The Classification of Hair Loss

Hair transplant surgeons describe hair loss in patients using classification systems. Classification systems can provide several advantages. They can help to determine what therapies or surgical procedures to use and help to standardize hair loss terminology, enabling better communication between hair transplant surgeons. Some systems are more comprehensive than others and the majority of systems are gender specific^1–4. The most common classification system used to describe hair loss in men is the Hamilton-Norwood system and in women, the Ludwig system is typically used⁵.

In the 1950s, Hamilton categorized hair loss into eight types (I-VIII). Non-balding men were categorized as type I to III and balding men were categorized as type IV to VIII^2,5. Hamilton based these categories on frontal hair recession and thinning patterns that were observed in over 300 men who were experiencing hair loss⁵. In 1975, Norwood revised this system based on where hair thinning starts such as in the temple and crown areas and then progresses along the top of the scalp^4,5. The main hair loss classification system used in women, the Ludwig system, was developed in 1977 by Ludwig³. Women's hair loss was classified into three different grades (I-III). A grade 1 women typically experienced thinning along the crown region and a grade 3 women experienced complete baldness³. Other classification systems that focus on hair loss in women include a five-stage classification system developed by Ebling and Rock, an eight stage system developed by Savin (nicknamed the Savin scale), and a self-reporting photographic based scale developed by Sinclair^5,6.

If you are curious about what class your hair loss might be considered be sure to ask your hair transplant surgeon at your next consultation.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Koo SH, Chung HS, Yoon ES, Park SH. A new classification of male pattern baldness and a clinical study of the anterior hairline. Aesthetic Plast Surg. 2000 Feb;24(1):46–51.


2. Hamilton JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951 Mar;53(3):708–28.


3. Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977 Sep;97(3):247–54.


4. Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975 Nov;68(11):1359–65.


5. Gupta M, Mysore V. Classifications of Patterned Hair Loss: A Review. J Cutan Aesthetic Surg. 2016 Mar;9(1):3–12.


6. Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. J Am Acad Dermatol. 2004 Aug;51(2):189–99.

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Free PRP & Laser Hair Therapy For New Hair Transplant Patients

For a limited time Sure Hair International is offering FREE Platelet Rich Plasma therapy and 3 months of laser hair therapy.

• 1 Platelet Rich Plasma Treatment (Valued at $1,500)


• 3 Months of Laser Hair Therapy (Valued at $1,500)

This promotion will be available for transplants performed until the end of November, 2016. Check out the following blog posts for more information on the benefits of laser hair therapy and platelet rich plasma therapy.

Advanced Laser Hair Therapy – 90% Effective Regrowth Treatment

The Vampire Treatment

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Ruxolitinib – A Treatment for Alopecia Areata

Hair loss can be caused by many different conditions such as chemotherapy-induced alopecia, androgenetic alopecia (male pattern baldness) and alopecia areata (spot baldness). Alopecia areata  or 'spot baldness' is an autoimmune disease where actively growing hair follicles are attacked by the body's own immune system¹. This condition can lead to total scalp hair loss (alopecia totalis) or total scalp and body hair loss (alopecia universalis)². Alopecia areata is a relatively common form of hair loss, second to androgenetic alopecia³.

As alopecia areata can impact the quality of life, potential treatments for this hair disorder have been examined⁴. For instance, ruxolitinib has been recently evaluated⁵. Ruxolitinib is currently approved to treat disease of the bone marrow (e.g., myelogibrosis)⁶. In a recent open-label clinical trial, 12 moderate to severe alopecia areata patients were given 20 mg of ruxolitinib, twice a day for 3 to 6 months⁵. At least 50% hair regrowth occurred in 9 of these patients by week 12 and 7 of these patients obtained over 95% regrowth by the end of treatment⁵.  Bacterial skin infection, upper respiratory tract infection, and urinary tract infection are some of the adverse effects reported in this study⁵.

