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Clinical Features

HAMILTON’S Grading of Androgenetic Alopecia-


Grade I-  Prepubertal smooth outline of the frontal scalp.


Grade II- Inverted V shaped frontal recession at puberty.


Grade III- Recession of the bitemporal hairline occurs in the early adulthood or the late twenties.


Grade IV- Deep frontotemporal & some midfrontal recession associated in

the older subjects with some vertical thinning.


Grade V- Further fronto-temporal recession & marked vertical thinning


Grade VI- Further progression with tendency towards confluence


Grade VII- Enlargement of both bald areas being separated by only a band of sparse hair


Grade VIII- Complete confluence of both areas leaving only a narrow fringe of occipital hair. Even these hairs may be lost later.

In males, the onset may be sudden wherein they begin as telogen effluvium, or insidious, when the hair fail to generate after telogen.

In women the early sign is a widened central parting. Patient complains her ponytail is becoming thinner. LUDWIG staged them in


Grades I, II, & III, according to the severity of frontovertical thinning, with Grade III manifesting as a patch of baldness in the vertical area. In the affected female the frontal & parietal hairline remain intact. There is diffuse loss of hair, which may start as telogen effluvium. Later there is parietal thinning & in elderly , diffuse thinning. In post-menopausal women, it may progress to male-pattern alopecia up to HAMILTON stage IV/ LUDWIG pattern III.. Damage to self-esteem is more apparent in women. If a women presents with irregular menses, infertility, hirsuitism, severe cystic acne, virilization or galactorrhoea hormonal evaluation for androgen excess is done (serum total or free testosterone, dehydroepiandrosterone sulfate, prolactin).


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