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Prevalence of Male and Female Pattern Hair Loss in Maryborough

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Maryborough, in central Victoria has an approximate population of 8000 and census data is well matched for Australia overall. Australia has compulsory voting and registration on the electoral roll. To determine the age-related prevalence of balding among men and women in Maryborough we conducted a postal survey of 5000 men and women aged 20 or older, and 427 were invited to attend for examination. Additional data was collected on dandruff, presence of gray hair. Supplementary questionnaires were sent to 340 children aged 5-9, attending a coeducational primary school. 1456 adults (34.1%) responded to the questionnaire. 396 attended for examination. The prevalence of androgenetic alopecia (AGA) increased with advancing age. 98.6% of men had bitemporal recession and severity was significantly associated with vertex and mid-frontal hair loss (p <0.01) but not age (p = 0.06). In all, 64.4% of women had bitemporal hair loss, and similar to men there was a significant association with mid-frontal hair loss (p =0.042) but not age (p =0.467). One hundred and forty children with completed questionnaires were examined. All 72 females and 68 males were assessed as stage 1 on the mid-line part and with no bitemporal recession (frequency stage 1 = 100%, 95% CI (confidence interval) 97.4%-100%). A significant but weak positive association existed between presence of gray hair and history of dandruff (p<0.01). The prevalence of mid-frontal hair loss increases with age and affects 57% of women and 73.5% of men aged 80 and over.
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Prevalence of Male and Female Pattern Hair Loss in Maryborough
DesmondC.C.GanandRodneyD.Sinclair
Department of Dermatology, University of Melbourne, St Vincent’s Hospital, Melbourne, Victoria, Australia
Maryborough, in central Victoria has an approximate population of 8000 and census data is well matched for
Australia overall. Australia has compulsory voting and registration on the electoral roll. To determine the age-
related prevalence of balding among men and women in Maryborough we conducted a postal survey of 5000 men
and women aged 20 or older, and 427 were invited to attend for examination. Additional data was collected on
dandruff, presence of gray hair. Supplementary questionnaires were sent to 340 children aged 5–9, attending a co-
educational primary school. 1456 adults (34.1%) responded to the questionnaire. 396 attended for examination. The
prevalence of androgenetic alopecia (AGA) increased with advancing age. 98.6% of men had bitemporal recession
and severity was significantly associated with vertex and mid-frontal hair loss (po0.01) but not age (p ¼0.06). In all,
64.4% of women had bitemporal hair loss, and similar to men there was a significant association with mid-frontal
hair loss (p ¼0.042) but not age (p ¼0.467). One hundred and forty children with completed questionnaires were
examined. All 72 females and 68 males were assessed as stage 1 on the mid-line part and with no bitemporal
recession (frequency stage 1 ¼100%, 95% CI (confidence interval) 97.4%–100%). A significant but weak positive
association existed between presence of gray hair and history of dandruff (po0.01). The prevalence of mid-frontal
hair loss increases with age and affects 57% of women and 73.5% of men aged 80 and over.
Key words: alopecia/baldness/common/pattern/prevalence
J Investig Dermatol Symp Proc 10:184 –189, 2005
Hamilton first classified male pattern hair loss (MPHL) on a
scale from I to VIII. (Hamilton, 1951). Norwood modified
Hamilton’s scale eliminating Type III, and including Type A
Variant, which represents a more severe frontal recession
form of hair loss, and the term ‘vertex’, which refers to
cases with isolated balding patch on the crown were incor-
porated to the scales. (Norwood, 1975) Simplified versions
of this scale have been used for population surveys (Severi
et al, 2003).
Ludwig noted that the clinical features of androgenetic
alopecia in females differed from common baldness in men
(Ludwig, 1977), and presents with diffuse hair loss, over the
mid-frontal scalp that he classified into three stages. A
modified five-point visual analog grading scale has also
been used to score female pattern hair loss (FPHL) (Sinclair
et al, 2002; Biondo et al, 2004) FPHL is now the preferred
term for androgenetic alopecia in females. (Olsen, 2001).
Crossover in the pattern of hair loss is not uncommon
and the Ludwig pattern is observed in a proportion of men
(Paik et al, 2001) and the Hamilton–Norwood patterns with
bitemporal recession is seen in some women. (Venning and
Dawber, 1988).
