See article PDF.)
Figure 2. Sinclair scale. Reproduced with permission from [65].
(Figure omitted. See article PDF.)
Figure 3. Hair shaft thickness heterogeneity in trichoscopy.
(Figure omitted. See article PDF.)
Figure 4. Triple-biopsy procedure. Reproduced with permission from [4].
(Figure omitted. See article PDF.)
Figure 5. Response to spironolactone over 24 months. Reproduced with permission from [65].
(Figure omitted. See article PDF.)
Figure 6. Response to finasteride at 12 months. Reproduced with permission from [72].
(Figure omitted. See article PDF.)
Androgenetic alopecia (AGA) is the most common cause of hair loss. The pattern of AGA in men (male pattern hair loss [MPHL]) was defined by Hamilton in 1951 [1] and modified by Norwood in 1975 [2] and the pattern of hair loss in women (female pattern hair loss [FPHL]) was defined by Ludwig in 1977 [3] and modified by Sinclair in 2004 [4]. The major difference is that Hamilton pattern hair loss is characterized by prominent bitemporal recession and a vertex baldness, while Ludwig pattern hair loss presents with diffuse thinning (loss of hair volume) over the mid-frontal scalp, with minimal or no bitemporal recession, and vertex baldness is rare. Ludwig illustrated the stages of progression of FPHL into three grades (Ludwig grades I, II and III), while the Sinclair scale identified five stages based on clinical severity (Figure 1 [3] and Figure 2 [5]).
Additional differences are that FPHL is generally less severe than MPHL, it occurs later (lower age-related prevalence) and the treatment response is more variable [6]. MPHL usually presents with an easily identifiable pattern of hair loss; however, this is preceded by diffuse thinning over the mid-frontal scalp that often escapes notice. The pattern of hair loss in women is less easily recognized, but FPHL can still be diagnosed clinically. However, other entities, in certain cases, should be considered in the differential diagnosis of this condition. The term FPHL is a description of clinical appearance, while the process of hair loss is referred to as female AGA. The purpose of this article is to provide current information on the prevalence, pathophysiology, diagnosis and management of this condition.
Epidemiology
An Australian epidemiological study indicated that in Caucasian adult females over...