Doctor Muhammad Ahmad proposes a new classification system for male patterned baldness.

Hair loss is the most common complaint among the male population. There are many causes of hair loss. Mainly it is divided into two major categories, androgenic and non-androgenic hair loss.

Androgenic hair loss is characterized by gradual loss of hair from the scalp. It is basically genetic in nature and androgens play an important role. Fibrotic changes start in the germinal cells, thereby gradually reducing the affected hair length. The hair is ultimately replaced by very fine, thin ‘vellus’ hair. This type of hair loss is generally programmed and many genes have been identified. On the other hand, non-androgenic hair loss may have various causes including trauma, infections, auto-immune diseases, etc.

It is evident from several studies that hair loss patterns have regional differences. Differences have also been noted among European and Asian populations, for example a Chinese study shows different ratios in various cities of china.

Classification systems

Many researchers have proposed different classifications for male patterned hair loss. The first was proposed by Beek in 1950. Later Hamilton, Norwood, Bouhanna, Lee etc added their classification systems. Among these, the Norwood-Hamilton system is the most widely used.

In the previous classification systems, there are a few limitations. Because of the diversity of genetic based hair loss patterns, there are certain hair loss patterns which cannot be classified in any of the systems and were named ‘non-specific’ patterns.

The author has attempted to introduce a new classification system, in which the Norwood-Hamilton scale maintains its ‘gold standard’ position and more points are added to it.

NPRT System

The new classification consists of four key points:

1. Norwood-Hamilton Scale constitutes the principal part. It is denoted by the letter ‘N’.

2. Temporal Peaks/Points is denoted by the letter ‘P’. Different grades are proposed from ‘0’ to ‘3’. P0 indicates ‘No’ hairloss at the temporal points. P1 indicates the temporal point (apex of the peak) is located not less than the junction of one third and two thirds of the distance between outer canthus to tragus. P2 indicates the temporal point is located not less than the half of the distance between outer canthus to tragus. P3 indicates the reverse of P1, i.e. the temporal point is located at the distance less than two thirds and one third between outer canthus to tragus.

3. Reverse Thinning is denoted by the letter ‘R’. It is the hair loss in the occipital area and above the ears (mastoid area) which may be combined with loss of peaks. ‘Reverse thinning’ means that more skin is visible than hair. R0 indicates ‘No’ reverse thinning. R1 indicates ‘mild reverse thinning’, i.e., the decreased density is limited only to 1 cm above ears and/or occipital area. R2 indicates ‘moderate reverse thinning’, i.e. the hair loss/decreased density is more than 1 cm but less than 2 cm. R3 indicates ‘severe reverse thinning’ and involves the decrease in density/hair loss to more than 2 cm above the ears and/or above the line joining both ear lobes.

4. Overall Thinning is denoted by the letter ‘T’. T0 indicates ‘No’ thinning. T1 indicates a ‘mild’ loss in density (less than 25%). T2 indicates the ‘moderate’ loss in density (more than 25% but less than 50%). T3 indicates ‘severe’ loss of density (more than 50%). The density can be measured at the level of external occipital protuberance. The density of 100 hair/cm2 is taken as normal.

The new system is based on the morphologic appearance of gross hair loss patterns. The new added points actually add-in the information and can predict the future hair loss pattern and treatment options, which may be required at a certain age. It also helps to avoid the possible misjudgments in the treatments plan.

The new classification system for male pattern baldness is helpful in ascertaining the exact situation of hair loss and can also predict the future hair loss pattern as well.