The prevalence of male and female pattern hair loss has
been reported in UK, US, Norway, and Asia. (Norwood,
1975; Venning and Dawber, 1988; Demuro-Mercon et al,
2000; Tang et al, 2000; Birch et al, 2001; Norwood, 2001;
Paik et al, 2001; Pathomvanich et al, 2002) Apart from the
MPHL prevalence studies in Norway (Demuro-Mercon et al,
2000) and Singapore (Tang et al, 2000), these studies re-
cruited in the main from dermatology clinics and health care
centres and it is unknown to what extent this sample group
is representative of the general community. Further, aside
from the Korean study (Paik et al, 2001), the pattern and
severity of FPHL was not reported.
The purpose of this study was to more precisely estimate
the prevalence and pattern of hair loss in the Australian
community using a different methodology. Additional infor-
mation about gray hair and dandruff was recorded.
Results
Study population Seven hundred and thirty-one (14.6%)
envelopes were sent back unopened or marked ‘‘Return
to Sender’’. These responses are regarded as either de-
ceased, moved away from the address, or unable to be
identified as having lived in the address and are excluded
from further analysis. The response rate after exclusions
was 34.1%. One thousand four hundred and fifty-six com-
pleted questionaires were received, 655 from men (mean
age 57.6) and 752 from women (mean age 55.6). Forty nine
did not report gender. Comparing the age distribution be-
tween respondents and the Maryborough population, there
Abbreviations: CI, confidence interval; CTE, chronic telogen efflu-
vium; DHT, dihydrotestosterone; FPHL, female pattern hair loss; M,
mean; MPHL, male pattern hair loss; N, total number of subjects;
OR, odds ratio; PHL, pattern hair loss; SD, standard deviation; T:V,
terminal hair to vellus-like hair ratio
Copyright r2005 by The Society for Investigative Dermatology, Inc.
184
was an over-representation in the older age groups among
the respondents (Table I).
All participants were invited to attend an examination. Of
the 1456 subjects who completed the questionnaires, 575
(293 males and 282 females) expressed interest in attending
hair and scalp examinations. The first 427 were given
appointments and 396 participants (203 males and 193
females) turned up for the examinations.
Secondary study of pre-pubertal children Two hundred
and ten subjects (107 males and 103 females) did not re-
spond. The response rate was 43.77%. All 140 children
examined had hair pattern stage 1 (95% CI (confidence in-
terval), 97.4%–100%). No child had temporal recession.
One child was excluded from the study because of pubertal
signs. In this cohort the normal baseline hair density is stage
1. Any adult or adolescent with a hair pattern of stage 2 or
greater is likely to have experienced hair loss.
Agreement between clinicians and subjects For both
male and female subjects, 60% of the subjects’ self-ratings of
hair thickness were identical to those of the clinicians. Where
disconcordance was seen, only 15 male subjects (7.4%) and
nine female subjects (4.6%) deviated by more than one grad-
ing. Therefore, subjects had difficulty obtaining precise grad-
ing but were capable of giving an approximate grading.
Kappa statistic revealed that clinicians had a fair agree-
ment with male subjects and a slight agreement with female
subjects. Combination of stages 3–5 and also stages 1 and
2 to transform the five-point hair thickness scale into a bi-
nary tool improved the agreement considerably (Table II).
This showed that the grading scale was an effective tool for
self-reporting severe or cosmetically significant AGA.
No significant differences were found between the mean
(1.60) of females subjects’ self-ratings and the mean (1.62)
of clinicians’ ratings (t(193) ¼0.487, p ¼0.627, two-tailed).
Hair patterns and MPHL in males The age-adjusted prev-
alence of mid-frontal and vertex scalp hair loss (stages 3–5)
was 44.9% (95% CI, 41.1%–48.8%). The prevalence in-
creased with age (Fig 1). Stage 1 was universal among pre-
pubertal boys but was reported by only 4.1% of men aged
80 or older. The age-specific frequency is shown in Table III.
Hair patterns and FPHL in females Stage 1 is the normal
female hair pattern and found universally among pre-pu-
bertal girls. Most female subjects (66.1%) were stage 1. The
frequency, however, of stage 1 decreased from 87.7% of
subjects at third decade to 42.6% of subjects over age of
80. Stage 2 hair density increased from 8.77% of subjects
at third decade to around 28% of subjects over 60 y of age.
