Female pattern hair loss is a common condition in women indicated by a diffuse
reduction in hair density over the crown and frontal scalp with retention
of the frontal hairline.
This condition which is often referred to
as the female counterpart of pattern baldness in men increases with in older age.
A huge number of women with female pattern
hair loss have clinical signs of gradual thinning
of scalp hair which may take place over a
period of several years. However, this kind
of hair loss can start at any time between
early teens and late middle age. Studies by
Venning and Dawber reported that 13% of pre-menopausal
women have reduced fronto-temporal activity—this
increases to 37% in postmenopausal women.
While hair loss in men may easily be noticed,
it is not as easily recognized in women. The
androgen dependence and the hereditary nature
of this process are also not as obvious on
affected women as it is on affected men. Most
often, excessive hair shedding might have
taken place before but unlike telogen effluvium,
hair thinning is usually noticed from the
very beginning. Clinical findings about this
case reveal a widening of the crown and scalp
with a diffuse reduction in hair density.
The pattern of hair loss varies in women and
some may show hair loss that affects only
a small area of the frontal scalp while others
may get their entire scalp affected, including
the parietal and occipital regions.
The final degree of hair loss and its rapid
progression also show variations. The vertex
balding seen in men is rare in women. In women’s
case, the frontal hairline is typically retained
although the minor degree of their post-pubertal
recession at the temples is not uncommon.
Observations done on women who have more pronounced
temporal recession show that this state usually
manifests more as hair thinning rather than
a complete loss of temporal hair as it is
seen on men.
Knowledge about the underlying cause of change
or growth of hair follicle cycling in normal
as well as balding scalp is the key to understanding
the clinical presentation of pattern baldness. In normal scalp, the anagen or growth
phase of hair lasts for several years while
the telogen (resting) phase can lasts for
3 months. However, in pattern hair loss, the
growth cycle is altered. This results to a
progressive reduction in the duration of the
anagen phase. Because of this, short, thin,
hypo-pigmented and insignificant wisps of
hair are produced and the condition is presented
Pattern Hair Loss Classification on Women
Women usually develop an age-dependent form
of scantiness of scalp hair. Hence, Ludwig
has been credited as correct with the classification
he brought about the clinical presentation
of female pattern hair loss. In 1977, he described
the distinctive features of female pattern
hair loss and classified it into three grades
of severity, often referred to as Ludwig I
(mild), II (moderate) and III (extensive).
In all these three Ludwig stages, there is
hair loss on the front and top of the scalp
with where in the frontal hairline is usually
retained. The back and sides of the scalp
may or may not be affected. Type I is described
as early thinning that can be easily hidden
with proper grooming. Type II is characterized
by the significant widening of the hairline’s
midline part and decreased volume which can
easily be noticed. Type III manifests a thin,
see-through look on the top of the scalp,
often associated with generalized thinning.
In this stage the hair becomes very thin over
the top of the scalp but a rim of hair is
usually retained along the frontal margin.
The thinning of hair in Androgenetic alopecia
in both men and women is attributed to decrease
in hair density. Grave hair density on the
frontal scalp of women is found to be progressively
lower with increasing age after the age of
about 40 years. There are several factors
considered in clinical assessment such as
curl, hair fiber and hair diameter which is
considered as the most common factor.
Pattern Hair Loss in Men and Women
Women generally exhibit diffused less hair
all over while men frequently have more "patterned" type
of hair loss that spares the back and sides.
Women often retain their frontal hairline
while men, on the other hand, characteristically
lose a significant amount of hair on the front
part of their scalp. Hair loss in women takes
effect in a gradual manner and tends to accelerate
during pregnancy and menopausal stage. It
is more often cyclical in women than in men,
and is more easily affected by hormonal changes,
medical conditions, and external factors.
More Information on Female Androgenetic Alopecia
There are several factors that influence
hair quality, and these factors contribute
to the subjective assessment of hair status.
The theory that hair density is the major
factor in assessing hair loss is implied by
the observation that although average hair
density is lower in Korean women compared
to European women, the frequency of clinical
hair loss in this race is much lower compared
to other races. This discrepancy might be
because of racial differences in other characteristics
of the hair, which may have a big impact on
how they look in general.