Female alopecia: Hair loss in women

What causes female pattern baldness?

Different Scales in Female Alopecia

Female alopecia, or hair loss in women, is a condition that can manifest in various forms and severity levels. The extent and pattern of hair loss can be classified into different scales, which are helpful for both healthcare professionals and patients to understand the condition and determine appropriate treatment strategies.

The Ludwig Scale

The Ludwig Scale, also known as the Ludwig Classification, is a widely used system for categorising and grading female pattern hair loss, or alopecia in women. Developed by Dr. Elizebeth Ludwig in 1977, this scale provides a structured method for assessing the extent and severity of hair loss in women. Female pattern hair loss, also known as androgenetic alopecia, is a common condition that can be emotionally distressing for those affected. The Ludwig Scale helps clinicians and researchers standardise the evaluation and diagnosis of this condition.

The Ludwig Scale consists of three main stages, often referred to as Ludwig I, Ludwig II, and Ludwig III, each representing a different level of hair loss and its impact on the appearance of the scalp

Ludwig I

In this stage, hair thinning is primarily characterised by a widening of the part in the hair. Hair loss is most noticeable at the crown of the head, and the frontal hairline typically remains relatively intact. This stage is often considered mild and may be less apparent to others, but it can be distressing to the individual experiencing it.

Ludwig II

In this intermediate stage, hair loss becomes more significant, and the scalp's visibility increases. The hairline remains stable, but the area of hair thinning at the crown becomes more pronounced. Women in this stage may begin to notice a decrease in hair volume and may experience a decrease in overall hair density.

Ludwig III

This is the most advanced stage on the Ludwig Scale. Hair loss is extensive, particularly at the crown of the head, leading to a more severe reduction in hair volume. The frontal hairline may also recede, further exacerbating the appearance of hair loss. The scalp is highly visible in this stage, and hair styling may be challenging.

Savin's Scale

The Savin Scale, also known as the Savin Classification, is indeed a recognised scale used for assessing female pattern hair loss or alopecia. The Savin Scale was developed by Dr. Shelly Friedman and Dr. Vera Price in collaboration with Dr. Savin, which is why it’s often referred to as the Savin Scale. This scale provides a detailed and systematic way to categorise and grade female pattern hair loss, similar to the Ludwig Scale and Sinclair Scale.

The Savin Scale consists of eight specific stages, ranging from no hair loss to severe hair loss, and it takes into account both the extent and density of hair loss.

Type 1: Minimal Hair Loss

No visible hair loss.
Full head of hair with no thinning.
Central part of the scalp may show slight hair reduction.

Type 2: Moderate Hair Loss

Noticeable hair thinning.
Hair loss extends beyond the central part of the scalp.
Decreased hair density becomes more apparent.

Type 3: Severe Hair Loss

Significant hair loss with pronounced scalp visibility.
Thinning affects the crown area.
Hair volume is considerably reduced.

Type 4: Very Severe Hair Loss

Advanced hair loss, impacting both the central and crown regions.
Scalp is highly visible, and hair density is significantly reduced.

Treatments for Hair Loss in Women

Diagnosing female alopecia is typically more intricate, and in many instances, it’s advisable to explore hair-enhancing treatments before considering hair transplants.

One promising option is the application of minoxidil (in 2% or 5% concentrations) in the form of a topical lotion. Minoxidil can often enhance hair thickness, leading to an overall increase in hair density.

Another therapeutic route is mesotherapy for hair loss, which should always be administered under the guidance of a medical professional following a thorough evaluation. These sessions involve injecting specialised formulations into the scalp, much like minoxidil, to stimulate hair growth and bolster overall hair density.

It’s important to bear in mind:

Minoxidil should be applied twice daily to areas affected by hair loss.
It may take at least six months of consistent treatment before noticeable improvements are seen.
While minoxidil is generally well-tolerated, some individuals may experience side effects. In such cases, mesotherapy-type treatments can be considered as a preferred alternative.

Hair transplant for women

Hair transplantation, or hair restoration, is a viable solution for many women dealing with hair loss concerns. In fact, women now account for 30% of hair transplant procedures worldwide. Much like any hair transplant procedure, it involves grafting hair follicles from a donor area, which should ideally be sufficiently dense. Women, in particular, have the option to choose the DHI (Direct Hair Implantation) hair transplant method without shaving their head, allowing for an effective solution to address areas affected by alopecia.

Hair transplantation proves beneficial in a range of scenarios:

Partial or Complete Reconstruction: Women can opt for hair transplants to restore areas of their scalp with partial or complete hair loss.
Scar Camouflage: It’s a reliable technique for concealing scars on the scalp, such as those caused by burns or other injuries.
Scalp Thinning Treatment: Women experiencing scalp thinning can benefit from hair transplants to regain hair density and improve overall hair health.

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