Is a Trichoscopy Necessary to Diagnose Hair Disorders?
Reviewed by Vicky Davis, FNP
Written by Our Editorial Team
Trichoscopy: a scary-sounding name for something that’s frankly not too scary. If your doctor, dermatologist or another healthcare professional has mentioned it in your presence, you may have had that familiar flutter of anxiety about medical procedures, and wondered if it’s really necessary.
Here’s the good news: trichoscopy, also known as hair and scalp dermoscopy, is neither necessary to diagnose hair disorders, nor is it something to be afraid of.
However, it can indeed help healthcare providers more easily and efficiently diagnose alopecias like androgenic alopecia and alopecia areata and other hair-related disorders in patients with hair loss, and it’s pretty easy to do. So while it’s not necessary, it may be your easiest path to getting answers.
Answers are typically necessary for treatment, and if you’ve been losing hair or are worried that you’re heading in the direction of balding, you might want one of these quick procedures.
Let’s take a look at how (and why) they work.
What is a Trichoscopy?
While the word itself sounds invasive and potentially unpleasant, trichoscopy is frankly neither of those things. Sure it’s a big word, but that’s only because medical experts like using big words to replace silly phrases like “hair microscope.”
And that’s all a trichoscopy procedure is: it’s a diagnostic method that involves holding a microscope to your scalp (or any other area where you might be able to see a hair issue) to examine your follicles close up.
Trichoscopy is based on the science of dermoscopy — non-invasive microscopic clinical evaluation of the skin. This is typically done to observe lesions and other abnormalities, but it has begun to be used as a method for diagnosis of hair loss as well.
Well, we say “begun,” but in reality, this tool was being used as a “new” for the evaluation of hair disorders starting back in 2008, which puts it more than a decade and a half in business.
When examining trichoscopic images, your healthcare provider is looking for signs of scalp disease and any hair shaft irregularities, as well as things like average hair thickness. They may be looking for patterns of irregular hair diameter diversity, or other signs of disease and disorder in the trichoscopic patterns.
Things that a healthcare provider may be concerned by include:
Fractured hairs and broken hair shafts
Reduced hair density
Hair shaft abnormalities or hair shaft variability
Abnormal hair residues
Abnormal curly hairs
Those may include lesions, irregular hair shapes like comma hair or exclamation mark hairs that suggest the onset of a disorder and inflammation that might suggest a scalp disorder. They may also look for vellus hair, coiled hair, corkscrew hair, tapered hair, and other irregularities in hair follicles.
What Happens During a Trichoscopy
A trichoscopy is not going to be much different than the little handheld device a healthcare professional uses to look at your ears, or the one an optometrist uses to look at your eyes.
Trichoscopy may violate your personal space, but the degree of that violation actually depends on the device being used.
Typical dermoscopes may need to come into contact with your scalp. These devices work with approximately a 10x magnification on average, so they need to be fairly close (and so does the doctor).
Modern medicine, however, has given us the videodermoscope, which adds 20 to 1,000 magnification capabilities to these devices. That means your doctor doesn’t even need to get that close to see much, much more.
What device your doctor uses may differ depending on your circumstances. If a dermatologist or healthcare professional needs to use a scope at all — some alopecias and other disorders can be diagnosed without trichoscopy — they may use it on hairs still attached to your body, or they may use it on hairs that have been taken off or have fallen off.
But don’t worry too much about how your doctor may get hair no longer attached to you — they’re not going to scalp you for cadaverized hairs. In most cases, seeing the hair and scalp together is far more useful, and far more common.
They’re looking for broken hair, which may suggest hair shaft disorders, follicular openings that look injured and may suggest scarring alopecia or frontal fibrosing alopecia and other signs of the destruction of hair follicles. They’ll also be assessing whether you have normal scalp conditions, your hair count, hair diameter variability and more for their trichoscopy findings.
Is a Trichoscopy Safe?
Is trichoscopy safe? Heck yes it is.
There are no known adverse effects or risks associated with it, unless a healthcare provider gets particularly rough with a fairly expensive piece of equipment.
Since there are no painful or invasive trichoscopic features — no needles, creams, cuts, plucking or other procedures — and no medications, preparations or anesthesia needed, you’re really only running the risk of a healthcare professional dropping the thing and causing a bruise — and that’s pretty unlikely.
In previous systems of hair and skin examination, oil or alcohol was used to make visualization easier. But now, high-powered devices have made looking up close and personal easy without those steps, making the process truly fuss-free.
Trichoscopy can also be done with epilated or already shed terminal hairs. If a provider wants to look at hair off your head, you might experience a little discomfort if they decide to do some plucking, but they usually try to use hairs that have already been shed.
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Is a Trichoscopy Necessary to Diagnose a Hair Disorder?
“Necessary” is a strong word. Trichoscopy is an effective, safe and simple diagnostic tool to find a hair disorder. According to experts, it’s a practical, effective, simple and reliable tool to diagnose not just hair disorders in general, but in particular hair disorders that have eluded diagnosis with other tools.
That said, it’s important to mention that, at least in the opinions of some experts, trichoscopy isn’t always necessary — in fact, many hair disorders can be fairly easily diagnosed with the naked eye and other assessment tools.
Arguably the biggest limitation of trichoscopy's diagnostic capability, however, is that it only reveals surface information. Finding hair disorders that are causing problems below the surface might require other diagnostic procedures like a scalp biopsy. And in some cases, you might also need to have cultures of bacteria or fungi examined, or hair looked at under other microscopic observation tools.
In other words, trichoscopic images are a valuable tool for the diagnosis of hair disorders, but it’s not an end-all, be-all replacement for other ways of looking at problems with hair health. So if you’re seeing problems with your own hair, asking for a trichoscopy is an incomplete attempt at getting help. It may be something a healthcare professional uses, but it may not be.
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Getting a Trichoscopy: Next Steps
While trichoscopy is an easy and reliable tool for the diagnosis of hair disorders, there are a few things you’ll need to do before getting a trichoscopic diagnosis. First and foremost, you’ll need to consult a healthcare professional.
You should do this anyway, especially if you feel that your hair has been thinning, receding or showing other signs of irregular or arrested growth. Common hair loss diseases like androgenetic alopecia (also known as androgenic alopecia, male pattern baldness or female pattern hair loss) are best treated as soon as possible.
We’re not being dramatic when we say that time is ultimately a determining factor in how much hair you’re able to save and protect.