Stages 3–5 hair density were uncommon until the sixth
decade, and affected over 25% of women aged 70 y and
above (Table IV).
If stage 2 is defined as mild hair loss and stages 3–5 as
moderate to severe hair loss, the age-adjusted prevalence
of hair loss in the community is 32.2% (95% CI, 28.8%–
35.6%), of whom 10.5% (95% CI, 8.2%–12.7%) have mod-
erate-to-severe hair loss (Fig 2).
Only 55.0% of women with stage 3–5 reported history of
hair loss. Only four female subjects (2.8% of those who
perceived hair loss) had treatment for hair loss.
Table II. Agreement between clinicians and subjects
Identical grading (%) jstatistic Interpretation of jvalues
Original male scale 121/203 ¼59.6 0.494 Fair agreement
Male two-point scale: stages 1, 2 and 3–5 177/203 ¼87.2 0.720 Good agreement
Original female scale 115/193 ¼59.6 0.291 Slight agreement
Female two-point scale: stages 1, 2 and 3–5 170/193 ¼88.1 0.540 Fair agreement
Table I. Age distribution of the respondents
Age
Respondents
(%)
Maryborough
population
(2001) (%)
Australian
population
(2001) (%)
20–29 6.5 13.1 18.9
30–39 11.9 15.4 21.0
40–49 15.4 17.7 20.4
50–59 20.1 18.2 16.4
60–69 19.5 14.6 10.7
70–79 18.8 13.9 8.3
80 and above 7.7 7.1 4.3
Figure 1
Age-specific frequency of male pattern hair loss. A comparison of
the age-specific frequency of male pattern hair loss in our cohort to that
found in similar studies in different patient cohorts.
PREVALENCE OF PATTERN HAIR LOSS 18510 : 3 DECEMBER 2005
Graying of hair The age- and sex-adjusted prevalence of
gray hair was 75.0% (95% CI, 72.7%–77.3%). The age-
specific prevalence in males was 75.6%, (95% CI, 72.3%–
78.9%) and in females was 74.8% (95% CI, 71.7%, 77.9%).
There was a clear increase in prevalence of gray hair with
advancing age (Fig 3).
Dandruff After adjusting for age and sex, we estimate
42.2% (95% CI, 39.6%–44.8%) of the community are af-
fected by dandruff at some stage of their life. A higher fre-
quency was found in males 48.9% (95% CI, 45.0%–52.7%),
compared to females 36.0% (95% CI, 32.6%–39.4%). No
clear trend was observed between age and dandruff (Fig 4).
Patterns of fronto-temporal hairline Additional information
about the frontal hairline in the temporal regions was recorded
during the examination. We categorized three types of tem-
poral hairline: absence of bitemporal recession, slight bitem-
poral recession, and marked bitemporal recession (Fig 5).
No pre-pubertal boy had temporal recession. Among
adult males, marked bitemporal recession was the com-
monest temporal hairline (age-adjusted frequency ¼
79.7%), followed by moderate (18.9%) and absence of re-
cession (1.4%). An ordinal logistic regression analysis of
bitemporal recession in men and age and severity of AGA
found a significant association between bitmeporal reces-
sion and hair thickness (po0.001), but no association with
age once hair thickness had been taken into account
(p ¼0.0648).
No pre-pubertal girl had temporal recession. In women,
moderate bitemporal recession was the most frequent fron-
tal hairline (age-adjusted frequency ¼55.2%), followed by
absence of recession (35.6%) and marked recession
(9.2%). As with men, ordinal logistic regression analysis
found that age was not significantly associated with bitem-
poral recession (p ¼0.467), but that hair thickness was
(p ¼0.042).
