Trichoscopic Features, Clinical Correlates, and Risk Prediction in Female Pattern Hair Loss: A Retrospective Case-Control Study

Boquan Long,1 Qi Long,1 Weitian Pan,2 Siqi Chen,1 Zhiming Ye,1 Hongwei Guo3 1Department of Dermatology, The second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 2The First Clinical College, Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 3Department of Dermatology, Zhanjiang Central Hospital, Guangdong Medical University (Central People’s Hospital of Zhanjiang), Zhanjiang, Guangdong, People’s Republic of ChinaCorrespondence:Hongwei Guo, Department of Dermatology, Zhanjiang Central Hospital, Guangdong Medical University (Central People’s Hospital of Zhanjiang), The 236th Yuanzhu Road, Chikan District, Zhanjiang, Guangdong, 524003, People’s Republic of China, Tel +86-13922087317, Email [email protected]: Female Pattern Hair Loss (FPHL) is often confused with another condition called Chronic telogen effluvium (CTE). Trichoscopy plays an increasingly prominent role in the diagnosis and prognosis of hair disorders.Objective: This study investigated the clinical manifestations and trichoscopic features of FPHL to identify correlations and to develop a nomogram model to predict the risk of FPHL.Methods: A retrospective case-control study was conducted, including 151 FPHL patients (cases) and 151 CTE patients (controls). Clinical and trichoscopic data were analyzed to identify independent risk factors for FPHL and to establish a predictive nomogram model.Results: The findings suggested that AGA family history (P< 0.05) and earlier onset of hair loss (P< 0.01) were more common in FPHL than CTE, suggesting that genetic background underlies early onset FPHL. Trichoscopic characteristics for FPHL differentiate from CTE and varied with the stage and severity of FPHL, while brown or white peripilar signs, white spot sign, yellow spot sign, scalp pigmentation, focal atrichia, hair shaft thickness heterogeneity > 10%, capillary dilatation, increased vellus hair, single hair were more predominantly observed in FPHL patients and positively correlated with disease severity (P< 0.05), implying that these trichoscopic signs could be poor prognosis indicators for FPHL. Logistic regression analysis identified multiple independent risk factors for FPHL, with the strongest being a family history of AGA (OR=4.26), followed by acne (OR=2.86), seborrheic dermatitis (OR=2.82), menstrual disorders (OR=2.23), a high-sugar and high-fat diet (OR=2.20), poor sleep quality (OR=2.06), and stress (OR=1.86).Conclusion: The nomogram model based on our data is effective in predicting FPHL risk, which could help optimize disease management.Keywords: female pattern hair loss, trichoscopy, risk factors, nomogram model