The Importance of Trichoscopy in Clinical Practice

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. Herein, we report selected cases harbouring scalp or hair diseases, in whom trichoscopy proved to be a valuable tool in their management. A review of the recent literature on this hot topic was performed comparing the described patterns with our findings in clinically common conditions, as well as in rare hair shaft abnormalities, where trichoscopy may display pathognomonic features. In our view, trichoscopy represents a valuable link between clinical and histological diagnosis. We detailed some trichoscopic patterns, complemented with our original photographs and our insights into nondescribed patterns. 1. Introduction Trichoscopy (scalp and hair dermoscopy) represents a valuable noninvasive and low-cost technique, still underutilized, to rapidly differentiate clinically frequent hair disorders [1]. In their revision, Miteva and Tosti give a comprehensive and a thorough description of the usefulness of this technique in the diagnosis and follow-up of most common hair and scalp disorders, based on updated data from the literature and their personal experience [1]. We, herein, describe its application in randomly selected patients harbouring miscellaneous hair disorders, not only as a diagnostic tool, but also in monitoring treatment response or giving an insight of prognosis. Trichoscopy may help to distinguish scarring versus nonscarring alopecia, early androgenetic alopecia (AGA) versus telogen effluvium, and it also supports the diagnosis and predicts the prognosis of alopecia areata (AA) [1]. 2. Materials and Methods From our clinical practice, we randomly selected patients harbouring hair or scalp complaints in whom trichoscopy assumed particular importance in clarifying the diagnosis, differential diagnosis, and prognosis and/or in monitoring the treatment response. The trichoscopic features were compared with data from the literature, when available. 3. Results and Discussion Considering the conditions causing scarring alopecia, the key point seems to be the reduction or the absence of follicular orifices and the presence of peripilar casts or erythema (Figure 1(a)) [2]. Hair tufting can be seen in cases of lichen planopilaris [3]. In addition to dermoscopy, clinical presentation and physician’s expertise are crucial for the diagnosis of such condition, subsequently confirmed by histopathology. There has been an effort to recognize specific features to distinguish the causes of scarring