Association analysis Logistic regression analysis of self-
reported gray hair by self-reported history of dandruff and
age showed a significant association between the two in
both males and females (po0.001 for both dandruff and
age, in both sexes). When this same association was
Table III. Hair patterns in male subjects
Age
Hair thickness
Total Stages 3 þ4þ5Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
5–9 68 (100%)
20–29 24 (69%) 5 (14%) 3 (9%) 3 (9%) 35 6 (17.14%)
30–39 34 (46%) 26 (35%) 7 (10%) 4 (5%) 3 (4%) 74 14 (18.9%)
40–49 28 (31%) 21 (24%) 13 (15%) 16 (18%) 11 (12%) 89 40 (44.9.%)
50–59 30 (24%) 33 (26%) 25 (20%) 25 (20%) 14 (11%) 127 64 (50.4%)
60–69 25 (18%) 26 (19%) 20 (14%) 39 (28%) 29 (21%) 139 88 (63.3%)
70–79 20 (16%) 24 (19%) 19 (15%) 33 (26%) 32 (25%) 128 84 (65.6%)
80 2 (4%) 11 (22.4%) 4 (8%) 16 (33%) 16 (33%) 49 36 (73.5%)
Total 163 (25%) 146 (23%) 91 (14%) 136 (21%) 105 (16%) 641 332 (44.9%
a
)
a
Adjusted to age.
Table IV. Hair patterns in female subjects
Age
Hair thickness
Total 1stage 1Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
5–9 72 (100%)
20–29 50 (88%) 5 (9%) 1 (2%) 1 (2%) 57 7 (12.3%)
30–39 73 (83%) 14 (16%) 1 (1%) 88 15 (17.0%)
40–49 91 (75%) 28 (23%) 3 (2%) 122 31 (25.4%)
50–59 106 (72%) 29 (20%) 11 (7%) 1 (1%) 147 41 (27.9%)
60–69 73 (59%) 37 (30%) 11 (9%) 2 (2%) 1 (1%) 124 51 (41.1%)
70–79 58 (46%) 35 (28%) 24 (19%) 6 (5%) 2 (2%) 125 67 (53.6%)
80 23 (43%) 15 (28%) 8 (15%) 8 (15%) 54 35 (57.4%)
Total 474 (66%) 163 (23%) 55 (8%) 22 (3%) 3 (0.4%) 717 247 (32.2%
a
)
a
Adjusted to age.
186 GAN AND SINCLAIR JID SYMPOSIUM PROCEEDINGS
examined using only the clinicians’ examination data, a
significant association was present only in females
(p ¼0.046) but not in males (p ¼0.369). Age was again sig-
nificant in both males and females (po0.001).
Discussion
This is an epidemiological study exploring hair patterns and
FPHL prevalence in the Australian community. We previ-
ously reported the prevalence of vertex and full androgen-
etic hair loss in a different cohort of Australian Men aged
40–69, using a more limited grading scale. Following that
study we recognized that a significant proportion of Aus-
tralian men developed frontal recession as their predomi-
nant pattern of hair loss and modified our grading scale to
include stage 4.
In comparison to previous prevalence studies from the
UK, US, Korea, and Thailand (Norwood, 1975; Venning and
Dawber, 1988; Birch et al, 2001; Norwood, 2001; Paik et al,
2001; Pathomvanich et al, 2002), our study recruited sub-
jects from a standard study population in Maryborough. The
recruitment of our study was similar to the studies done in
Norway (Demuro-Mercon et al, 2000) and Singapore (Tang
et al, 2000), but the two studies reported only the epide-
miology of MPHL. Using census data of Maryborough, we
are able to calculate an estimated weighted prevalence,
which is a more representative estimate of pattern hair loss
prevalence in the general community. The limitations of this
research include a response rate of 34%, a potential pos-
itive response bias, the limitations of self-reporting hair
stages and an over-representation of older age groups in
the respondents.
Our study showed that MPHL is common in the Austral-
ian community. The prevalence correlates well with that re-
ported by Norwood (1975), and supports the contention
that MPHL in the western community had an earlier onset
and a higher prevalence than that of their Asian counter-
parts. (Paik et al, 2001; Pathomvanich et al, 2002).
There is no gold standard for diagnosis of FPHL partic-
ularly in the early stages. Scalp biopsy had been proposed
as the gold standard for diagnosis (Whiting, 1990); however,
hair follicle miniaturization cannot be demonstrated in all
women with visible hair loss, and so these criteria may lack
Figure 2
Hair patterns in the female subjects. The age-specific frequency of
hair patterns and hair loss severity in the female subjects in our cohort.
