S1 Guideline for Diagnostic Evaluation in Androgenetic Alopecia in Men, Women and Adolescents

U. Blume-Peytavi; A. Blumeyer; A. Tosti; A. Finner; V. Marmol; M. Trakatelli; P. Reygagne; A. Messenger


The British Journal of Dermatology. 2011;164(1):5-15. 

In This Article

Clinical Picture


In most men, AGA involves the fronto temporal area and the vertex, following a pattern corresponding to the Hamilton–Norwood scale (Fig. 1).[17,18] In some instances, however, men develop diffuse thinning of the crown with retention of the frontal hairline with a pattern that resembles the Ludwig type observed in women.

Figure 1.

Hamilton–Norwood classification of male balding.18


Female pattern hair loss may have three different patterns:

  1. Diffuse thinning of the crown region with preservation of the frontal hairline. There are two scales that describe this pattern: the commonly used 3-point Ludwig scale (Fig. 2)[19,20] and the 5-point Sinclair scale (Fig. 3).[21–23]

  2. Thinning and widening of the central part of the scalp with breach of frontal hairline (Olsen scale: Christmas tree pattern, Fig. 4).[20,24]

  3. Thinning associated with bitemporal recession (Hamilton–Norwood type, Fig. 1).[17,18,24]

However, involvement of the parietal and occipital scalp with diffuse alopecia is clinically observed (Fig. 5).[24,25]

Figure 5.

Regions of the scalp potentially involved in pattern hair loss.20,24 F, frontal; M, mid; T, temporal; V, vertex.


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