Differences in Demographic and Clinical Characteristics Among Subtypes of Female Pattern Hair Loss

Abstract

Background

Female pattern hair loss (FPHL) is the most common hair loss disorder in women that can be classified into three patterns, including Ludwig, Olsen, and Hamilton-Norwood subtypes. Information regarding the comparison of demographics, clinical characteristics, and associated comorbidities among subtypes of FPHL is scarce and contradictory.

Objective

To evaluate and compare the epidemiology, clinical manifestations, and comorbid conditions of FPHL subtypes and determine their associated factors.

Methods

This retrospective study included patients who were diagnosed with FPHL between January 2000 and November 2021. Participants were classified into three subtypes, namely Ludwig, Olsen, and Hamilton-Norwood, and were statistically compared. Variables significantly associated with each FPHL subtype were identified using multivariable multinomial logistic regression analysis.

Results

Among the 519 patients with FPHL, the Ludwig subtype was the most prevalent (51.1%), followed by the Olsen (32.9%) and Hamilton-Norwood (16%) subtypes. The Hamilton-Norwood subtype revealed significantly higher frequencies of early disease onset (61.4%), menstrual irregularity (22.9%), polycystic ovary syndrome (PCOS, 18.1%), and seborrhea (30.1%) but lower frequencies of overweight (24.1%) and type 2 diabetes mellitus (DM, 2.4%). Multivariable multinomial regression analysis demonstrated that the Hamilton-Norwood subtype was a predictor for early disease onset and PCOS compared to Ludwig (early onset: odds ratio (OR) = 2.14, 95% confidence interval (CI) = 1.39–4.22, P = 0.02; PCOS: OR = 2.02, 95% CI = 1.55–4.84, P = 0.03), and Olsen (early onset: OR = 1.89, 95% CI = 1.03–3.92, P = 0.04; PCOS: OR = 2.24, 95% CI = 1.89–5.31, P = 0.01). In contrast, the Hamilton-Norwood pattern was at decreased risk for type 2 DM compared to Ludwig (OR = 0.51, 95% CI = 0.03–0.82, P = 0.02), and Olsen (OR = 0.68, 95% CI = 0.04–0.79, P = 0.03).

Conclusion

The Ludwig pattern was found to be the most prevalent FPHL subtype among Thai patients. Moreover, the Hamilton-Norwood subtype was associated with early disease onset and PCOS, whereas the Ludwig and Olsen subtypes were associated with type 2 DM.

Keywords:

• AGA
• androgenetic alopecia
• comorbidity
• FPHL
• non-scarring alopecia
• subtype

Abbreviations

AGA, Androgenetic alopecia; ANOVA, Analysis of variance; BMI, Body Mass Index; CI, Confidence interval; DM, Diabetes mellitus; FPHL, Female pattern hair loss; IQR, Interquartile range; OR, Odds ratio; PCOS, Polycystic ovary syndrome; SD, Standard deviation.

Data Sharing Statement

The data sets used to support the findings of this study are available from the corresponding author upon request.

Ethics Approval and Consent to Participate

This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Mahidol University Institutional Review Board for Ethics in Human Research (MURA2022/778). Concerning the included participants, the requirement for informed consent was waived, and the data were anonymized before analysis.

Disclosure

The authors declare that this manuscript was prepared in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.