Introduction: Androgenetic alopecia (AGA) in males is patterned and therefore easy to recognize. However, in females, AGA usually presents with diffuse thinning over the crown (widening of the partition). A clinical diagnosis based on conventional Ludwig classification may underestimate early FPHL (female pattern hair loss). Moreover FPHL in women could be a diffuse process, which may present without patterning.
Aims: To study the prevalence of AGA in females with non-patterned FPHL with the aid of scalp biopsy.
Methodology: Fifty-nine Indian females complaining of increased shedding of hair of more than 6 months duration with reduction in volume of hair but without any evidence of thinning over crown (FPHL stage 1 as per the 5-point visual analogue scale) were enrolled. After a through clinical history and examination to rule out any known causes of hair loss, they were subjected to a triple scalp biopsy procedure, all of which were sectioned transversely. Diagnostic definitions were applied (Terminal hair: vellus hair ratio; 4:1 was diagnostic of FPHL;8:1 of chronic telogen effluvium (CTE); and ratios between 4:1-8:1 were considered indeterminate)
Results: After analyzing 177 biopsies from 59 women, thirty-four(57.6%) had FPHL, seventeen(28.8%) had CTE, and 8(13.6%) were indeterminate.
Discussion: Had scalp biopsy not been offered to our 59 patients there would have been a delay in diagnosis of AGA (in >50% of women) and there-by delaying treatment. Scalp biopsy can also help to distinguish CTE from FPHL.
Conclusion: Though scalp biopsy serves as a diagnostic tool for early non-patterned FPHL, it is currently grossly underutilized. It should be offered as a routine diagnostic procedure in patients presenting with hair loss; especially females with chronic hair shedding without thinning; where a clinical diagnosis of FPHL is not possible. Indeterminate group of patients should be followed up to see whether they evolve into FPHL.