BASP ESCALA APLICAÇÃO

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126 International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3
INTRODUCTION
Pattern hair loss (PHL) is the most common type of hair loss in men. In females, it is less common. Through the 
years, several classifications have been proposed, but the 
Norwood‑Hamilton classification for men and Ludwig’s 
classification for women are the most commonly used systems. 
In 1951, Hamilton proposed the first systemic classification 
for PHL. He classified the patterns based on fronto‑parietal, 
frontal recession and vertex thinning.[1] Norwood, in 1975, 
put an emphasis on vertex only classification as an addition to 
the Hamilton classification.[2] Savin introduced a classification 
based on pictorial depiction of hair density as derived from 
midline scalp width.[3] Olsen proposed assigning different 
designations to the areas of the scalp (temporal, frontal, 
mid and vertex) as they bald at different rates in different 
individuals.[4,5] In an article in 1977, Ludwig presented a 
separate classification for women emphasizing on the 
preservation of the frontal hairline despite the loss of hair 
on the top of the scalp.[6] For surgical purposes, Bouhanna 
created a multifactorial classification of certain parameters 
such as fixed distances from the face, scalp mobility and 
thickness and covering power of hair, which can be quantified 
and computerized.[7] However, all of these have limitations 
Address for correspondence: 
Dr. Shweta Agarwal, 
Department of Dermatology, 
Venereology and Leprosy, 
Dr. D. Y. Patil Hospital, 
Sector 5, Nerul, 
Navi Mumbai ‑ 400 706, 
Maharashtra, India. 
E‑mail: dr.shwetaagarwal@
gmail.com
Application of the Basic and Specific 
Classification on Patterned Hair Loss in 
Indians
Shweta Agarwal, Kiran Godse, Aditya Mahajan, Sharmila Patil, 
Nitin Nadkarni
Department of Dermatology, Venereology and Leprosy, Dr. D. Y. Patil Hospital, 
Nerul, Navi Mumbai, Maharashtra, India
ABSTRACT
Context:	Several	classifications	 for	pattern	hair	 loss	(PHL)	have	been	used	over	 the	
years.	The	Norwood‑Hamilton	classification	for	men	and	Ludwig’s	classification	for	women	
is used commonly, but they have their limitations. Aims: The objective of the following 
study	is	to	evaluate	the	efficacy	of	the	basic	and	specific	(BASP)	classification	in	Indian	
populations. Subjects and Methods:	We	used	the	BASP	classification	to	classify	the	
PHL in the patients visiting our out-patient department in the period from June 2012 to 
May	2013.	763	patients	were	classified	out	of	which	313	were	females	and	450	were	
males. Results: The majority of the female patients were in the 3-5th decade of life 
and in males were in 4-6th decade. Conclusions:	The	BASP	classification	 is,	 easily	
remembered,	reproducible	classification	for	the	diagnosis	and	treatment	for	both	male	
and female pattern alopecia.
Key words:	Basic	and	specific	classification,	Indian	population,	pattern	hair	loss
such as Norwood‑Hamilton is difficult to memorize and 
female pattern hair loss (FPHL) in men cannot be classified 
by this and Ludwig’s classification cannot be used to classify 
male pattern hair loss in females. In addition, most of these 
classifications were based on Caucasians subjects and not 
Asians as in comparison with Caucasian patients, Asian 
patients with androgenetic alopecia (AGA) have different 
types of hair loss and family histories which may alter the 
treatment response. There was considerable overlap in 
types IV, V and VI in the Norwood classification with the 
‘a’ variants further confusing the picture.[8] Thus a common 
classification system for men and women, which is easy to 
memorize and can be used for all races is required.
In an article in 2000, Koo et al. from Korea, classified 
male pattern alopecia into six types based on the English 
alphabetical letter shape of the hair loss area.[9]
The basic and specific (BASP) classification was designed by 
Lee et al.[10] This included four basic types and two specific 
types [Figure 1]. The basic type represents the shape of the 
anterior hairline and the specific type represents the density 
of hair on the frontal and vertex area. The final type is the 
combination of the basic and the specific type.[10]
Original Article
Access this article online
Website:
www.ijtrichology.com
DOI:
10.4103/0974-7753.125606 
Quick Response Code:
Agarwal, et al.: Application of the BASP classification in Indians
International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3 127
SUBJECTS AND METHODS
Patients were classified according to the pattern of hair 
loss as per BASP classification as mentioned below. The 
patients enrolled were those who visited the out‑patient 
department and inpatients who complained of hair loss. 
A detailed history regarding some of the etiological factors 
was elicited.
Inclusion criteria
All those who were classified as having PHL.
