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The Ludwig pattern of androgenetic alopecia is due to a hierarchy of androgen sensitivity within follicular units that leads to selective miniaturization and a reduction in the number of terminal hairs per follicular unit.
Br J Dermatol. 2008 Dec; 159(6):1300-2.BJ

Abstract

BACKGROUND

Hair follicles exist within follicular units (FUs). In utero the central primary hair follicles are surrounded by smaller secondary follicles. Each FU is nourished by a single arborizing arrector pili muscle that attaches circumferentially around the primary follicle with variable attachment to other follicles. Androgenetic alopecia (AA) miniaturizes susceptible scalp hair follicles in a distinctive and reproducible fashion manifesting in different patterns between men and women.

OBJECTIVES

We hypothesized that there is an additional layer to the patterning in AA, with a hierarchy of susceptibility within FUs to AA, and that the diffuse hair loss seen in women with AA is due to a reduction in the number of terminal hairs per FU rather than uniform miniaturization of entire FUs.

METHODS

We compared the mean numbers of FUs and terminal hairs per FU in 4-mm scalp punch biopsies in 24 women with AA with those in 21 controls.

RESULTS

There was no significant difference in the number of FUs; however, women with AA had 2.40 terminal hairs per FU compared with 3.38 in the control group (P=0.0001) associated with a mean increase of 0.6 vellus hairs per FU. Complete miniaturization of all hairs within the FU was not seen.

CONCLUSIONS

Diffuse hair loss in women with AA is due to a reduction in the number of terminal hairs per FU and an increase in the number of vellus hairs. This supports the hypothesis of a hierarchy of susceptibility within FUs to AA. Further investigation is required to ascertain whether secondary and tertiary hair follicles are more susceptible than primary follicles.

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Authors+Show Affiliations

Yazdabadi A
Department of Dermatology, St Vincent's Hospital, University of Melbourne, Fitzroy, Vic. 3065, Australia. yazdaa27@gmail.com
Magee J
No affiliation info available
Harrison S
No affiliation info available
Sinclair R
No affiliation info available

MeSH

AlopeciaAndrogensBiopsyFemaleHair FollicleHumansScalp

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18795932

Citation

Yazdabadi, A, et al. "The Ludwig Pattern of Androgenetic Alopecia Is Due to a Hierarchy of Androgen Sensitivity Within Follicular Units That Leads to Selective Miniaturization and a Reduction in the Number of Terminal Hairs Per Follicular Unit." The British Journal of Dermatology, vol. 159, no. 6, 2008, pp. 1300-2.
Yazdabadi A, Magee J, Harrison S, et al. The Ludwig pattern of androgenetic alopecia is due to a hierarchy of androgen sensitivity within follicular units that leads to selective miniaturization and a reduction in the number of terminal hairs per follicular unit. Br J Dermatol. 2008;159(6):1300-2.
Yazdabadi, A., Magee, J., Harrison, S., & Sinclair, R. (2008). The Ludwig pattern of androgenetic alopecia is due to a hierarchy of androgen sensitivity within follicular units that leads to selective miniaturization and a reduction in the number of terminal hairs per follicular unit. The British Journal of Dermatology, 159(6), 1300-2. https://doi.org/10.1111/j.1365-2133.2008.08820.x
Yazdabadi A, et al. The Ludwig Pattern of Androgenetic Alopecia Is Due to a Hierarchy of Androgen Sensitivity Within Follicular Units That Leads to Selective Miniaturization and a Reduction in the Number of Terminal Hairs Per Follicular Unit. Br J Dermatol. 2008;159(6):1300-2. PubMed PMID: 18795932.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Ludwig pattern of androgenetic alopecia is due to a hierarchy of androgen sensitivity within follicular units that leads to selective miniaturization and a reduction in the number of terminal hairs per follicular unit. AU - Yazdabadi,A, AU - Magee,J, AU - Harrison,S, AU - Sinclair,R, Y1 - 2008/09/15/ PY - 2008/9/18/pubmed PY - 2009/2/7/medline PY - 2008/9/18/entrez SP - 1300 EP - 2 JF - The British journal of dermatology JO - Br J Dermatol VL - 159 IS - 6 N2 - BACKGROUND: Hair follicles exist within follicular units (FUs). In utero the central primary hair follicles are surrounded by smaller secondary follicles. Each FU is nourished by a single arborizing arrector pili muscle that attaches circumferentially around the primary follicle with variable attachment to other follicles. Androgenetic alopecia (AA) miniaturizes susceptible scalp hair follicles in a distinctive and reproducible fashion manifesting in different patterns between men and women. OBJECTIVES: We hypothesized that there is an additional layer to the patterning in AA, with a hierarchy of susceptibility within FUs to AA, and that the diffuse hair loss seen in women with AA is due to a reduction in the number of terminal hairs per FU rather than uniform miniaturization of entire FUs. METHODS: We compared the mean numbers of FUs and terminal hairs per FU in 4-mm scalp punch biopsies in 24 women with AA with those in 21 controls. RESULTS: There was no significant difference in the number of FUs; however, women with AA had 2.40 terminal hairs per FU compared with 3.38 in the control group (P=0.0001) associated with a mean increase of 0.6 vellus hairs per FU. Complete miniaturization of all hairs within the FU was not seen. CONCLUSIONS: Diffuse hair loss in women with AA is due to a reduction in the number of terminal hairs per FU and an increase in the number of vellus hairs. This supports the hypothesis of a hierarchy of susceptibility within FUs to AA. Further investigation is required to ascertain whether secondary and tertiary hair follicles are more susceptible than primary follicles. SN - 1365-2133 UR - https://www.unboundmedicine.com/medline/citation/18795932/The_Ludwig_pattern_of_androgenetic_alopecia_is_due_to_a_hierarchy_of_androgen_sensitivity_within_follicular_units_that_leads_to_selective_miniaturization_and_a_reduction_in_the_number_of_terminal_hairs_per_follicular_unit_ L2 - https://doi.org/10.1111/j.1365-2133.2008.08820.x DB - PRIME DP - Unbound Medicine ER -