Diagnosing Hair Loss with Trichoscopy: Only Part of the Story

Clinical Decision are Never Made with Trichoscopy of a Single Area

 
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in how to diagnose hair loss.

Question

In an area of thinning on my scalp I see miniaturization!!

Does it mean I will will need a hair transplant soon.

How do I know how extensive it is?

Answer

First, one should never use trichoscopy photos to make that kind of a decision or give those answers. No.

If this photo you are looking at is from the temples it has a dramatically dramatically different implication than if from the mid scalp and dramatically dramatically different yet if it’s from the back of the scalp. We don’t let the appearance of 50 little hairs dictate what’s happening to the other 95,000!!

You need a full history and a full examination. There are no substitutes for a proper diagnosis. There are many causes of miniaturization. Of course, AGA is the most common but it’s not the only cause and that’s why you need a proper examination ! If your miniaturization is from alopecia areata - a hair transplant is completely off the data.

Don’t be tricked into thinking trichoscopy is the final answer to how we make clinical decision. Not at all. It’s one of many parts of the proper work up and evaluation of hair loss. But one needs a full story and full examination of the scalp in order to make decisions. Your stage of hair loss can only be determined when one has a chance to see the full scalp and see the other 95, 000 hairs too.