Visualization of the Hair Bulbs: A Sign that Something is Not Right!

Seeing The Hair Bulbs Deep Under the Skin is Not Normally Possible

One of the things I love about swimming in the warmer oceans of the world is the ability to see the entire ocean floor on a calm day. The colors, the plants, the fish, the rocks - there’s nothing quite like it. In the murky & muddy fresh water lakes of the world, we often don’t get to see quite the same magical scene. Even when one stands above the water of some shallow ocean areas, the ocean floor can often be easily seen.

Ocean Floor.

Let me be the first to say that the scalp is not the ocean. When one looks at the surface of the scalp from above either with the naked eye or with trichoscopy magnification - one does not see very deep into the scalp. One does not get to see the hair bulbs standing so tall from their position 6 mm under the surface. One does not get to see red and blue tubes and pipes that represent the arterioles, capillaries and venules. One does not get to see inflammatory cells under the scalp. Rather, one just gets to see the surface of the scalp and everything happening up there. We only get to see the surface.

If we liken that to a body of water, it’s like we only get to see the water plants on the surface or the water spiders, ducks and birds that grace the surface.

With trichoscopy, one should not normally see the hair bulbs

With trichoscopy, one should not normally see the hair bulbs when one looks at the skin with these fancy magnification devices. When one does actually see the bulbs, it signifies something is definitely not quite right. Either the skin has thinned or a layer of the skin is missing or the hairs have healed in such a way that they find themselves way too high up in the skin (2 mm to 3 mm below the surface instead of 6).

“Visualization of the bulbs” is a trichoscopy sign seen in many hair loss issues including scarring alopecia, topical steroid atrophy, aplasia cutis congenita. It can also be seen after hair transplantation when hairs have been mishandled by too rough implantation or when grafts have not been placed deep enough in the skin or when excessive “popping” causes then to heal in an abnormally high position in the skin. This photo of a curly hair tells me this hair was handled too roughly and placed too high up in the skin. “Visualization of the hair bulb” is obvious.