Exclusion criteria
All those who had diffuse hair loss, alopecia areata, any 
infection or inflammation of the scalp and hair, any drugs 
affecting hair growth or under stress.
The patients who fitted into the inclusion criteria and 
had no exclusion criteria were enrolled into the study 
after taking consent. Personal, drug and family history 
was elicited. Digital photographs were taken in four 
views.
The BASP classification
The basic and the specific type were further divided 
into three to four grades. One basic type is selected 
depending on the pattern and graded according to the 
extent of hair loss with regards to the reference points. 
The specific type may be selected wherever applicable 
and graded.
Basic type
The shape of the anterior hairline is divided into four basic 
types: L, M, C and U.
L ‑ Linear line (no hair loss)
M ‑ Shape of the hairline resembles the alphabet M
C ‑ Shape of the hairline resembles the alphabet C
U ‑ Shape of the hairline resembles the alphabet U.
The reference points are:
• Original anterior hairline (anterior hairline at that time 
when baldness is not present)
• The top of the vertex (highest point on the posterior 
crown)
• The occipital protuberance.
Type L
“L” refers to linear line seen when there is no hair loss 
seen along the anterior border in the fronto‑temporal 
region [Figure 2].
Type M
Recession in the fronto‑temporal hairline is more 
prominent than the mid‑anterior hairline hence the hairline 
looks like the alphabet “M”.
Type M0
The original hairline is preserved. No hair loss is seen.
Type M1
Fronto‑temporal recession is present but does not 
extend beyond the anterior one‑third of the virtual line 
connecting the original hairline and the top of the vertex 
[Figure 3].
Type M2
Fronto‑temporal recession extends further but not beyond 
the middle‑third of the virtual line.
Type M3
Fronto‑temporal recession extends further into the last 
one‑third of the virtual line [Figure 4].
Type C
Recession in the mid‑anterior hairline is more prominent 
than the Fronto‑temporal hairline. The entire anterior 
hairline regresses posteriorly in the shape of semi‑circle 
resembling the letter “C”.
Figure 1: Basic and specific classification
Agarwal, et al.: Application of the BASP classification in Indians
128 International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3
Figure 2: Basic type L
Figure 3: Basic + specific M1F1
Figure 4: Basic + specific type M3F3
Figure 5: Specific type F1
Agarwal, et al.: Application of the BASP classification in Indians
International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3 129
Type C0
The original hairline is preserved.
Type C1
The mid‑anterior hairline recedes to the anterior 1/3rd of 
the virtual line connecting the original hairline and the top 
of the vertex.
Type C2
The mid‑anterior hairline recedes to the middle 1/3rd of 
the virtual line.
Type C3
The mid‑anterior hairline recedes to the posterior 1/3rd of 
the virtual line.
Type U
The anterior hairline recedes posteriorly beyond the vertexforming a horseshoe shape resembling the letter “U”. It is 
the most severe type of AGA.
Type U1
The anterior hairline recedes to lie within the superior 
1/3rd of the virtual line connecting vertex and the posterior 
occipital protuberance.
Type U2
The anterior hairline recedes to lie within the middle 
1/3rd of the virtual line connecting vertex and the posterior 
occipital protuberance.
Type U3
The anterior hairline recedes to lie within the inferior 
1/3rd of the virtual line connecting vertex and the posterior 
occipital protuberance.
Specific type
The specific type may be included whenever necessary. 
There are two specific types: F and V.
Type F
It represents a general decrease in the density of hair 
over the entire top of the scalp, regardless of the anterior 
hairline.
Type F1
Thinning of the hair on the crown is perceptible (mild 
change) [Figures 3 and 5].
Type F2
Thinning of the hair on the crown is pronounced (moderate 
change).
Type F3
The hair on the crown is very sparse or absent (severe 
change) [Figure 4].
Type V
The hair around the vertex is notably sparser.
Type V1
Thinning of the hair around the vertex is perceptible (mild 
change).
Type V2
Thinning of the hair around the vertex is pronounced 
(moderate change).
Type V3
Thinning of the hair around the vertex is very sparse or 
absent (severe change).
RESULTS
The male patients were 450 and the number of female 
patients was 313. The majority of the patients were in 
the 3‑5th decade in females and 4‑6th decade in males 
[Table 1].
In men, majority (63%) were diagnosed with M type, with 
M2 being most common (34%). One of the males was 
diagnosed with female pattern alopecia [Table 2].
All women were diagnosed with F type with F1 (87%) being 
most common and none of them were diagnosed with 
male pattern alopecia. As the age increased, the grading 
downgraded from F1 to F3.
Nearly 48% men gave a history of having similar hair loss 
on their paternal side of the family, 1% gave a history of 
having similar history on the maternal side of the family 
and 51% gave negative history of similar complaints.
