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Advanced Trichoscopy

Trichoscopy corresponds to scalp and hair dermoscopy and has been increasingly used as an aid in the diagnosis, follow-up, and prognosis of hair disorders Trichoscopy allows all of the following: 1. Fast diagnosis of hair shaft disorders 2. Immediate differentiation between cicatricial and noncicatricial alopecia 3. Diagnosis and information on short-term prognosis of alopecia areata, and 4. Differential diagnosis between telogen effluvium and androgenetic alopecia These are just the most common applications ; many others are being developed At the first step, whether the loss of orifices exists or not should be observed. After cicatricial alopecia is indicated from the loss of orifices, the existence of micropustules and/or hair tufting with six or more hairs should be carefully observed. Either finding indicates neutrophil- or mixed cell-mediated cicatricial alopecia such as folliculitis decalvans/tufted folliculitis, acne keloidalis and dissecting cellulitis of the scalp according to the recently proposed classification of primary cicatricial alopecia. If there are no findings such as micropustules and hair tufting, lymphocytic cicatricial alopecia is highly suggested. At the further step, lymphocytic cicatricial alopecia are differentiated by presents of follicular red dots - specific for discoid lupus erythematosus or hair tufting which indicates lichen planopilaris. When loss of hair orifices cannot be seen in the hair loss area, diagnosis as noncicatricial alopecia is established. Among noncicatricial alopecia, AA is most commonly encountered. When numerous yellow dots are observed, the diagnosis of AA is confirmed. When hair diameter diversity (≥20%), corresponding to hair follicle miniaturization, is seen, the diagnosis should be AGA. There are no specific findings to diagnose telogen effluvium therefore the diagnosis of telogen effluvium is based on exclusion of AGA, diffuse-type AA and other types of alopecia. Trichoscopy can also assist in the diagnosis of multiple genetic hair shaft disorders, such as monilethrix, trichorrhexis invaginata, trichorrhexis nodosa, pili torti, and pili annulati, avoiding the need to pluck or cut hairs to perform light microscopy.

trichoscopy; alopecia; hair

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