Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study.

BACKGROUND: Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. OBJECTIVE: We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. METHODS: Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. RESULTS: TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LIMITATIONS: Inability to determine causation and limited generalizability. CONCLUSION: TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.

Lyophilized growth factor intralesional injection in female pattern hair loss: A clinical and trichoscopic study.

Various therapeutic modalities have been tried for female pattern hair loss (FPHL) treatment. To our knowledge, no previous studies had evaluated the therapeutic effect of lyophilized growth factor (L-GF) intralesional injection in FPHL. The current study aimed to evaluate the efficacy and safety of intralesional L-GF injection in FPHL by clinical and trichoscopic evaluation. This study included 20 patients with FPHL. All patients received three treatment sessions of intralesional injection of L-GF 4 weeks apart. Patients were followed-up for further 3 months. The outcome was evaluated by trichoscopy, photography score, patient's satisfaction score and side effects were reported. Trichoscopic evaluation showed significant posttreatment increase in all hair parameters associated with a significant decrease in vellus hair count. Ludwig's grade II showed posttreatment significant differences in all trichoscopic parameters from the baseline. No significant differences were detected regarding all trichoscopic parameters between the two Ludwig's grades posttreatment. 80% of patients showed photography score improvement that was significantly higher in Ludwig's grade II than in grade I. 100% of patients showed improvement in patient's satisfaction score with insignificant difference between Ludwig's grades. Intralesional injection of L-GF is safe and improved various trichoscopic hair parameters and clinical scores in FPHL.

Effect of Behavioral Factors on Severity of Female Pattern Hair Loss: An Ordinal Logistic Regression Analysis.

Background: Female pattern hair loss (FPHL) is one of the most common types of hair loss with complex genetic predisposition. A frontal pattern hair loss with ponytail hairstyle is pervasively seen among young Chinese women. The purpose of this study is to investigate the association between the severity of FPHL and behavioral factors which include dietary, and sleep habits, and to test the hypothesis on whether ponytail hairstyle is an independent factor that increases the risks of being more severe on the FPHL scale. Methods: A cross-sectional survey was performed with a structured questionnaire in this study. The severity of FPHL was graded according to basic and specific (BASP) classifications. Ordinal logistic regression analysis was performed to investigate the factors related to the severity of FPHL. Results: 1,825 participants with different severities of FPHL completed the questionnaire. Ordinal logistic regression analysis revealed that the age group between thirty and forty years (OR:2.03, 95% CI: 1.56,2. 65), insufficient time with poor quality (OR:1.30, 95% CI: 1.05,1.62), presence of alcohol consumption (OR:2.15, 95% CI: 1.14,4.42), ponytail hairstyles (OR:2.03, 95% CI: 1.40,2.96), and oily scalps (OR:2.00, 95% CI: 1.65,2.43) were risk factors which increased the odds of being in the more severe type of FPHL, compared to the age group that ranged from eighteen to thirty years, sufficient sleep with good quality, without alcohol consumption, ponytail hairstyles, and oily scalps. Conclusion: Avoiding alcohol consumption and ponytail hairstyles, in combination with proper control of scalp oil, improve sleep quality with sufficient time may help prevent FPHL from deteriorating to the more severe type.

The level of stress and the assessment of selected clinical parameters in patients with androgenetic alopecia.

Androgenetic alopecia is the most common type of hair loss both in male as well as female patients. It is a type of non-cicatricial hair loss. Pathophysiology of the disease remains largely unknown. It is believed that the occurrence of FPHL (female pattern hair loss) is linked with cellular insensitivity to androgens. Human hair does not only represent beauty, health and youth, but it also has a significant impact on one's self-esteem. For many patients, hair loss is a stigmatizing experience, many of them complain about a lower quality of life, anxiety or even depression. AIM: Aim of the study was to evaluate the levels of selected clinical parameters, including exposure to stress and disease progression based on the Ludwig scale, and of the applied therapies in a group of female patients with androgenetic alopecia. MATERIALS AND METHODS: A group of 106 patients with androgenetic alopecia was analyzed with respect to their age, duration of disease, disease progression based on the Ludwig scale, family history of AGA, exposure to stress (with the level of stress subjectively assessed by the patients using a score of 1 to 10), and treatment modality. Comparison of the results will be carried out with the help of the Statistica software, using the Student's t-test or its non-parametric equivalent. RESULTS: Patients reported very high levels of stress exposure: 7 and 8 on a scale of 1 to 10. The type of treatment applied (local vs. systemic) was of no significance with respect to the alleviation of stress. Disease progression was not found to correlate with the level of stress. When analyzing disease progression, using the Ludwig classification scale, most of the patients met the criteria of type I-2 (24.74%). As regards the comparison of treatment modalities in the study group, a great majority of patients was treated with topical agents in the form of scalp massage liquids (80.00%), while 17.14% of the study population underwent systemic treatment. A small percentage of patients also resorted to esthetic medicine procedures (3.81%), and 22.86% of them used dietary supplements or OTC topical agents. CONCLUSIONS: High levels of stress exposure reported by patients most probably stemmed from the symptoms of the disease itself, as the study population was quite diverse in terms of their levels of professional activity and the type of profession performed.

