The Ludwig scale was the first-ever tool to classify the pattern of hair loss in women. Even though it’s quite simple, it was and still is quite helpful. In this guide, you’ll learn more about the progression of hair loss according to the Ludwig scale.
What Is The Ludwig Scale Of Classification?
The Ludwig scale is a classification system used to determine the extent and progression of hair loss in women with pattern baldness.
The scale was proposed by Erich Ludwig in 1977 in his study titled, “Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex” evaluating the development of female androgenetic alopecia in 468 women.
Stages Of The Ludwig Scale
According to Ludwig’s study, hair loss severity in female androgenetic alopecia can be divided into three stages:
Stage I — Hair in the crown region of the scalp becomes noticeably thinner. However, this phenomenon is limited to the area 1-3 cm behind the hairline.
Stage II — Hair loss becomes more severe as there is a significant reduction in the density of the hair in the crown area.
Stage III — A complete loss of hair occurs in the top and crown of the scalp, but the frontal fringe is retained.
There are different treatment options for female pattern baldness, including minoxidil, spironolactone, platelet-rich plasma (PRP) to stimulate hair growth and laser therapy. It’s important that you consult a medical professional for the best treatment plan.
Are there other patterns of hair loss in female androgenetic alopecia?
According to a 2015 review on female pattern hair loss, female androgenetic alopecia can occur in three different patterns.
Diffuse thinning — The top and crown of the scalp lose hair while the frontal hairline is preserved (this can be seen happening in the Ludwig scale).
Christmas tree pattern hair loss — This is when women have a Christmas tree-like pattern of hair loss when the hair is parted in the middle. This triangle has its base towards the front of the scalp.
Classic male pattern of hair loss — Described in the Norwood-Hamilton scale for classification of hair loss in male pattern baldness, this type of hair loss can “rarely” also be seen in women.
What Are The Limitations Of The Ludwig Scale?
Though the Ludwig scale was the first of its kind in classifying the progression of hair loss in female pattern baldness, it had several limitations.
As noted in a 2016 review, the Ludwig scale doesn’t describe the Christmas tree pattern or male pattern of hair loss in women. It also doesn’t go into detail about different degrees of hair loss, which were later described by Savin in 1992.
Savin’s pictorial grading of female pattern hair loss from Gupta M, Mysore V. Classifications of Patterned Hair Loss: A Review. J Cutan Aesthet Surg. 2016 Jan-Mar;9(1):3-12. doi: 10.4103/0974-2077.178536. PMID: 27081243; PMCID: PMC4812885/CC BY-NC-SA 3.0
At Which Ludwig Stage Can You Get A Hair Transplant?
You can get a hair transplant at Stage I, II or III of the Ludwig scale. A 2021 study published in Plastic and Reconstructive Surgery noted women undergoing a hair transplant in all stages of the Ludwig scale.
If you have a stable donor area and are in good health, you might be considered a suitable candidate for a hair transplantation surgery. The results of the procedure are permanent.
Experiencing Hair Loss?
Surgical and non-surgical treatments for hair loss are arranged by Longevita for both men and women in London and Istanbul. Arranging access to highly experienced teams of professionals, we are proud to have a 98% satisfaction rate. If you’re interested in starting your journey with us, please do not hesitate to contact us.
Dr Hassan
Based in London, Dr Hassan is a highly qualified plastic surgeon with over decades of experience. He is well-accomplished and experienced in the art of hair transplantation surgery, and his specialities include non-surgical treatments, such as platelet-rich plasma (PRP) injections for the scalp. Dr Hassan can always be counted on to achieve the best possible outcomes for his patients.
Dr Hassan is an independent, GMC-registered plastic surgeon (GMC: 6107783) with over 20 years of experience in hair restoration and cosmetic surgery. He performs his hair transplant procedures at Kensington Cosmetic Clinic, a CQC-registered (1-14206333213) independent hospital in London.
