Digital Trichoscopy

A Detailed View of the Hair and Scalp

Many of the features that help distinguish one type of hair loss from another are difficult to see with the naked eye.

Digital trichoscopy allows the hair and scalp to be examined under magnification, providing a much closer view of the follicles, hair shafts and surrounding scalp.

At YT Medical, trichoscopy is used as part of our wider hair and scalp assessment process to support the investigation and monitoring of hair-loss concerns.

It is non-invasive and can provide useful additional information without removing hair or taking a tissue sample.

What Is Trichoscopy?

Trichoscopy is the examination of the hair and scalp using magnified dermoscopic imaging.

The technique allows characteristic features of the scalp, follicular openings and individual hairs to be examined in considerably more detail than would otherwise be possible.

Digital technology also enables images to be captured and retained where appropriate, providing a visual reference that may be useful during future reviews.

What Can Digital Trichoscopy Show?

Depending on the condition being investigated, trichoscopy may allow closer assessment of features including:

• Hair-shaft thickness
• Variation in hair diameter
• Miniaturised hairs
• Short regrowing hairs
• Broken or damaged hairs
• Follicular openings
• Empty follicles
• Scaling
• Redness
• Perifollicular changes
• Signs of scalp inflammation
• Features associated with follicular scarring

The relevance of these findings depends on the wider clinical picture.

No individual trichoscopic feature should be interpreted in isolation.

Pattern Hair Loss

In male and female pattern hair loss, susceptible follicles gradually produce finer hairs through a process known as miniaturisation.

Trichoscopy can make differences in hair-shaft diameter and the proportion of finer hairs easier to appreciate.

This can be particularly useful when the visible degree of thinning is still relatively subtle.

Alopecia Areata

Alopecia areata can produce characteristic changes to hairs within and around affected areas.

Trichoscopy may provide additional information when examining patchy hair loss and can help distinguish features consistent with alopecia areata from some other causes of localised loss.

Diffuse Hair Shedding

Patients experiencing widespread shedding may have conditions such as telogen effluvium, pattern hair loss or a combination of more than one process.

Trichoscopy can contribute to the assessment, although the patient’s history and other investigations may be particularly important in cases of diffuse shedding.

Scarring Alopecia

Where a scarring form of hair loss is suspected, close examination of the scalp is particularly important.

Features such as loss of follicular openings, inflammation and changes around individual follicles may raise concern about a cicatricial or inflammatory process.

Conditions in this group include:

• Frontal Fibrosing Alopecia
• Central Centrifugal Cicatricial Alopecia
• Lichen Planopilaris
• Other forms of scarring alopecia

Trichoscopy can provide useful supporting information, but it does not replace dermatological assessment or scalp biopsy where these are required to establish a diagnosis.

What Happens During Digital Trichoscopy?

A Simple, Non-Invasive Examination

Selected areas of your scalp are examined using a magnifying imaging device.

Different parts of the scalp may be assessed depending on the type and pattern of hair loss.

For example, comparison between areas can sometimes be useful when assessing changes in hair density or follicular characteristics.

The procedure does not involve injections, surgery or removal of scalp tissue.

Digital Images and Monitoring

Hair growth is slow, and meaningful changes do not always become obvious from one week or month to the next.

Where appropriate, digital imaging can provide a more consistent reference for monitoring changes over a longer period.

This may be useful when assessing:

• Progression of hair loss
• Changes in hair density
• Areas of miniaturisation
• Scalp condition
• Response during an ongoing treatment programme

Monitoring should still take account of the natural hair-growth cycle and the expected timescale of the particular condition or treatment.

Is Trichoscopy a Hair-Loss Diagnosis?

It Is Part of the Assessment, Not the Whole Assessment

Trichoscopy is a valuable tool, but it should not be treated as an automatic computerised diagnosis of hair loss.

A meaningful assessment also considers:

• Your history
• The pattern of hair loss
• How quickly it has developed
• Scalp symptoms
• Medical history
• Family history
• Relevant health factors
• Other clinical findings

In selected cases, blood testing, specialist medical assessment or scalp biopsy may provide information that trichoscopy cannot.

Our approach is therefore to use technology to support clinical assessment rather than replace it.

Why Use Digital Trichoscopy Before Hair Restoration?

Understanding the existing hair and scalp can help inform treatment planning.

Before recommending a regenerative treatment, hair-retention programme or surgical hair restoration, it may be useful to assess whether there is evidence of:

• Active miniaturisation
• Significant scalp inflammation
• Another underlying hair-loss pattern
• Features requiring further investigation
• Areas suitable for future monitoring

For hair-transplant patients, assessment of the wider pattern of hair loss is especially important because transplantation must be planned with existing and potential future hair loss in mind.