The diagnosis of androgenetic alopecia in children: Considerations of pathophysiological plausibility.

Androgenetic alopecia (AGA), one of the most common causes of hair loss in men and women, is an infrequent cause of alopecia in children. In AGA, patients generally start noticing hair thinning after the onset of puberty due to progressive miniaturisation of the hair follicle which leads to vellus transformation of terminal hair. However, the occurrence of prepubertal AGA has rarely been reported in the literature. The pathophysiology of AGA is tightly linked to androgen hormones; prepubertal children do not usually produce significant amounts of adrenal or gonadal androgens. When it does occur, an underlying abnormality should be suspected. Secondary causes of AGA must be excluded when evaluating a patient before the appearance of puberty. Premature puberty, polycystic ovarian syndrome and other causes of hyperandrogenism can present with hair loss in an androgenetic pattern. This article reviews the normal physiology of androgen hormones and their role in the pathophysiology of childhood AGA.

Methods of treatment patients with androgenetic alopecia based on reference of Department of Dermatology in Cracow.

Androgenetic alopecia (AGA in men/female pattern hair loss FPHL in women) has been associated with the most frequent culprit of hair loss concerning both men and women. It may be viewed as chronic, progressive, non scarring type of hair loss. The main factor in its pathophysiological mechanism plays genetic susceptibility to androgens of certain individuals. Increased level of androgens shown to be the cause in men, whereas in women this level may be elevated or normal. For the management of the condition topical treatment with minoxidil has been approved, as well as orally administered finasteryd, spironolakton or dutasteride. AIM: The main objective of this research project was to study the patients with AGA in terms of gender, age, prescribed treatment and hormone dysfunctions. MATERIALS AND METHODS: The analyzed population consisted of 104 patients treated in dermatology department in Cracow in three years period (2015-2018) for AGA. Initially, demographic characteristics and treatment were tested. The next step of the analysis was the comparison of groups according to gender and, what is more among women according to age (up to 45 and >45 years of age). Statistical analysis was performed with U Mann-Whitney and Chi square Pearsons tests. RESULTS: The majority of patients participating in the study were women (87,5%). The average age of the study population was 45,5±15,5 years of age. The most frequently ordered medicine was minoxidil 5% solution (82,2% of patients), besides polytherapy of two medicines were applied in 45,8% of patients. In the study group hypothyroidism was observed in 10.6% of patients. The examined group of women were older than men (48.3 vs. 25.8 years; p<0.0001). Male patients were more often ordered systemic treatment (52.9 vs.15,4%; p=0.0012), whereas topical treatment was more often applied to women (94.5 vs. 69.2; p=0.0024). Women usually were ordered more than one medicine in contrast to men (44.0 vs. 15.4%; p=0.0495). Therefore no significant difference between women up to 45 and >45 years of age was observed. CONCLUSIONS: Statistically significant occurrence of hypothyroidism was observed. Therefore this connection requires further studies. Other endocrinological dysfunctions like acne, hirsutism or menstrual disorder were relatively rare.

[Androgenetic alopecia in women]. / Androgenní alopecie zen.

Androgenetic alopecia is one of the most common diagnoses in a hair clinic. It is non-scarring pattern hair losses that affect individuals, independent on severity, age and gender. The incidence of AGA increases within the age. AGA affects women less frequently, is usually milder and is associated with diffuse thinning of the hair scalp. Prompt diagnosis and treatment are essential for obtaining optimal outcome.

