Female pattern baldness has also been classified although the system is much simpler than the male classification design. Female pattern hair loss was arbitrarily arranged into three basic types by Dr Ludwig. The three basic patterns are classified as Ludwig type I, Ludwig type II, and the most extensive hair loss in women is Ludwig type III. The classification shows a progressive increase in diffuse hair loss from the top of the scalp, but the front temporal hair line remains intact. The Ludwig system takes no account of male baldness patterns developing in females although Dr. Ludwig suggested that females with male pattern baldness development should be classified according to the Hamilton-Norwood scales. Minimal diffuse hair loss is the most common form of female alopecia with up to 80% of affected women presenting with this mild form. Ludwig pattern III is rare, found in 5% or less of women with Alopecia Androgenetica.
Type I. Perceptible thinning of the hair on the crown, limited by a line situated 1-3cm behind the frontal hair line.
Type II. Pronounced rarefaction of the hair on the crown within the area seen in type I.
Type III. Full baldness (total denudation) within the area seen in types I and II.
Ebling and Rook also developed a five stage classification system for female pattern baldness. Unlike the three stage Ludwig classification, Ebling and Rook took into account that women could have both a diffuse form of alopecia and also a male pattern with recession of the front temporal hair line. The first two stages are essentially the same as the Ludwig system. Types III, IV, and V are quite rare and generally occur in post menopausal women. Male pattern balding in premenopausal women strongly suggests abnormal androgen production as can occur in polycystic ovary syndrome and other conditions.
Type I shows perceptible thinning of the hair on the crown.
Type II shows pronounced rarefaction of the hair on the crown within the area seen in type I.
Type III shows continued diffuse hair loss in the region defined in types I and II, but also the initial loss of hair from the front temporal hair line.
Type IV shows a continuation of this diffuse loss and front temporal recession.
Type V shows a complete loss of hair on the top of the scalp resembling a male pattern of baldness.