title: The Hair Shedding Visual Scale: A Quick Tool to Assess Hair Loss in Women.
abstract: BACKGROUND
  Hair shedding is a common consequence of the normal hair cycle that changes with internal and external factors. Female pattern hair loss (FPHL) is difficult to assess in terms of shedding severity as the conscious perception of hair shedding varies according to each individual, and most utilized methods are semi-invasive or very time consuming. In this study, we establish and validate a hair-shedding scale for women with thick hair of different lengths.
  
  
  METHODS
  A visual analog scale was developed for thick hair of short, medium, and long lengths by dividing a bundle of hairs of each length into nine piles of increasing hair amount that were then photographed and arranged in order of size. Twenty women with no FPHL with each length of hair (60 total) were asked to select the photographed hair bundle that best correlated with the amount of hair they shed on an average day. A total of 94 women with FPHL with excessive shedding were then asked to repeat the same process.
  
  
  RESULTS
  Women with no FPHL and short, medium and long hair had mean shedding scores of 2.5, 2.35 and 2.4, respectively. Women with FPHL and short, medium and long hair had mean shedding scores of 7.25, 7.0 and 7.14, respectively. Statistically significant Spearman's ρ coefficient and κ coefficient demonstrated correlation and inter-observer reliability.
  
  
  CONCLUSIONS
  Our results show that women with FPHL not only shed considerable hair more than women with no FPHL, but that this hair-shedding visual scale is a fast and effective method of evaluating hair-shedding amounts in an office setting.
authors.affiliation: Universidad Nacional Autonoma de Mexico Clínica de Oncodermatología, Circuito Escolar S/N, Col. UNAM C.U., Del Coyoacán, Mexico City, Mexico.
authors.forename: María Abril
authors.initials: MA
authors.lastname: Martínez-Velasco
authors.affiliation: Tecnologico de Monterrey, Campus Monterrey, Ave. Eugenio Garza Sada 2501, Monterrey, NL, Mexico.
authors.forename: Norma Elizabeth
authors.initials: NE
authors.lastname: Vázquez-Herrera
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Avenue Suite 2175, Miami, FL, USA.
authors.forename: Austin John
authors.initials: AJ
authors.lastname: Maddy
authors.affiliation: Universidad Nacional Autonoma de Mexico Clínica de Oncodermatología, Circuito Escolar S/N, Col. UNAM C.U., Del Coyoacán, Mexico City, Mexico.
authors.forename: Daniel
authors.initials: D
authors.lastname: Asz-Sigall
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Avenue Suite 2175, Miami, FL, USA. atosti@med.miami.edu.
authors.forename: Antonella
authors.initials: A
authors.lastname: Tosti
keywords: Alopecia; FPHL; Female pattern hair loss; Hair loss; Hair shedding; Scale; Shedding; Telogen effluvium; Thick hair; Visual analogue scale