Factors associated with female pattern hair loss and its prevalence in Taiwanese women: a community-based survey.

BACKGROUND: Although female pattern hair loss (FPHL) has been considered simply the female counterpart of male pattern hair loss in men, the risk factors may differ. OBJECTIVE: We sought to evaluate factors associated with FPHL and to estimate its prevalence in women. METHOD: In total, 26,226 subjects aged 30 years and older participated in a cross-sectional survey. Ludwig and Norwood classifications were used to assess the degree of hair loss. Information on possible risk factors for FPHL was collected using a questionnaire interview. RESULTS: The prevalence of FPHL (Ludwig grade >I) for all ages was 11.8% (95% CI 11.5%-12.2%), increasing with advancing age. After controlling for age and family history, statistically significant associations were noted between FPHL and high fasting glucose (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.04-1.28), fewer childbirths (OR 1.24, 95% CI 1.12-1.38), breast-feeding (OR 0.88, 95% CI 0.78-0.98), oral contraceptive use (OR 1.21, 95% CI 1.01-1.45), and ultraviolet exposure more than 16 hours per week (OR 1.12, 95% CI 1.02-1.22). LIMITATIONS: The validity and reliability of FPHL classification may be not perfect in this survey and may need to be verified. Information on family history may be still subject to recall bias. CONCLUSIONS: Risk factors for FPHL and male androgenic alopecia may differ.

A systematic review of clinical trials using single or combination therapy of oral or topical finasteride for women in reproductive age and postmenopausal women with hormonal and nonhormonal androgenetic alopecia.

Female pattern hair loss (FPHL) is a hereditary form of hair loss in women and the most common patterned progressive hair loss in female patients with androgenetic alopecia (AGA). One of the best methods for treating hair loss in women is the finasteride treatment. This systematic review includes a summary of the pharmacology of finasteride and the effect of the drug on women, especially those in the menopausal age group, and is aimed at elucidating methods of preventing systematic side effects. A search of all published literature from 1999 to 2020 has been conducted with the use of PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, as well as Cochrane Skin databases. A total of 380 articles were found, of which 260 articles were removed and 87 review studies were excluded. Lastly, full texts of 33 original articles were reviewed and 14 articles that met the inclusion criteria were selected. Ten out of the 14 articles reported a high rate of alopecia recovery in women taking finasteride. Based on the results, it can be stated that 5 mg of oral finasteride per day could be an effective and safe treatment in normoandrogenic women with FPHL, especially when used in combination with other drugs, such as topical estradiol and minoxidil. We also found that topical finasteride is more effective than other topical formulas for treating hair loss.

A Cross-Sectional, Observational Study of the Clinico-Epidemiological Profile of Female Pattern Hair Loss in Western India and its Association with Metabolic Syndrome.

Background: The increasing prevalence of female pattern hair loss (FPHL) is an alarming concern. There are many studies on FPHL in the world literature but there is a dearth of Indian data on the same. Aims and objectives: The present study aims to ascertain the demographic variables and clinical features of FPHL in Western India and its association with metabolic syndrome (MetS) to add over and above the existing data. Materials and Methods: Ninety females who were diagnosed with FPHL were included after approval of the institutional ethics committee. Demographic details, detailed history, and clinical features were noted, following which a few blood investigations for diagnosis of MetS were advised and evaluated. Results: Our study population's age ranged from 17 to 65 years, with the mean age of 34.7 ± 1.3 years. According to the Basic and Specific (BASP) classification, The basic pattern prevalence as found in our study was 46.7% for M type, 35.6% for L type, and 17.7% for C type. The FPHL severity score revealed that 82 (91.1%) had advanced disease at presentation. Prevalence of MetS was found to be 34.4% and had a significant correlation with age of onset in years (p=0.041) and severity score (p=0.013) implying that it leads to an early onset and greater severity of FPHL. Conclusion: FPHL is increasingly common among Indian women, who frequently present with a bitemporal recession of the hairline. Calculation of the female pattern hair loss severity index (FPHL-SI) can help in the categorization of patients and assessment of prognosis. MetS should be actively looked for in patients of FPHL and managed accordingly.

Differences in Demographic and Clinical Characteristics Among Subtypes of Female Pattern Hair Loss.

