Studies dealing with the relationship between the clinical staging of female, pattern hair loss (FPHL) and quantitative measurements of hair parameters are limited. This study was performed to quantify Turkish women's hair characteristics in FPHL, to assess the relationship between clinical presentations of FPHL with hair density and anagen hair ratio and to compare the differences in hair parameters between FPHL and normal women, using epiluminescence microscopy combined with digital image analysis (Trichoscan). Hair density and anagen hair ratio measurements of 39 patients with FPHL were evaluated according to clinical stages and compared with those of 31 healthy volunteers. The results of digital image analysis were compared with the results of visual counting using the photomacrographs of the same images. Mid-scalp hair density and anagen ratio of the patients were detected to be significantly lower than those of the controls. The visual counting detected significant differences among the hair densities of all groups including controls, Ludwig I, and Ludwig II/III groups, while digital image analysis revealed a significant difference only between controls and Ludwig II/III groups. Thus digital image analysis was found to underestimate hair density, and the amount of underestimation demonstrated a positive correlation with hair density. In conclusion, diminished hair density seems to be the main sign in the clinical diagnosis of hair loss, although digital image analysis was found to be less competent than visual counting in detecting hair density. Thus, the increase in hair density in the assessment of various treatment modality effects may be underestimated by digital image analysis
