The Ziering Whorl Classification of Scalp Hair

Background. Although easily recognized, the whorl has never been formally studied or observed for similarities among individuals and ethnic groups. Objective. To standardize terminology, define the anatomic location, develop a classification system, and determine ethnic variability of the scalp whorl. Methods. We retrospectively reviewed digital photographs of 534 patients, men and women. From these photos, patterns and variation in the whorl were determined. Then the data were separated by gender and race. Five different racial groups were identified: White, African American, Hispanic, Asian, and South Asian. If alopecia was so severe that no pattern was clearly identified, they were listed as indeterminate. Results. Five distinct natural whorl patterns were identified. There was limited variation in these patterns, mostly involving tightness and direction of the spiral. White males have the most distinct whorls. Conversely, African Americans and women tend to have a diffusion pattern as opposed to a distinct whorl. Conclusion. The whorl is an important part of the natural flow of the hair. It is our goal that this classification method can help surgeons identify and improve the surgical reconstruction of the whorl.