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Loss Inherited hair loss (Alopecia Androgenetica) Male pattern

Causes

Male pattern

Female pattern

Changes in hair growth

Male pattern baldness

Male pattern baldness is often diagnosed with the help of a classification system using diagrammatic representations of progressively more extensive hair loss. Originally designed by Dr. Hamilton in the 1950s the pattern baldness classification system was modified to its current form by Dr. Norwood in the 1970s. There are now seven recognized categories of male Alopecia Androgenetica based on Hamilton-Norwood’s classification system. Frequently when consulting with a Trichologist the diagnosis of Androgenetic Alopecia will be made in reference to the classification and you will be given your subclass such as “type III” or similar. These classification scales are used extensively in monitoring treatment trials.

Type I. Minimal or no recession of the hair line.
Type II. Triangular, usually symmetrical, areas of recession at the front temporal hair line.
Type III. This represents the minimal extent of hair loss sufficient to be considered as baldness according to Norwood. Most type III scalps have deep symmetrical recession at the temples that are bare or only sparsely covered by hair.
Type III vertex. In this presentation, the hair loss is primarily from the vertex with limited recession of the frontotemporal hair line that does not exceed the degree of recession seen in type III.
Type IV. The frontotemporal recession is more severe than in type III. There is sparse hair or no hair on the vertex. The two areas of hair loss are seperated by a band of moderately dense hair that extends across the top. This band connects with the fully haired fringe on the sides of the scalp. Type IV is distinguished from type III vertex in which the loss is primarily from the vertex.
Type V. The vertex hair loss region is still separated from the frontotemporal region but it is less distinct. The band of hair across the crown is narrower and sparser. The vertex and front temporal regions of hair loss are bigger, all further progression is characterized by surviving hair on the sides and back of the scalp forming a distinct horseshoe shape.
Type VI. The bridge of hair that crossed the crown is now gone with only sprase hair remaining. The front temporal and vertex regions are now joined together and the extent of hair loss is greater.
Type VII. The most severe form of hair loss presents as extensive loss. A narrow band of of hair in a horseshoe shaps survives on the sides and back of the scalp. This hair is usually not dense and may be quite fine. The hair is also sparse on the nape of the neck and in a semi circle over both ears.

The Hamilton and Norwood male pattern baldness classification systems are comprehensive and involve several stages. However, the distinction between the different patterns for different ethnic groups is not always clear. Some trichologists, especially in Europe, use in addition a simpler five stage classification system developed by Rook and Ebling. This system is rarely used in medical research as it is not detailed enough, but the five stage classification is useful for explaining hair loss to patients. This simplified classification is easier to comprehend. In addition, Ebling developed several classifications for particular ethnic groups and these may be more relevant to some patients than the Hamilton and Norwood "catch-all" classifications. Three schemes under the classification of Rook-Ebling are presented down below for most European man - Mediterraneans or Latins, Jews or Arabs and from Nordic countries. Thus, the Mediterranean or Latin development of pattern baldness involves recession of the frontal hairline and the development of vertex baldness. These two regions of hair loss expand and unites into the extensive type V pattern. Though in the Semitic (Jewish, Arabian) presentation of pattern alopecia involves progressive recession of the frontal hairline but there is no associated thinning on the vertex. And finally the Nordic presentation differs with a central lock of surviving hair on the top of the head.

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