International Journal of Trichology

: 2011  |  Volume : 3  |  Issue : 3  |  Page : 4-

Part C – Hair Dermoscopy


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. Part C – Hair Dermoscopy.Int J Trichol 2011;3:4-4

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. Part C – Hair Dermoscopy. Int J Trichol [serial online] 2011 [cited 2023 Feb 4 ];3:4-4
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Basic trichoscopy

Lidia Rudnicka*, Malgorzata Olszewska 1 , Adriana Rakowska

Department of Dermatology CSK MSWiA, Warsaw, Poland; 1 Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.

*E-mail: [email protected]

Trichoscopy (hair and scalp dermoscopy) allows identification of hair and scalp diseases based on analysis of trichoscopy structures and patterns. Structures which may be visualized by trichoscopy include hair shafts, hair follicle openings, the perifollicular epidermis and cutaneous microvasculature. Trichoscopy allows distinguishing between normal terminal hairs and vellus (or vellus-like) hairs, which by definition are 0.03 mm or less in thickness and less than 3 mm in length. The method enables visualization of micro-exclamation hairs (in alopecia areata) or comma hairs (in tinea capitis) and hair shaft structure abnormalities, including genetic hair dystrophies, such as monilethrix, trichorrhexis invaginata or trichorrhexis nodosa. The number of hairs in one pilosebaceous unit may be assessed. In healthy individuals the usual number of hair per one pilosebacous unit is 2. Three to four hairs per unit are observed occasionally. A lower number of hairs is characteristic for hair loss (i.e. telogen effluvium, androgenic alopecia), an abnormally high number is characteristic for tufted folliculitis. In trichoscopy it may be distinguished whether hair follicles are normal, empty, fibrotic ("white dots") filled with hyperkeratotic plugs ("yellow dots") or containing hair fragments ("black dots). Red dots (in discoid lupus erythematosus) and dirty dots (in healthy children playing in the ground) were recently described. Analysis of perifollicular epidermis and blood vessels may provide additional information allowing trichoscopy diagnosis of most common hair and scalp diseases.

Dermoscopy of hair shaft disorders

Antonella Tosti

Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, FL, USA

E-mail: [email protected]

Dermoscopy is a non-invasive diagnostic tool that allows the recognition of morphologic structures not visible by the naked eye. Scalp dermoscopy is very useful for evaluation of patients with hair and scalp disorders. In particular it allows fast diagnosis of several hair shaft disorders including monilethrix, trichorrexis invaginata, pili torti, pili annulati, trichorrhexis nodosa. The main advantage of dermoscopy in the evaluation of hair shaft disorders is the fact that large areas can be fastly screened including eyebrows and eyelashes that maybe difficult to evaluate using different methods. This session will illustrate the specific findings in the different hair shaft disorders.

Dermoscopic evaluation of pigmented lesions on the scalp

Alon Scope

Department of Dermatology, Sheba Medical Center, Ramat Gan, Israel.

E-mail: [email protected]

The scalp is often overlooked during screening examinations for skin cancer. owever, melanoma can occur anywhere on the body, including the scalp. Furthermore, patients at high risk of melanoma, having numerous nevi, often harbor nevi on the scalp. Possibly because of lack of patient awareness and delay in physician diagnosis, melanoma on the scalp has been associated with poorer prognosis than in other anatomic sites. To this end, physicians performing skin cancer screening, and certainly physicians with particular interest in hair disease and trichoscopy, should incorporate clinical and dermoscopic evaluation of the scalp for suspicious lesions into their examination. Dermoscopy is a technique that utilizes a hand-held magnification device known as dermatoscope; the instrument not only illuminates the skin and magnifies skin lesions, but also allows the physician to visualize colors and structures beneath the surface of the skin that are not normally apparent to the naked eye. With dermoscopy, reproducible patterns of benign lesions, such as scalp nevi, can be recognized, and pigmented lesions suspicious for melanoma or other skin cancers can be detected.

Dermoscopic trichogram

Sundaram Murugusundram

Consultant Dermatologist, Chennai Skin Foundation and Yesudian Research Centre, Chennai, India.

E-mail: [email protected]

We describe a simple, reliable and rapidly diagnostic method of examining the plucked hair roots for the disorders of hair growth using a hand held dermascope. Approximately 20 hairs in a defined area are firmly grasped between the thumb and the index finger, plucked with a sudden jerk, placed on a white paper (writing pad), covered by a glass slide and examined with the dermascope. It provides information about stages of hair growth (anagen/telogen), dystrophy of roots, vellus/terminal hair ratio, shaft diameter variations and defects if present. Anagen roots appear like Golf stick, telogen roots appear like ear bud, Dysplastic roots appear like hockey stick and dystrophic hairs appear tapered like rat tail. An increased number of telogen with hair diameter variations represents androgenetic alopecia and without hair diameter variations represents telogen effluvium. Dystrophic hairs denote cytotoxic drug induced alopecia, alopecia areata (AA) and diffuse AA. Lack of telogen with more dystrophic hairs reveals trichotillomania. This method aids a busy clinician to quickly do a bed side trichogram for the accurate assessment of the patient's hair loss with only a dermascope without the need for mounting of hairs and a microscope.