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Title: Towards a consensus on how to diagnose and quantify female pattern hair loss - The Female Pattern Hair Loss Severity Index (FPHL-SI).
Authors: Sinclair, Rodney
Other Authors: Harries, M. J.
Tosti, A.
Bergfeld, W.
Blume-Peytavi, U.
Shapiro, J.
Lutz, G.
Messenger, A.
Paus, R.
Keywords: Female Pattern Hair Loss
Severity Index
Three Point Severity Scale
Hair Density
Disease Severity
Early Disease
Ludwig Scale
Head & Neck Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth HealthCare, Richmond, Victoria, Australia, Victoria, Australia
Issue Date: Dec-2015
Publisher: Wiley
Citation: J Eur Acad Dermatol Venereol. 2015 Dec 17.
Abstract: BACKGROUND: Female pattern hair loss (FPHL) is a common non-scarring alopecia characterized by widening of the midline hair part at the crown (vertex). In 1977, Ludwig developed a scale that graded the degree of visible vertex hair thinning from I (least severe) to III (most severe). However, by the time patients exhibit the full manifestations of 'Ludwig I', they have already lost a significant volume of hair. Although current therapies may realistically halt progression of hair loss, improvements in hair density is often more limited. Identification and grading of FPHL at an earlier stage is desirable to institute appropriate therapy before significant hair loss has occurred and to enable monitoring over time. AIM: To generate consensus guidance for the recognition and quantification of FPHL that can be used in the clinic. METHODS: Nine clinicians from Europe, North America and Australia experienced in the management of FPHL developed this scale by consensus. RESULTS: We propose a three-point severity scale (termed the FPHL Severity Index (FPHL-SI)) that combines validated measures of hair shedding, midline hair density and scalp trichoscopy criteria to produce a total FPHL-SI score (maximum score = 20). The score is designed to grade FPHL severity over time, while being sufficiently sensitive to identify early disease. A score of 0-4 makes FPHL unlikely; a score of 5-9 would indicate early-stage FPHL, with higher scores indicating greater disease severity. CONCLUSIONS: As a starting point for further public debate, we employ criteria already used in clinical practice to generate a pragmatic FPHL grading system (FPHL-SI) of sufficient sensitivity to identify and monitor early FPHL changes. This may have to be further optimized after systematic validation in clinical practice.
DOI: 10.1111/jdv.13455
PubMed URL:
ISSN: 0926-9959
Journal Title: Journal of the European Academy of Dermatology and Venereology
Type: Journal Article
Affiliated Organisations: Salford Royal NHS Foundation Trust, The University of Manchester, Manchester, UK
University of Miami, Miami, FL, USA
University of Bologna, Bologna, Italy
Cleveland Clinic, Cleveland, OH, USA
Charité University of Berlin, Berlin, Germany
University of British Columbia, Vancouver, Germany
New York University, New York, NY, USA
Hair and Nail, Bonn, Germany
Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
University of Melbourne, Melbourne, Australia
University of Manchester, Manchester, UK
University of Münster, Münster, Germany
Type of Clinical Study or Trial: Prospective Study
Appears in Collections:Dermatology
Head & Neck

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