Female Androgenetic Alopecia: An Update on Diagnosis and Management

Michela Starace; Gloria Orlando; Aurora Alessandrini; Bianca Maria Piraccini


Am J Clin Dermatol. 2020;21(1):69-84. 

In This Article

Clinical Presentation

FAGA is characterized by a progressive hair follicle miniaturization with the conversion of terminal follicles in velluslike follicles, an increased telogen/anagen ratio and a shortened hair cycle. If untreated, it leads to a slow progressive hair thinning of the scalp, though not to complete baldness, as happens in males.[16]

Three main patterns of FAGA presentation have been described. Most frequently it shows a frontal hair thinning accentuation resulting in the 'Christmas tree' pattern (Olsen pattern)[25] (Figure 1). The second most common pattern is characterized by central scalp involvement with the sparing of the frontal hairline (Ludwig pattern)[26] (Figure 2). Finally, in patients with significant androgenization, bitemporal recession can be observed; rarely it could be associated with vertex thinning (Hamilton pattern)[27] (Figure 3).

Figure 1.

'Christmas tree' pattern of female androgenetic alopecia (FAGA), with frontal hair thinning accentuation

Figure 2.

Typical female androgenetic alopecia (FAGA) presentation, with involvement of the central hairline at different degrees of severity (ac)

Figure 3.

Hamilton pattern in female androgenetic alopecia (FAGA)

However, severe FAGA often involves parietal and occipital regions with diffuse hair thinning.[28]