Original Article

Clinical and Trichoscopic Graded Live Visual Scale for Androgenetic Alopecia

Author Affiliation(s)


Introduction: Currently, the mostly used classifications of androgenetic alopecia (AGA), only provide a macroscopic and subjective description of this disorder, without evaluating trichoscopic features.

Objective: The aim of this study is to elaborate a graded live visual AGA severity scale including macroscopic and microscopic (trichoscopic) pictures, and to determine the most frequent trichoscopic characteristics associated to each grade.

Methods: A retrospective observational study was conducted on 122 patients (50 females and 72 males) affected by AGA. Macroscopic and trichoscopic photographs were taken at standardized scalp points.

Results: Each picture was ranked from AGA stage I to VII, according to Hamilton scale for men and Savin scale for women, and the most representative images of each severity degree were collected to produce a graded live visual scale. In males, two live visual scales, one for the anterior and one for posterior region of the scalp were created. In females, only one scale of the anterior region was realized. For each stage of severity, the corresponding trichoscopic parameters were statistically analyzed.

Conclusions: We realized new macroscopic and trichoscopic graded live visual scales for male and female patients affected by AGA, which could help physicians in giving an objective evaluation of the disease and in better managing it.

Keywords : androgenetic, alopecia, trichoscopy, scale


1. Lolli F, Pallotti F, Rossi A et al. Androgenetic alopecia: a review. Endocrine. 2017;57(1):9-17. DOI: 10.1007/s12020-017-1280-y. PMID: 28349362. 2. Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001;27:53-54. PMID: 11231244 3. Banka N, Bunagan MJ, Shapiro J. Pattern hair loss in men: diagnosis and medical treatment. Dermatol Clin. 2013;31(1):129-140. DOI: 10.1016/j.det.2012.08.003. PMID: 23159182. 4. Ellis JA, Sinclair R, Harrap SB. Androgenetic alopecia: pathogenesis and potential for therapy. Expert Rev Mol Med. 2002;4(22):1-11. DOI: 10.1017/S1462399402005112. PMID: 14585162. 5. Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975;68(11):1359-1365. DOI: 10.1097/00007611-197511000-00009. PMID: 1188424. 6. Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977;97(3):247-254. DOI: 10.1111/j.1365-2133.1977.tb15179.x. PMID: 921894. 7. Savin RC. A method for visually describing hair loss in male pattern baldness. J Invest Dermatol. 1992;98:604. 8. Lee WS, Ro BI, Hong SP, et al. A new classification of pattern hair loss that is universal for men and women: basic and specific (BASP) classification. J Am Acad Dermatol. 2007;57(1):37-46. DOI: 10.1016/j.jaad.2006.12.029. PMID: 17467851. 9. Rudnicka L, Olszewska M, Waśkiel A, Rakowska A. Trichoscopy in Hair Shaft Disorders. Dermatol Clin. 2018;36(4):421-430. DOI: 10.1016/j.det.2018.05.009. PMID: 30201151. 10. Jain N, Doshi B, Khopkar U. Trichoscopy in alopecias: diagnosis simplified. Int J Trichology. 2013;5(4):170-178. DOI: 10.4103/0974-7753.130385. PMID: 24778525. PMCID: PMC3999645. 11. Nie J, Hou W. A semiquantitative grading scale for frontal and vertex of androgenetic alopecia. Int J Dermatol. 2019;58(5):582-588. DOI: 10.1111/ijd.14324. PMID: 30592306. 12. Galliker NA, Trüeb RM. Value of trichoscopy versus trichogram for diagnosis of female androgenetic alopecia. Int J Trichology. 2012;4(1):19-22. DOI: 10.4103/0974-7753.96080. PMID: 22628985. PMCID: PMC3358933. 13. Kasumagic-Halilovic E. Trichoscopic Findings in Androgenetic Alopecia. Med Arch. 2021;75(2):109-111. DOI: 10.5455/medarh.2021.75.109-111. PMID: 34219869. PMCID: PMC8228579. 14. Hu R, Xu F, Han Y, Sheng Y, Qi S, Miao Y, et al. Trichoscopic findings of androgenetic alopecia and their association with disease severity. J Dermatol. 2015;42(6):602-607. DOI: 10.1111/1346-8138.12857. PMID: 25810236. 15. Rakowska A, Slowinska M, Kowalska-Oledzka E, et al. Dermoscopy in female androgenic alopecia: method standardization and diagnostic criteria. Int J Trichology. 2009;1(2):123-130. DOI: 10.4103/0974-7753.58555. PMID: 20927234. PMCID: PMC2938574. 16. Yazdabadi A, Magee J, Harrison S, Sinclair R. 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. Br J Dermatol. 2008;159(6):1300-1302. DOI: 10.1111/j.1365-2133.2008.08820.x. PMID: 18795932. 17. Sinclair R, Torkamani N, Jones L. Androgenetic alopecia: new insights into the pathogenesis and mechanism of hair loss. F1000Res. 2015;4(F1000 Faculty Rev):585. DOI: 10.12688/f1000research.6401.1. PMID: 26339482. PMCID: PMC4544386. 18. Govindarajulu SM, Srinivas RT, Kuppuswamy SK, Prem P. Trichoscopic Patterns of Nonscarring Alopecia's. Int J Trichology. 2020;12(3):99-106. DOI: 10.4103/ijt.ijt_1_19. PMID: 33223733. PMCID: PMC7659741.

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