Trichoscopic Diagnosis of Structural Hair Defects in a Clinical Setting: A Cross-Sectional Analytical Study

Trichoscopy is a simple, noninvasive procedure practiced in the diagnosis of a multitude of scalp and hair disorders. Hair shaft abnormalities usually represent a diagnostic challenge to dermatologists.

The aim of the study was to determine the practicality, versatility, and value of using the handheld dermoscope in the assessment of hair shaft abnormalities and the diagnosis of different hair/scalp disorders.

Eight hundred and seven patients of both sexes, aged from 1 to 76 years, with complaints pertaining to scalp and hair, were the subjects of the study. All patients were examined by the handheld dermoscope, and 400 were additionally examined by the folliscope, digital dermoscope, or their hairs mounted for light microscopy.

Based on trichoscopic findings, more than half the patients demonstrated thinned terminal hairs and a predominance of single-haired scalp pilosebaceous units (57% and 55.5%, respectively). Over a quarter of the patients showed hair diameter heterogeneity, upright regrowing hairs, and increased vellus hairs (37%, 31%, and 25%, respectively). Other trichoscopic findings included scalp scaling (19%), hair weathering (12%), thinned wavy hairs (10.5%), brush-like hair fractures (9%), exclamation mark hairs (9%), and longitudinal cleavage (trichoptilosis) (8%). The clinical diagnostic spectrum was topped by the following diagnoses in order of frequency: female pattern hair loss, telogen effluvium, traction alopecia, and trichotillomania. Trichodynia appeared to be significantly associated with numerous hair shaft abnormalities.

Most hair shaft abnormalities can be reliably diagnosed with high accuracy using a handheld dermoscope in an office setting. Skillful knowledge of dermoscopy is an important aid in the diagnosis of hair and scalp disorders.