Ruxolitinib is just an example of the many off label emerging therapies being developed. Other off-label therapies for alopecia areata include topical or systemic steroids, and topical immunotherapies⁷. Talk to your doctor if you are interested in finding out more information on hair loss treatments.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Paus R, Slominski A, Czarnetzki BM. Is alopecia areata an autoimmune-response against melanogenesis-related proteins, exposed by abnormal MHC class I expression in the anagen hair bulb? Yale J Biol Med. 1993 Dec;66(6):541–54.


2. Islam N, Leung PSC, Huntley AC, Gershwin ME. The autoimmune basis of alopecia areata: a comprehensive review. Autoimmun Rev. 2015 Feb;14(2):81–9.


3. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol. 2010 Feb;62(2):191–202, quiz 203–4.


4. Masmoudi J, Sellami R, Ouali U, Mnif L, Feki I, Amouri M, et al. Quality of life in alopecia areata: a sample of tunisian patients. Dermatol Res Pract. 2013;2013:983804.


5. Mackay-Wiggan J, Jabbari A, Nquyen N, Cerise J, Clark C, Ulerio G, et al. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight. 2016 Sep 22;1(15):e89790.


6. Jakafi (ruxolitinib) tablets, for oral use [Internet]. U.S. Food and Drug Administration. 2016 [cited 2016 Oct 10]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/202192s012lbl.pdf


7. Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev. 2008;(2):CD004413.

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Are Robots Taking Over Hair Transplants?

Hate waiting for lines at the bank? How about waiting in line at the theatre? Debit machines and movie ticket kiosks are what I gravitate towards when I'm at the bank or seeing a movie as they dramatically shorten wait times. These technology based shortcuts can also be used in hair transplants.

Follicular unit extraction (FUE) is a donor harvesting technique that removes hair follicles from a donor region without creating the need for linear incisions (1). FUE can be quite time consuming as only one follicular family (a group of 1 – 4 hair follicles) is removed at a time (2). The amount of time required to remove hair follicles from a donor region is decreased when adding robotic technology and automation to FUE (2).

Robotic FUE systems are made up of three major components. The first is a robotic arm that contains two different types of punches; a sharp punch and a blunt punch. The sharp punch makes a superficial 1 mm incision around the hair follicle and the blunt punch then creates follicle detachment through a second deeper incision (2). The next major component is the suction system. Suction is used to help move the hair follicle above the skin surface to allow for easier extraction (2). Cameras are also a major component of robotic FUE systems. These cameras are equipped with processing software that helps direct punch incision, ensuring punches are correctly placed at the right angle for effective extraction (2). This imaging software can also prevent overharvesting; only allowing follicles to be extracted when they are 1.6 mm apart from each other (2).

There are several different robotic and automated devices on the market today such as the NeoGraft automated hair transplant system, the surgically advanced follicular extraction (SAFE) system and the ARTAS Robotic System (Restoration Robotics Inc., San Jose, CA) (3-6). Be sure to speak with your hair transplant surgeon if you are interested to learn about robotic or automated devices in your upcoming hair transplant consultation.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Rassman WR, Bernstein RM, McClellan R, Jones R, et al. Follicular unit extraction: minimally invasive surgery for hair transplantation. Dermatol Surg 2002;28:720-8.


2. Avram MR, Watkins SA. Robotic Follicular Unit Extraction in Hair Transplantation. Dermatol Surg 2014;40(12):1319-26.


3. NeoGraft web site. Available from: http://neograft.com/. Accessed July 14, 2014.


4. Rose PT. The latest innovations in hair transplantation. Facial Plast Surg 2011;27:366-77.


5. Gupta A. Microrefined microfollicular hair transplant: a new modification in hair transplant. Ann Plast Surg 2014;73:257-65.


6. Harris JA. New methodology and instrumentation for follicular unit extraction: lower follicle transection rates and expanded patient candidacy. Dermatol Surg 2006;32:56-61; discussion 2.

 

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