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Trichoscopy for Hair Disease Diagnosis

Non-invasive in-vivo dermoscopy of hair and scalp using polarized handheld and digital videodermoscopes (×10–×70 magnification) to identify pathognomonic patterns in alopecia areata, androgenetic alopecia, scarring alopecia, tinea capitis and trichotillomania.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Trichoscopy for Hair Disease Diagnosis?

Trichoscopy is the in-vivo non-invasive examination of hair and scalp with a polarized dermoscope (handheld ×10) or computerized videodermoscope (×20–×70 with image storage). It allows visualization of hair shafts (calibre, color, breakage patterns), follicular openings (ostia, dots, plugs), perifollicular skin and scalp vascular patterns, and is now the first-line evaluation for any hair complaint or alopecia.

It distinguishes scarring (cicatricial) from non-scarring alopecia: in scarring alopecia (lichen planopilaris, frontal fibrosing alopecia, discoid lupus, folliculitis decalvans, dissecting cellulitis) follicular ostia are absent or replaced by white dots / structureless white areas, with perifollicular erythema, tubular casts, or branching vessels; in non-scarring alopecia (alopecia areata, androgenetic, telogen effluvium, traction, trichotillomania) follicular ostia are preserved.

Pathognomonic patterns: yellow dots and exclamation-mark hairs in alopecia areata; hair-shaft diameter variability and yellow dots without inflammation in androgenetic alopecia; comma hairs and corkscrew hairs in tinea capitis; flame and v-sign hairs in trichotillomania; perifollicular tubular hyperkeratosis and lonely hair sign in frontal fibrosing alopecia; arborizing red vessels and milky red areas in dissecting cellulitis; tufted folliculitis (multiple hairs from single ostium) in folliculitis decalvans.

Symptoms

Diffuse hair shedding > 100 hairs/day (telogen effluvium evaluation)
Patchy or circular hair loss (alopecia areata)
Frontotemporal recession or vertex thinning (androgenetic alopecia)
Receding frontal hairline with eyebrow loss in postmenopausal women (FFA)
Painful, scarring scalp lesions with pustules (folliculitis decalvans)
Scaly patchy alopecia with broken hairs in child (tinea capitis)
Irregular bizarre hair loss with broken hairs of various lengths (trichotillomania)

Risk Factors

Family history of androgenetic alopecia, FFA, alopecia areata
Autoimmune disease (vitiligo, thyroid, atopic dermatitis) — alopecia areata
Postmenopausal age, FFA, lichen planus
Pediatric or pubertal age — tinea capitis
Tight hairstyles, traction (braids, weaves)
Chemotherapy, severe stress, postpartum (telogen effluvium)
Psychiatric comorbidity (trichotillomania, anxiety)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden or progressive hair loss
  • Visible patches of baldness or shrinking hair density
  • Itching, burning, redness or pain on the scalp
  • Scaling, crusting or pustules in alopecia patches
  • Eyebrow or eyelash loss
  • Hair loss with systemic symptoms (fever, joint pain, fatigue)
  • Failure of over-the-counter treatments after 3–6 months

Treatment Methods

01
Polarized handheld dermoscope (×10) for office evaluation; videodermoscope (×20–×70) for documentation, monitoring and research
02
Standardized 4-quadrant scalp examination plus eyebrow, beard, body hair as indicated
03
Image storage with patient-comparison capacity at follow-up to monitor treatment response
04
Add minoxidil hair pull test, KOH/fungal culture for tinea, biopsy when scarring alopecia suspected
05
Combine with global photography, Hamilton-Norwood / Ludwig / Sinclair scoring for AGA
06
Use trichoscopic patterns to guide biopsy site selection (transverse/horizontal section preferred for cicatricial alopecia)
07
Patient counseling using shared dermoscopic images improves understanding and adherence to therapy (minoxidil, finasteride, intralesional steroids, JAK inhibitors, hair transplant)

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Dermatoloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.