Figure 3
Age-specific frequency of gray hair. Age-specific frequency of any
gray hair in our patient population.
Figure 4
Age-specific frequency of subjects with history of dandruff. Age-
specific frequency of subjects with history of dandruff in our patient
population.
Figure 5
Classification of temporal hairline. Absence, moderate, and marked.
PREVALENCE OF PATTERN HAIR LOSS 18710 : 3 DECEMBER 2005
sensitivity (Sinclair et al, 2002). Furthermore, follicular min-
iaturization may be advanced before there is a visible de-
crease in hair density, especially among women with high
baseline scalp hair follicle densities. As reported by Birch
et al (2001) hair densities in normal women follow a normal
distribution. Although women noted to have FPHL have a
lower mean hair density, there is an extensive overlap of hair
densities between women with and without FPHL.
The finding that all pre-pubertal females have stage 1
hair density allows us to conclude that stage 2 is a deviation
from the baseline pre-pubertal hair density and represents
hair loss. Women with stage 2 hair loss should be regarded
as having mild FPHL, even though this cannot always be
demonstrated histologically. Extrapolation of our data indi-
cates that a significant proportion of women with stage 2
hair loss would progress to more severe FPHL. Neverthe-
less, this may only be proved with a longitudinal study.
Application of this yields a much higher estimation of
female AGA prevalence. As 55% of women with marked
FPHL (stages 3, 4, or 5) did not report hair loss on the
questionnaires, it is likely that many women with FPHL will
not deem it cosmetically significant or seek medical inter-
vention.
In contrast to what was reported by Birch and Messen-
ger (2003), we found that bitemporal recessive frontal hair-
line is significantly associated with advancing stages of
mid-scalp hair loss in both males and females, independent
of age. This finding suggests that the pathogenesis of hair
loss in both midscalp and bitemporal frontal hairline is
probably related, if not the same.
Of interest, a history of dandruff has a consistent but
weak association with the presence of gray hair in females.
The association in males is only significant in the full-cohort
self-report data. There are no substantial differences in the
numbers of females as compared to males in the full-cohort,
or having received clinical examinations, and so this does
not explain the differences seen. The explanation may be
because of the difference in reporting dandruff. In the ques-
tionnaire, subjects are asked about any history of dandruff
or dandruff, whereas clinicians are only able to assess any
presence of active dandruff.
This association has not been previously reported. As
Malassezia organisms are involved in both dandruff and
pityriasis versicolor which produces depigmentation of the
skin (Ljubojevic et al, 2002), we postulate that the Ma-
lassezia organisms may act as the mechanistic link be-
tween graying of hair and dandruff. As the association is
only weakly predictive, however, many other variables are
likely to affect presence of gray hair in an individual. Further
research is required to explore this association.
Methods
Sampling frame The sampling frame for this study was adults
aged 20 y and above registered on the 2000 Electoral Roll in the
city of Maryborough (6400 adults). Maryborough is a rural city in
Central Victoria, 100 km north of Melbourne, Australia. Although
slightly over-represented in the older age groups, the distribution of
age and gender in the population of Maryborough is similar to that
of Australia. Previous epidemiological studies have been conduct-
ed in this town and have received great support from the local
community (Foley
et al
, 1993; Plunkett
et al
, 1999).
Five thousand adults were randomly selected from the sampling
frame. The survey period was February 2003 to May 2003. A pilot
study comprising 300 subjects randomly selected from outside the
City of Maryborough was conducted prior to the commencement
of the survey. Each subject in pilot study was posted questionnaire
similar to that used in the main survey. Responses were collected
to evaluate questionnaire design and indicate response rate for
estimation of sample size in the main study.
Recruitment Permission to conduct the survey was obtained from
the Shire Council responsible for the City of Maryborough. A notice
regarding the survey was published in the local newspaper. Local
GP were contacted to prepare them for queries from their patients
regarding the survey. A questionnaire with an explanatory letter
was posted to each of the 5000 subjects. To maximize response
rate, reminders were posted to non-respondents 2 wk after the
initial posting.
Questionnaire All subjects were asked to complete the question-
naire containing information about history of hair loss, specific
forms of hair diseases and treatment, information of presence of
gray hair and history of dandruff. More importantly, they were
asked to self-rate hair-thickness using the sex-specific grading
scales provided (Figs 6 and 7).
