title: Occipital involvement in female pattern hair loss: histopathological evidences.
abstract: BACKGROUND
  Female pattern hair loss (FPHL) is characterized by diffuse thinning of hair in the frontal and parietal areas of the scalp, and preservation of the frontal hairline is the norm. Hair on the occipital scalp is thought to be preserved.
  
  
  OBJECTIVE
  To investigate whether the occipital area is involved in FPHL or whether there is a diffuse type of FPHL.
  
  
  METHODS
  Forty female patients who had complained about hair loss for more than a year and were diagnosed with FPHL according to the Ludwig classification were included. Two punch biopsies from both the midscalp and the occiput were taken. Histological sections were prepared horizontally and stained with haematoxylin and eosin. Terminal follicles, vellus like follicles, anagen, telogen, catagen follicles, hair bulbs and telogen germinal units were counted in two sections of the upper dermis and the dermal-subcutaneous junction. If the terminal/vellus ratio was lower than 4:1, the diagnosis of androgenetic alopecia (AGA) was made. When the ratio was between four and seven to one, AGA was suspected.
  
  
  RESULTS
  While 29 of 40 patients (72.5%) had findings consistent with AGA on the midscalp, 11 of 40 (27.5%) displayed signs of suspected AGA. Ten of 40 patients (25%) had AGA involving the occiput.
  
  
  CONCLUSIONS
  The involvement of the occipital scalp is significant in FPHL. In some patients, this situation may be so apparent that clinically visible alopecia is seen. However, in other patients, it may also present only as thinning.
authors.affiliation: Department of Dermatology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey. tugbarezanekmekci@gmail.com
authors.forename: T R
authors.initials: TR
authors.lastname: Ekmekci
authors.forename: D
authors.initials: D
authors.lastname: Sakiz
authors.forename: A
authors.initials: A
authors.lastname: Koslu
mesh_terms: D000293:Adolescent; D000328:Adult; D000505:Alopecia / Q000473:pathology*; D002452:Cell Count; D005260:Female; D005500:Follow-Up Studies; D018859:Hair Follicle / Q000254:growth & development / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D012535:Scalp / Q000473:pathology*; D012720:Severity of Illness Index; D055815:Young Adult