Glossary
Ludwig scale
A 3-stage visual classification of female pattern hair loss based on central thinning severity, with the frontal hairline typically preserved. The older companion to the Sinclair scale.
The Ludwig scale is a 3-stage visual classification of female pattern hair loss developed by Erich Ludwig in 1977. It remains in widespread clinical use alongside the more granular 5-point Sinclair scale.
The three stages, with the frontal hairline typically preserved throughout:
- Ludwig I: Mild thinning across the central scalp; the part is widened compared to baseline but density is reasonable.
- Ludwig II: Moderate thinning; the central scalp is visibly less dense, the part is broadly widened, and scalp may be partly visible through hair.
- Ludwig III: Severe central thinning; the central scalp is largely bare, often described as a near-complete band of loss across the top.
Roughly, Ludwig I corresponds to Sinclair 2 to 3, Ludwig II to Sinclair 3 to 4, and Ludwig III to Sinclair 5.
The Ludwig scale captures the diffuse central pattern characteristic of female pattern hair loss and distinguishes it from the bitemporal recession seen in male pattern loss. Frontal hairline involvement in a woman raises concern for a different process, particularly frontal fibrosing alopecia.