Examination In order to measure agreement between subject and
clinician reporting and to record additional information on frontal
hairline, a random sample of 427 subjects who expressed interest
on the survey were examined by a consultant dermatologist or
dermatology registrar familiar with the hair thickness scales used
and blinded to the results of the questionnaires. Hair thickness, hair
pattern, dandruff, gray hair, solar keratoses, and skin cancers were
recorded.
Secondary study of pre-pubertal children To assess mid-frontal
scalp hair thickness in pre pubertal children, to determine ‘‘baseline’
hair density prior to the possible onset of pattern hair loss, ques-
tionnaires and consent forms were sent to the parents of the 350
children at Carey Baptist Grammar School in Kew Victoria. Children
aged from 5–10 y were invited to undergo visual examination of their
scalp to score the presence and severity of AGA. Examinations were
conducted by a consultant dermatologist, a pediatrician, and a re-
search student. Hair wave and color, which might affect the ap-
pearance of the mid-frontal hair density, were also scored.
Data analysis Questionnaire results were compared to examina-
tion results and the kstatistic for observed agreement between
clinicians’ ratings and subjects’ self-ratings was calculated.
Descriptive statistics on hair thickness, hair pattern, gray hair
and dandruff were analyzed from the questionnaires. Subjects re-
porting hair loss related to other diagnoses such as alopecia ar-
eata, thyroid disease, chemo/radiotherapy etc were excluded from
analysis.
Age-specific weighting of prevalence estimates was undertaken
using the 2001 census data for Maryborough. The 95% CI were
calculated for the weighted prevalence estimates with the weight-
ing variable applied.
Figure 6
Male hair pattern grading scale. Stages 1–5.
188 GAN AND SINCLAIR JID SYMPOSIUM PROCEEDINGS
Ordinal regression analysis was performed to explore associ-
ation of frontal hairline with hair thickness and age using clinicians’
examination data (dependent variable ¼frontal hairline). Logistic
regressions were performed to explore association of grayness
and dandruff firstly using self-reported data in the questionnaires,
and then clinicians’ examination data. (dependent variable ¼gray-
ness; dandruff and grayness both dichotomized)
The following people provided assistance throughout the study: Mr
Bernie Waixel and members of the Maryborough District Health Serv-
ice, members of the Maryborough local publishers, Dr Shannon Ha-
rrison, Dr Alex Chamberlain, Dr Julia Hyun, Dr Michael Starr, Uma
Ramadass, Sem Liew, Adam Chapman and staff members of the
Department of Dermatology of St Vincent’s Hospital Melbourne. Ap-
proved by St Vincent’s Hospital Research and Ethics Committee (Ref-
erence number 123/02).
DOI: 10.1111/j.1087-0024.2005.10102.x
Manuscript received September 20, 2004; revised November 18, 2004;
accepted for publication December 2, 2004
Address correspondence to: MD, Professor Rodney D. Sinclair, FACD,
St Vincent’s Hospital, 41 Victoria Parade, Fitzroy, 3065, Melbourne,
Victoria, Australia. Email: sinclair@svhm.org.au
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Figure 7
Female hair pattern grading scale. Stages 1–5.
PREVALENCE OF PATTERN HAIR LOSS 18910 : 3 DECEMBER 2005
... In males, the increased prevalence of hair loss with age is attributed to hormonal influence on hair growth with increasing age. 10,12 In consonance with our study, other authors report an increased prevalence of hair loss with age. 9,12 The mean age of the participants who had hair loss is higher than that reported in other studies. ...
... 10,12 In consonance with our study, other authors report an increased prevalence of hair loss with age. 9,12 The mean age of the participants who had hair loss is higher than that reported in other studies. 7,14,32 We are unable to account for this difference in age affected as all these studies were conducted in adults. ...
... Androgenic alopecia is reported to be common as individuals age and most of the participants who had hair loss in this study were aged fortyfive years and above. 12 A few participants (3.8%) had two types of HL. It is not unusual to have individuals presenting with more than one type of hair loss. ...