Background: Female pattern hair loss (FPHL) is the most common hair loss disorder in women that can be classified into three patterns, including Ludwig, Olsen, and Hamilton-Norwood subtypes. Information regarding the comparison of demographics, clinical characteristics, and associated comorbidities among subtypes of FPHL is scarce and contradictory. Objective: To evaluate and compare the epidemiology, clinical manifestations, and comorbid conditions of FPHL subtypes and determine their associated factors. Methods: This retrospective study included patients who were diagnosed with FPHL between January 2000 and November 2021. Participants were classified into three subtypes, namely Ludwig, Olsen, and Hamilton-Norwood, and were statistically compared. Variables significantly associated with each FPHL subtype were identified using multivariable multinomial logistic regression analysis. Results: Among the 519 patients with FPHL, the Ludwig subtype was the most prevalent (51.1%), followed by the Olsen (32.9%) and Hamilton-Norwood (16%) subtypes. The Hamilton-Norwood subtype revealed significantly higher frequencies of early disease onset (61.4%), menstrual irregularity (22.9%), polycystic ovary syndrome (PCOS, 18.1%), and seborrhea (30.1%) but lower frequencies of overweight (24.1%) and type 2 diabetes mellitus (DM, 2.4%). Multivariable multinomial regression analysis demonstrated that the Hamilton-Norwood subtype was a predictor for early disease onset and PCOS compared to Ludwig (early onset: odds ratio (OR) = 2.14, 95% confidence interval (CI) = 1.39-4.22, P = 0.02; PCOS: OR = 2.02, 95% CI = 1.55-4.84, P = 0.03), and Olsen (early onset: OR = 1.89, 95% CI = 1.03-3.92, P = 0.04; PCOS: OR = 2.24, 95% CI = 1.89-5.31, P = 0.01). In contrast, the Hamilton-Norwood pattern was at decreased risk for type 2 DM compared to Ludwig (OR = 0.51, 95% CI = 0.03-0.82, P = 0.02), and Olsen (OR = 0.68, 95% CI = 0.04-0.79, P = 0.03). Conclusion: The Ludwig pattern was found to be the most prevalent FPHL subtype among Thai patients. Moreover, the Hamilton-Norwood subtype was associated with early disease onset and PCOS, whereas the Ludwig and Olsen subtypes were associated with type 2 DM.

Urban-rural differences in the prevalence of female pattern hair loss among secondary school girls: A cross-sectional study.

AIM: Female pattern hair loss (FPHL) is a common condition that is influenced by many external and internal factors. We aimed to identify the prevalence of FPHL among secondary school girls and identify possible associated factors. METHODS: FPHL among 3405 adolescent females was identified using detailed history, physical examination, and dermoscopy in this cross-sectional study. RESULTS: Among the 3405 included students, 2430 (71.4%) had no FPHL and 975 (28.6%) were diagnosed with FPHL (p = 0.001). The mean age of girls with FPHL was 16.43 ± 1.10 and ranged between 15 and 18 years. Among those with FPHL, 427 (43.8%) attended urban schools while 548 (56.2%) attended rural schools. No significant differences regarding paternal and maternal education, family income, or parental degree of education were observed among those with FPHL and those without (p = 0.230; p = 0.063; p = 0.276, respectively). CONCLUSION: FPHL had an overall prevalence of 28.6% among secondary school girls with a significant predominance in rural over urban areas and with a significantly associated family history. Irregular menses, history of thyroid disease, and hirsutism were significant predictors for FPHL.

Different platelet-rich plasma preparation protocols in Female pattern hair loss: Does it affect the outcome? A pilot study.

BACKGROUND: Platelet-rich plasma (PRP) injection is a promising modality for hair regeneration in female pattern hair loss (FPHL). A standard protocol on best methods for PRP preparation has not been established. OBJECTIVES: To optimize standard PRP preparation protocols and evaluate its clinical efficacy in FPHL. METHODS: Comparative study enrolled 40 female patients with FPHL divided randomly into 4 equal groups. Each group received 3 sessions of monthly intradermal injection of PRP prepared by different methods regarding number of spins, centrifugation speeds, type of the centrifuge, and the size of PRP tube. Patients were evaluated by trichoscan before and 1 month after the 3rd session for number of terminal, vellus hair, and average hair width. RESULTS: A statistically significant increase in platelet count in PRP prepared by combination of digital centrifuge, large-sized sodium citrate tube, and low centrifugation speed (900 rpm). All patients showed statistically significant increase in percentage of terminal hair and average width of hair after treatment as assessed by trichoscan, without statistically significant difference between studied groups. CONCLUSIONS: Digital centrifuge, large-sized sodium citrate tubes, and a single spin with low centrifugation speed (900 rpm) were ideal for PRP preparation. PRP is an effective and safe modality in FPHL therapy.

