Trichoscopy

Trichoscopy is a diagnostic technique that provides images of the scalp and hair. It is effective for diagnosing alopecia and other cutaneous disorders.

Tricoscopia

General Description

Trichoscopy is an imaging diagnostic test used to analyze the scalp and hair in detail. This non-invasive technique allows for the detection of potential pathologies, particularly alopecia, and helps determine their type. It is also used to monitor a patient’s response to prescribed treatment and assess its efficacy.

During trichoscopy, magnifying lenses are used in combination with polarized and non-polarized light, which reduces reflections, to observe the skin, hair follicles, and hair shaft. There are two types of trichoscopy depending on the device used:

Manual trichoscopy: uses a small device providing 10× magnification. It is very useful for treatment follow-ups.
Digital trichoscopy: a more advanced system, similar to a handheld camera, providing images with up to 140× magnification. By allowing highly detailed examination, it is the ideal option for comprehensive diagnosis.

Trichoscopy is the appropriate procedure for early diagnosis, enabling intervention when hair disorders are still reversible. In advanced cases, it is a reliable method to determine the exact cause.

When is it indicated?

Trichoscopy is part of the standard diagnostic process for hair and scalp disorders. This test is indicated for detecting:

Androgenic alopecia: atrophy of hair follicles due to the effect of androgens (steroidal hormones such as testosterone).
Scarring alopecia: destruction of hair follicles, replaced by scar tissue. It is usually a consequence of autoimmune diseases, trauma, or infections.
Alopecia areata: an autoimmune alopecia in which the immune system erroneously attacks hair follicles.
Telogen effluvium: sudden hair shedding caused by premature entry of follicles into the resting phase. Typically a temporary process triggered by stress or nutritional deficiencies.
Trichotillomania: an uncontrollable impulse to pull out hair from the scalp, eyebrows, or eyelashes. It is a type of obsessive-compulsive disorder.
Seborrheic dermatitis: chronic inflammatory disease causing dandruff, itching, and scalp redness.
Psoriasis: chronic inflammatory disorder causing red plaques covered with scales and intense pruritus.
Lichen planopilaris: autoimmune inflammatory disease targeting hair follicles, causing scarring alopecia.
Tinea capitis: contagious fungal infection (Microsporum or Trichophyton) characterized by scaly patches, hair loss, itching, and black dots.
Cutaneous lupus erythematosus: chronic autoimmune disease often triggered by sunlight, manifesting as rashes, lesions, scarring, or alopecia.

How is it performed?

A device (trichoscope) collects images directly from the scalp via a meticulous scanning process. These images, transmitted in real time to a monitor, allow the specialist to detect abnormalities in the skin or hair follicles. Additionally, specialized software analyzes the images to determine hair density and diameter.

Two types of trichoscopy are used depending on the structures analyzed:

Dry trichoscopy: the trichoscope slides directly over the scalp without any products. It is commonly used to evaluate skin scaling and hair structure.
Immersion trichoscopy: gels are applied to improve visualization. This is useful for more detailed observation of erythema or blood vessels.

Often, both types are performed during the same session.

Risks

Trichoscopy is a safe method that does not pose health risks to the patient.

Occasionally, slight irritation may occur due to device pressure on the skin.

What to expect from trichoscopy

Trichoscopy is performed in the dermatologist’s office, with the patient seated. Typically, the procedure follows these steps:

Direct observation of the scalp and hair by the specialist.
Application of the trichoscope on the skin to assess the scalp and hair condition.
Image capture for detailed analysis and subsequent treatment follow-up comparison.
Application of immersion liquid: gel is spread over the scalp to facilitate imaging.
Repetition of steps 2 and 3.
Image recording and evaluation using software (assessing follicle density, thickness, quantity, and condition).

In most cases, results and treatment recommendations are discussed during the same consultation.