Hair shedding in women: how much is too much?

Abstract

Background: Human hair growth is cyclical but asynchronous. Women normally shed 50-150 hairs per day. Moat shedding goes unnoticed. Women commonly present complaining of increased hair loss due to excessive hair shedding, especially after washing their hair. This may indicate either an increase in the actual amount of hair fall or an increase in their perception of hair fall. Changes in actual hair fall occur in number of hair conditions including anagen effluvium, acute and chronic telogen effluvium, alopecia areata, cicatricial alopecia and female pattern loss. Aim: To develop and validate a hair shredding scale, and to use that scale to define normal and excessive hair loss. Methods: Long, black hair shed from a woman with FPHL was counted and separated into 6 bundles that were to create a visual analogue scale. The scale was piloted for usability in a hair loss clinic. Hair shedding scores were subsequently obtained from women newly diagnosed with female pattern hair loss (FPHL). Normal shedding was defined among adolescent school girls. Results: 50 women completed the pilot study. There was strong agreement between scores at week 0 and weeks 2. 209 consecutive women with previously untreated FPHL and with shoulder length or long hair were scored for hair loss. 142 (68%) reported grade 5 or 6 shedding. the mean shedding score among these women was 4.96. the mean hair shedding score was 2.68 in an assessment of 100 school girls with a mean age of 13.51 year no hair loss. 99 girls had shedding scores < 4 and 1 girl had grade 5 shedding. Discussion: This hair shedding scale accurately defines normal and abnormal hair shedding in females with long hair. Grades 1-4 can be considered normal. Grades 5 and 6 shedding indicate excessive hair shedding. Excessive hair shedding is found in 70% of women with FPHL.