Treatment with oral vitamin D alone, topical minoxidil, or combination of both in patients with female pattern hair loss: A comparative clinical and dermoscopic study.

BACKGROUND: One of the most common dermatological complaints among female is female pattern hair loss (FPHL). Serum vitamin D is a factor lately taken into consideration in approaching patients complaining of hair loss. AIM: To evaluate the serum level of 25-hydroxy vitamin D in patients with FPHL and to evaluate the efficacy of vitamin D therapy alone or combined with minoxidil in the treatment of this disease. METHODS: 45 patients with FPHL and 15 controls to measure serum level of vitamin D were enrolled in the study. Patients then were subdivided into 3 groups: group I received topical minoxidil and oral vitamin D, group II received topical minoxidil, and group III received oral vitamin D for 6 months. Clinical and dermoscopic evaluation was done for the three groups before and after treatment. RESULTS: Vitamin D level was significantly decreased in patients compared to controls. After treatment, as regard Ludwig scale, there was statistically significant improvement in group I than II while no significant improvement was found in group III. Dermoscopy revealed that thin hair and single-hair unit were significantly improved in groups I and II, while it was not significantly improved in group III. CONCLUSION: Oral vitamin D combination to topical minoxidil is recommended to treat patients with FPHL; they had better results than vitamin D or topical minoxidil alone.

Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female Pattern Hair Loss: A Prospective, Single-Center, Parallel-Group, Evaluator Blinded, Randomized Trial.

Background: The efficacy of topical minoxidil (MX) alone on female pattern hair loss (FPHL) is limited. Combination therapy based on topical MX is currently expected to provide better outcomes. Objectives: This study aimed to assess whether the combined therapies including MX plus oral spironolactone (SPT) and MX plus microneedling (MN) have advantages in efficacy and safety over topical MX alone on mild-to-moderate FPHL with normal hormone levels in the blood and regular menstrual cycle. Methods: A prospective, single-center, parallel-group, evaluator blinded, randomized trial including 120 non-menopause women with proven FPHL (Sinclair class II-III) was performed in China. Patients were randomly assigned to three groups, namely, the MX group (5% topical MX alone, once daily), the MX + SPT group (MX plus SPT 80-100 mg daily), and the MX+MN group (MX plus MN every 2 weeks, 12 sessions). The change from the baseline to week 24 was assessed in hair growth (hair density and diameter under dermoscope), scalp tissue structure (epidermal thickness, dermis thickness, and average hair follicle diameter under ultrasound biomicroscopy), physician's global assessment (using a 7-point global-assessment scale and Sinclair's stage change), patient evaluation (Women's Androgenetic Alopecia Quality of Life Questionnaire and Sinclair's hair-shedding score) and side effects. Results: In total, 115 participants completed the trial. At week 24, the hair density increased most in MX + MN group and increased least in MX group (p < 0.001 for MX + MN group vs. MX + SPT group; p = 0.009 for MX + SPT group vs. MX group). The hair shaft diameter significantly increased in all groups (p < 0.001, respectively), but there were no significant differences among the three groups (p = 0.905). The epidermal thickness and average hair follicle diameter only increased in MX + MN group. Dermis thickness increased in all groups, but there were no significant differences among the three groups. Both physician's and patient assessments showed improvement in all three groups. Scalp pruritus was the most common side effect. The MX + SPT group had the most reported adverse effects. Limitations: The main limitations of this study are the relatively small sample size, the exclusion of severe FPHL patients, and the potential bias from unblinded treatments among the 3 groups. Conclusion: Topical MX combined with MN is a better choice than either MX plus oral SPT or MX alone for the treatment of mild-to-moderate FPHL patients.

The Predictive Value of Midscalp Hair Density and Terminal Hair Percentage in the Severity Evaluation of FPHL Assessed by Trichoscan in a Sample of Chinese Population.