Agarwal, et al.: Application of the BASP classification in Indians
130 International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3
Almost 42% women gave a history of similar complaints on 
the maternal side, none had similar complaints on the paternal 
side and 58% had no family history of similar complaints.
It was observed that the basic type of Hair loss had paternal 
inheritance and the specific type had maternal inheritance.
DISCUSSION
The study by Hong et al. conducted a comparative 
study consisting of eight dermatological specialists, 
17 dermatological residents and 15 general physicians 
who classified PHL in 100 sets of photographs using 
both the BASP and Norwood‑Hamilton classifications. 
They found that BASP classif icat ion not only 
distinguishes all kinds of hair loss patterns, but also 
has better reproducibility and repeatability than the 
Norwood‑Hamilton classification.[11] The prevalence 
of FPHL (Ludwig grade >I) for all ages was 11.8%, 
increasing with advancing age.[12] The Asian Consensus 
Committee for AGA developed an algorithmic guideline, 
based on the BASP classification since the pre‑existing 
classifications of AGA cannot easily classify the 
patterns of AGA that are more frequently seen in 
Asians.[13]
Table 1: Age wise distribution of individual types
Sex Type Age group Total
20‑29 30‑39 40‑49 50‑59 60‑69 >70
Male C1
Number 5 12 8 9 3 0 37
% 13.5 10.4 7.4 7.6 5.7 0 8.2
C2
Number 3 6 12 10 5 2 38
% 8.1 5.2 11.1 8.5 9.4 11.1 8.5
C3
Number 1 9 6 8 3 1 28
% 2.7 7.8 5.6 6.8 5.7 5.6 6.2
M0
Number 6 5 7 11 1 0 30
% 16.2 4.3 6.5 9.3 1.9 0.0 6.7
M1
Number 6 26 20 21 12 5 90
% 16.2 22.6 18.5 17.8 22.6 27.8 20.0
M2
Number 10 40 38 41 20 5 154
% 27.0 34.8 35.2 34.7 37.7 27.8 34.3
M3
Number 2 3 2 3 3 2 15
% 5.4 2.6 1.9 2.5 5.7 11.1 3.3
U1
Number 2 12 15 12 4 2 47
% 5.4 10.4 13.9 10.2 7.5 11.1 10.5
U2
Number 2 2 0 3 2 1 10
% 5.4 1.7 0.0 2.5 3.8 5.6 2.2
F2
Number 0 1 0 0 0 0
% 0 0.8 0 0 0 0
Total 37 116 108 118 53 18 450
Female F1
Number 26 50 9 5 0 1 91
% 35.6 41.7 14.1 23.8 0.0 8.3 29.1
F2
Number 41 57 37 14 12 6 167
% 56.2 47.5 57.8 66.7 52.2 50.0 53.4
F3
Number 6 13 18 2 11 5 55
% 8.2 10.8 28.1 9.5 47.8 41.7 17.6
Total 73 120 64 21 23 12 313
Table 2: Sex wise distribution of final type (males)
Type 
M C U
Type_F_V Total
F1 F2 V1 V2 V3
C1
Number 0 4 0 33 0 37
% 0.0 9.8 0.0 16.2 0.0 8.2
C2
Number 0 33 0 5 0 38
% 0.0 80.5 0.0 2.5 0.0 8.5
C3
Number 0 0 5 23 0 28
% 0.0 0.0 4.9 11.3 0.0 6.2
M0
Number 0 0 9 21 0 30
% 0.0 0.0 8.7 10.3 0.0 6.7
M1
Number 0 1 60 30 0 91
% 0.0 2.4 58.3 14.7 0.0 20.22
M2
Number 24 4 29 92 5 154
% 29.6 9.8 28.2 45.1 25.0 34.3
M3
Number 0 0 0 0 15 15
% 0.0 0.0 0.0 0.0 75.0 3.3
U1
Number 47 0 0 0 0 47
% 58.0 0.0 0.0 0.0 0.0 10.5
U2
Number 10 0 0 0 0 10
% 12.3 0.0 0.0 0.0 0.0 2.2
Total
Number 81 42 103 204 20 450
Agarwal, et al.: Application of the BASP classification in Indians
International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3 131
Limitations
When fronto‑parietal and vertex regions of alopecia have 
become confluent, type F2 and F3 can be confused with 
type V.
The subjects were mostly out‑patients so it is not indicative 
of the prevalence and the types of PHL in the general 
populations.
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How to cite this article: Agarwal S, Godse K, Mahajan A, Patil 
S,	Nadkarni	N.	Application	of	the	basic	and	specific	classification	
on patterned hair loss in Indians. Int J Trichol 2013;5:126-31.
Source of Support: Nil, Conflict of Interest: None declared.
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