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Background: Hair loss studies have mostly been clinical with no trichoscopy features of the hair loss documented in Nigeria. Objective: The objective of this study was to determine the community prevalence, types of hair loss, trichoschopy features and the risk factors for the observed hair loss types. Methods: This was a cross-sectional descriptive study of traders (Fitz Patrick's skin types V-VI) at an urban market. The traders were clinically evaluated for hair loss. Sociodemographic, clinical and trichoscopy data were recorded using a study questionnaire. Data was analyzed using SPSS version 22.0. Statistics such as means, medians, frequencies, t-test and chi-square test were presented. Levels of significance of all tests was set at, P<0.05%. Results: A total of 307 participants (32.6% male and 67.4% female) with a mean age of 42.7±12.8 years were studied. The prevalence of hair loss was 68.7% (51% in males and 77.3% in females) and the mean age of those with hair loss was 44.8±12.3 years. The pattern of hair loss was patterned, diffuse and localized in 94.3%, 3.8% and 1.9% respectively. The main types of hair loss were androgenetic alopecia (26.9%) and traction alopecia (71.7%). The prevalent hair practices were; braids and weave-on (extensions) in 78.2%, turban-like head gear in 76.9%, and chemical relaxers in 73.8%. Trichoscopy features characteristic of the observed hair loss types were documented. Conclusion: Hair loss is common in the community. The common hair care practices and increasing age could be contributors to hair loss.
... Androgenetic alopecia (AGA) affects both genders in a distinctive pattern of hair loss from the scalp (MPHL for male PHL and FPHL or female PHL). Bitemporal recession affects 98.6% of men and 64.4% of women; whereas mid-frontal hair loss affects nearly two thirds of women and three quarters of men over the age of 80 years [3]. Loss of hair from the vertex is typical of MPHL, encountered in majority of affected men. ...
... A person has 100,000 head hairs on average, depending on hair color, of which around 100 are shed each day. [4] This explains why hair was initially used as trace evidence and a possible way of identification by the legal and medical communities. [5] Virchow is credited with one of the first forensic hair analysis reports, which he wrote in 1861 for a murder case, in which he employed examination variables that are still part of the macro and microscope processes used in hair analysis today. ...
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The outer cuticle, middle cortex, and inner medulla make up hair, which is an epidermal outgrowth. Hair is resilient under harsh natural conditions, thus it is frequently collected at crime scenes, making human hair analysis important in the forensic sciences field. It aids in the formation of a triangle connecting a crime scene, a victim, and a culprit. The aim of this study is to observe the microscopic structure of male and female human hair. Samples of hair specimens from males and females were collected. The materials used were ethanol to degrease and a stereomicroscope to observe the structural differences between the male and female hair samples. The comparison between male and female hair is done on the grounds of color, shaft profiles, the proximal and distal ends of the hair, cuticle, and surface texture, and the other found characters. This study of comparison between male and female hair specimens revealed that the hair color at the distal end is found to be brown for females while it is completely black in that of males, and the surface texture of males is found to have some irregularities while there are no irregularities in female. This study can be concluded that the structural comparison between male and female hair specimens can be used as evidence for forensic analysis at crime scenes.
... According to the American Hair Loss Association, by the age of 35, two-thirds of American men will have some degree of appreciable hair loss, and by the age of 50, approximately 50 to 85% of men will have significant hair thinning [4,6]. The prevalence of male pattern hair loss has been evaluated by an Australian team [7]. Among the 396 men and women over 20 years old examined by dermatologists, 98,6% of the men showed some level of bitemporal recession. ...
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Background: Hair loss is a not life-threatening dermatological condition with some physical effects but with more severe psychosocial consequences. Nutrition deficiencies have been associated to hair loss, opening the door for food supplement's use in decreasing hair loss.
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Androgenetic alopecia (AGA) is the most common hair loss disorder which is seen in both men and women. AGA is a nonscarring progressive reduction of the hair follicle with a usually characteristic pattern distribution in genetically predisposed men and women. AGA is classified into several patterns. Currently, the Hamilton-Norwood classification system for men and the Ludwig grade system for women are the most commonly used grading systems for AGA.