Background: Female pattern hair loss (FPHL) is the most common hair loss disorder in women, which may impair patient's self-identity. It presents as a diffuse reduction in hair density at the mid and frontal regions of the scalp with preservation of the frontal hairline. TrichoScan can be used as a diagnostic tool and for monitoring patients in male pattern hair loss, but little is known in FPHL with Chinese population. Objective: To explore the predictive value of various TrichoScan characteristics at different areas of the scalp in the diagnosis and evaluation of FPHL. Materials and Methods: A total of 261 FPHL subjects were divided into three groups according to Ludwig classification. Together with 108 healthy controls, they were evaluated by computer-assisted TrichoScan. Various hair parameters were analyzed in the frontal, midscalp, vertex, parietal, and occipital areas of the scalp. Results: Declining hair densities, terminal hair percentage, hair follicular unit density, mean hair diameter, and average hair/unit combined with increased intermediate hair percentage, and vellus hair percentage were observed across all areas of the scalp for FPHL subjects. Hair density and terminal hair percentage in the midscalp area were the factors most affecting Ludwig classification. The two parameters combined achieved 85.12% correct classification rate and an area under the ROC curve of 0.88 in the diagnosis of FPHL. Additionally, we reported a unique type of FPHL which mostly affected the parietal area, occurring with or without traditional midline changes. Conclusion: FPHL in a Chinese population presented characteristics of reduced hair density and miniaturization of hair follicles in the midline scalp and to a lesser extent in the parietal area. Hair density and terminal hair percentage in the midscalp exhibited the greatest predictive value of Ludwig classification. Our results may further provide the basis for quantitative classification of FPHL.

Regenerative medicine strategies for hair growth and regeneration: A narrative review of literature.

Hair loss, or alopecia, is associated with several psychosocial and medical comorbidities, and it remains an economic burden to individuals and the society. Alopecia is attributable to varied mechanisms and features a multifactorial predisposition, and the available conventional medical interventions have several limitations. Thus, several therapeutic strategies for alopecia in regenerative medicine are currently being explored, with increasing evidence suggesting that mesenchymal stem cell (MSC) implantation, MSC-derived secretome treatment, and blood-derived platelet-rich plasma therapies are potential treatment options. In this review, we searched the Cochrane Library, MEDLINE (PubMed), EMBASE, and Scopus using various combinations of terms, such as "stem cell," "alopecia," "hair loss," "Androgenetic alopecia," "male-pattern hair loss," "female-pattern hair loss," "regenerative hair growth," "cell therapy," "mesenchymal stem cells," "MSC-derived extracellular vesicles," "MSC-derived exosomes," and "platelet-rich plasma" and summarized the most promising regenerative treatments for alopecia. Moreover, further opportunities of improving efficacy and innovative strategies for promoting clinical application were discussed.

The Hair Shedding Visual Scale: A Quick Tool to Assess Hair Loss in Women.

INTRODUCTION: Hair shedding is a common consequence of the normal hair cycle that changes with internal and external factors. Female pattern hair loss (FPHL) is difficult to assess in terms of shedding severity as the conscious perception of hair shedding varies according to each individual, and most utilized methods are semi-invasive or very time consuming. In this study, we establish and validate a hair-shedding scale for women with thick hair of different lengths. METHODS: A visual analog scale was developed for thick hair of short, medium, and long lengths by dividing a bundle of hairs of each length into nine piles of increasing hair amount that were then photographed and arranged in order of size. Twenty women with no FPHL with each length of hair (60 total) were asked to select the photographed hair bundle that best correlated with the amount of hair they shed on an average day. A total of 94 women with FPHL with excessive shedding were then asked to repeat the same process. RESULTS: Women with no FPHL and short, medium and long hair had mean shedding scores of 2.5, 2.35 and 2.4, respectively. Women with FPHL and short, medium and long hair had mean shedding scores of 7.25, 7.0 and 7.14, respectively. Statistically significant Spearman's ρ coefficient and κ coefficient demonstrated correlation and inter-observer reliability. CONCLUSION: Our results show that women with FPHL not only shed considerable hair more than women with no FPHL, but that this hair-shedding visual scale is a fast and effective method of evaluating hair-shedding amounts in an office setting.