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Title: The Ludwig pattern of androgenetic alopecia is due to a hierarchy of androgen sensitivity within follicular units that leads to selective miniaturization and a reduction in the number of terminal hairs per follicular unit.
Epworth Authors: Sinclair, Rodney
Other Authors: Yazdabadi, Anousha
Magee, Jill
Harrison, S.
Keywords: AA
Alopecia, Androgenetic
Androgenetic Alopecia
Hair Follicle
Female Pattern Baldness
Department of Dermatology, Epworth HealthCare, Richmond, Victoria, Australia.
Head & Neck Clinical Institute, Epworth HealthCare
Issue Date: Dec-2008
Publisher: Wiley
Citation: British Journal Dermatology. 2008 Dec;159(6):1300-2
Abstract: BACKGROUND: Hair follicles exist within follicular units (FUs). In utero the central primary hair follicles are surrounded by smaller secondary follicles. Each FU is nourished by a single arborizing arrector pili muscle that attaches circumferentially around the primary follicle with variable attachment to other follicles. Androgenetic alopecia (AA) miniaturizes susceptible scalp hair follicles in a distinctive and reproducible fashion manifesting in different patterns between men and women. OBJECTIVES: We hypothesized that there is an additional layer to the patterning in AA, with a hierarchy of susceptibility within FUs to AA, and that the diffuse hair loss seen in women with AA is due to a reduction in the number of terminal hairs per FU rather than uniform miniaturization of entire FUs. METHODS: We compared the mean numbers of FUs and terminal hairs per FU in 4-mm scalp punch biopsies in 24 women with AA with those in 21 controls. RESULTS: There was no significant difference in the number of FUs; however, women with AA had 2.40 terminal hairs per FU compared with 3.38 in the control group (P=0.0001) associated with a mean increase of 0.6 vellus hairs per FU. Complete miniaturization of all hairs within the FU was not seen. CONCLUSIONS: Diffuse hair loss in women with AA is due to a reduction in the number of terminal hairs per FU and an increase in the number of vellus hairs. This supports the hypothesis of a hierarchy of susceptibility within FUs to AA. Further investigation is required to ascertain whether secondary and tertiary hair follicles are more susceptible than primary follicles.
DOI: 10.1111/j.1365-2133.2008.08820.x
PubMed URL:
ISSN: 0007-0963
Journal Title: British Journal Dermatology
Type: Journal Article
Affiliated Organisations: Department of Dermatology, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Dermatology
Head & Neck

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