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Features of platelet-rich plasma in the complex therapy in patients with androgenic alopecia are analyzed. A comparative evaluation of the clinical efficacy of the three treatment methods was carried out: topical applications of a5% solution of minoxidil, intradermal injection of platelet-rich plasma, and combination of these techniques. A solution of minoxidil was applied to the dry skin of the scalp 1 ml twice a day without washing throughout the observation period. The course of treatment consisted of 4 procedures with an interval of 4 weeks. Clinical efficacy was assessed by the dynamics of morphometric indices of hair growth. It was established that after complex therapy in the form of minoxidil applications and injections of plasma rich plasma, the hair density increased by 32% (p=0,00004), the diameter of the hair shafts by 26% (p=0,00004). At the same time, the share of vellus hair decreased by 30% (p=0,00082), and the proportion of telogen hair decreased by 39% (p=0,00008). The results of using complex therapy significantly exceeded the clinical effect of platelet-rich plasma and topical applications of a 5% solution of minoxidil. The data obtained allows to suggest that plasma enriched with platelets and minoxidil potentiate each other’s effects, and their complex application seems promising for the treatment of androgenetic alopecia.
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Background and aims: Female pattern hair loss affects females of all ages with a trend to increase after menopause. This disorder may have significant psychological impact and lead to anxiety and depression. Objective: In a single center, double blind, randomized, placebo-controlled study, the effects of oral Pycnogenol® intake (3 × 50 mg/day for a total of 6 months) on hair density, scalp microcirculation, and a variety of skin physiological parameters was studied in Han Chinese menopausal women (N = 76) in Shanghai, China. Methods: Measurements were taken at the beginning and after 2 and 6 months, respectively. Hair density was determined by digital photographs and further evaluated by Trichoscan software. Transepidermal water loss was measured by a humidity sensor in a closed chamber on the skin surface. Changes in microcirculation were detected as resting flux on the scalp by reflection photoplethysmography. Results: Pycnogenol® intake significantly increased hair density by 30% and 23% after 2 and 6 months of treatment, respectively, as detected by Trichoscan® evaluation of digital photographs. Interestingly, photoplethysmography revealed that this beneficial effect was associated with a decrease in resting flux of the scalp skin, which might indicate an improvement of microcirculation. None of these effects were observed in the placebo taking group. In addition, a significant transient decrease of transepidermal water loss was observed in scalp skin under Pycnogenol,® but not placebo treatment. Conclusion: Oral intake of Pycnogenol® might have the potential to reduce hair loss in postmenopausal women.
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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.
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• Decrease in hair density in the central (vertex, mid and frontal) scalp, bitemporal and parietal regions in women. • Miniaturization of affected hairs. • Two ages of onset: early (post-puberty to third decade) and late (age 40+ years). • Signs of hyperandrogenism (hirsutism, irregular periods) or hyperandrogenemia occur in a subset of women with female pattern hair loss (FPHL) but most women with FPHL have neither. • Many, but not all, affected women respond to antiandrogens or 5α-reductase inhibitors with increased hair growth indicating an androgen etiology in at least some cases of FPHL.
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‘Patterned’ hair loss of the so-called male type (androgenic alopecia) has long been regarded as a marker of pathological virilization when it occurs in women—an indicator of specific ovarian or adrenal disease. We have believed for many years that patterning is relatively common in normal women, although it is generally masked by the hair styles adopted to convey an appearance of dense hair. Since it is medically important to confirm the physiological nature of female patterning, we carried out a population survey of 564 normal women. The hair density of each subject was carefully examined from above and the hair style flattened or wetted to show the vertex pattern, using the standard grading methods of Hamilton and Ludwig. Thirteen per cent of premenopausal and 37% of post-menopausal women had detectable Hamilton grades of 2–7 which were not obvious from frontal viewing. We conclude that in the absence of other signs of virilization, patterned alopecia in women is a poor indicator of significant androgen metabolism diseases.
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Androgenetic alopecia in the female occurs much more frequently than is generally believed. The condition is still considered infrequent, for it differs, in its clinical picture and in the sequence of events leading to it, from common baldness in men. To facilitate an early diagnosis (desirable in view of the therapeutic possibilities by means of antiandrogens) a classification of the stages of the common form (female type) of androgenetic alopecia in women is presented. The exceptionally observed male type of androgenetic alopecia can be classified according to Hamilton or to the modification of this classification proposed by Ebling & Rook.