Background: The Hamilton-Norwood classification (HNC) is used to assess the severity of pattern hair loss (PHL). Conflicting associations between PHL and cardiovascular disease (CVD) have been reported from studies that used different methods to assess alopecia severity. No classification including the HNC has been validated for population studies. We aimed to simplify the HNC, produce the adapted HNC and test its reliability for use in population studies. Methods: Identifying vertex alopecia as distinct allowed for a simpler alignment of alopecia figures where scores 4V and 5V in the adapted HNC replace IV and V in the original HNC. The two classifications were to be used by twelve of our staff (secretaries, nurses, dermatology trainees and dermatologists) to evaluate 16 men with PHL. Observer agreement was estimated using intraclass correlation coefficient (ICC) and a percentage method duplicated from the recent basic and specific (BASP) classification. Results: The ICC improved with the adapted HNC when assessed by both the nurses/secretaries (from 0.47 to 0.61) and dermatology residents/consultants (from 0.68 to 0.76). Agreement using the BASP percentage method for dermatologists was 62–69% for the original and 93–100% for the adapted HNC. Conclusions: The adapted HNC increased reliability at various staff levels, making it suitable for epidemiological studies; its use in future studies could help elucidate the association between PHL and CVD.

Keywords:
Male pattern baldness, Androgenetic alopecia, Hamilton-Norwood classification, Basic and specific classification, Male pattern hair loss
1.
Hamilton JB: The relationship between common baldness and male sex hormones. Trans NY Acad Sci 1946;8:101.
2.
Norwood OT: Male pattern baldness: classification and incidence. South Med J 1975;68:1359–1365.
3.
Lee WS, Ro BI, Hong SP, et al: A new classification of pattern hair loss that is universal for men and women: basic and specific (BASP) classification. J Am Acad Dermatol 2007;57:37–46.
4.
Ahouansou S, Le Toumelin P, Crickx B, Descamps V: Association of androgenetic alopecia and hypertension. Eur J Dermatol 2007;17:220–222.
5.
Mansouri P, Mortazavi M, Eslami M, Mazinani M: Androgenetic alopecia and coronary artery disease in women. Dermatol Online J 2005;11:2.
6.
Lesko SM, Rosenberg L, Shapiro S: A case-control study of baldness in relation to myocardial infarction in men. JAMA 1993;269:998–1003.
7.
Trevisan M, Farinaro E, Krogh V, et al: Baldness and coronary heart disease risk factors. J Clin Epidemiol 1993;46:1213–1218.
8.
Herrera CR, D’Agostino RB, Gerstman BB, Bosco LA, Belanger AJ: Baldness and coronary heart disease rates in men from the Framingham Study. Am J Epidemiol 1995;142:828–833.
9.
Ford ES, Freedman DS, Byers T: Baldness and ischemic heart disease in a national sample of men. Am J Epidemiol 1996;143:651–657.
10.
Miric D, Fabijanic D, Giunio L, et al: Dermatological indicators of coronary risk: a case-control study. Int J Cardiol 1998;67:251–255.
11.
Sasmaz S, Senol M, Ozcan A, et al: The risk of coronary heart disease in men with androgenetic alopecia. J Eur Acad Dermatol Venereol 1999;12:123–125.
12.
Lotufo PA, Chae CU, Ajani UA, Hennekens CH, Manson JE: Male pattern baldness and coronary heart disease: the Physicians’ Health Study. Arch Intern Med 2000;160:165–171.
13.
Schnohr P, Lange P, Nyboe J, Appleyard M, Jensen G: Gray hair, baldness, and wrinkles in relation to myocardial infarction: the Copenhagen City Heart Study. Am Heart J 1995;130:1003–1010.
14.
Shahar E, Heiss G, Rosamond WD, Szklo M: Baldness and myocardial infarction in men: the atherosclerosis risk in communities study. Am J Epidemiol 2008;167:676–683.
15.
Schnohr P, Nyboe J, Lange P, Jensen G: Longevity and gray hair, baldness, facial wrinkles, and arcus senilis in 13,000 men and women: the Copenhagen City Heart Study. J Gerontol A Biol Sci Med Sci 1998;53:M347–M350.
16.
Rebora A: Baldness and coronary artery disease: the dermatologic point of view of a controversial issue. Arch Dermatol 2001;137:943–947.
17.
Guarrera M, Cardo P, Arrigo P, Rebora A: Reliability of Hamilton-Norwood classification. Int J Trichology 2009;1:120–122.
18.
Olsen EA, Whiting D, Bergfeld W, et al: A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol 2007;57:767–774.
19.
Lee WS, Oh Y, Ji JH, et al: Analysis of familial factors using the basic and specific (BASP) classification in Korean patients with androgenetic alopecia. J Am Acad Dermatol 2011;65:40–47.
© 2012 S. Karger AG, Basel
2012
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