The Ludwig scale

Similar to its male equivalent, there is a classification for female baldness called the Ludwig scale. It only has 4 stages (compared to 7 for men according to the Hamilton-Norwood scale), because female androgenetic alopecia, which represents over 95% cases of baldness in women, has 4 stages of severity. There are now almost 2 million French women affected by this condition.

Androgenetic baldness in women is caused by the secretion of a new hormone; when it comes into contact with the 5-Alpha reductase enzyme, it weakens the hair follicles, then causing the hair to fall out. Fortunately, complete baldness in women is extremely rare.

This alopecia results in the loss of hair on the top of the head (tonsure), and the hair in this area gradually becomes thinner, and the parting widens.

There are, of course, other types of female baldness, which can take several forms and are sometimes quite uneven (e.g. patchy baldness on the right and left sides of the head). These types of baldness are generally non-cicatricial and are sometimes very aggressive and even painful (sores, burns, skin infections, etc.) External causes (chemotherapy, 3^rd degree burn, radiotherapy, infection, virus, etc.) often cause this category of alopecia. It is called temporary alopecia as the hair often grows back. Unfortunately, it can be irreversible if a burn has destroyed the hair follicle.

There are other possible reasons for hair loss. Stress is a frequent and well-known cause. In fact, feelings of anxiety increase androgen secretions and iron deficiencies, weakening the hair and causing it to fall out. When a women is particularly sensitive to experiencing hair thinning due to stress, it is called chronic alopecia because it appears after each major period of stress. Natural hormonal changes, such as menopause, also cause chronic alopecia.

For an easier understanding, the different stages of baldness in women are listed below using the LUDWIG scale

Stage 1

Alopecia begins with a decreasing number of hairs spread across the top of the head (vertex). In the thinning area, the hairs become sparser, finer and shorter, and the scalp starts to become visible. This alopecia is concentrated in the parting. A thin front section of about 1 to 3 cm still remains with almost normal hair density.

=>  Performing a micrograft procedure is possible because the hair loss is concentrated only along the parting, and the donor area is very big with a good supply of hairs.

Stage 2.1

Moderate alopecia in the vertex region, covering a large line from front to back, in other words a more pronounced widening of the parting, leaving hair of about 2 to 3 cm along the front hairline.

=> Performing a micrograft procedure is possible because the hair loss is concentrated in the parting. Although the hair loss has progressed, the donor area is still big with a good supply of hairs. The results look natural and aesthetically pleasing.

Stage 2.2

At this stage, the alopecia covers almost the entire vertex area. It is the most extreme form of alopecia on the scale, and mainly affects women going through the menopause (around age 60). It is often compared to level 4 alopecia on the Hamilton-Norwood scale because it is very similar. The top of the head is bald, and some short and fine hairs are visible, or even fuzz. This alopecia can become more severe across the whole head in the most serious cases due to a drop in estrogen and progesterone levels during the menopause.

=> A micrograft procedure can be considered, if the baldness does not affect the donor areas as it becomes quite visible and gradually worsens. The results look natural and aesthetically pleasing.

Stage 3

Alopecia begins with a decreasing number of hairs spread across the top of the head (vertex). In the thinning area, the hairs become sparser, finer and shorter, and the scalp starts to become visible. This alopecia is concentrated in the parting. A thin front section of about 1 to 3 cm still remains with almost normal hair density.

=> A micrograft procedure can be considered if the now very obvious balding has not affected the donor areas. At this stage, it should be noted that the baldness is widespread and this makes the procedure difficult. The results can increase the density of the hair but do not restore the hair to its original condition.

Some advice to follow if you notice abnormal hair loss:

• Review your menopause treatment and talk to your gynecologist.
• Have a hormonal blood test to identify any possible thyroid issues.
• Check whether your contraception has an impact on hair loss, and change it if necessary.