Trichoscopic diagnosis of structural hair defects in a clinical setting: A Cross-sectional analytical study

Background: Trichoscopy is a simple, non-invasive procedure practiced in the diagnosis of a multitude of scalp and hair disorders. Hair shaft abnormalities usually represent a diagnostic challenge to dermatologists.Objectives: To determine the practicality, versatility and value of using the hand-held dermoscope in assessment of hair shaft abnormalities and the diagnosis of different hair/scalp disorders.Methods: Eight hundred and seven patients of both sexes, aged from 1 to 76 years, with complaints pertaining to scalp and hair were the subjects of the study. All patients were examined by the hand-held dermoscope and 400 were additionally examined by the folliscope, digital dermoscope or their hairs mounted for light microscopy. Results: Based on trichoscopic findings, more than half the patients demonstrated thinned terminal hairs and predominance of single-haired scalp pilosebaceous units, 57%and 55.5% respectively. Over a quarter of the patients showed hair diameter heterogeneity, upright regrowing hairs and increased vellus hairs, 37%, 31% and 25% respectively. Other trichoscopic findings included scalp scaling (19%), hair weathering (12%), thinned wavy hairs (10.5%), brush-like hair fractures (9%), exclamation mark hairs (9%) and longitudinal cleavage (trichoptilosis) (8%). The clinical diagnostic spectrum was topped by the following diagnoses in order of frequency; female pattern hair loss, telogen effluvium, traction alopecia and trichotillomania. Trichodynia appeared significantly associated with numerous hair shaft abnormalities. Conclusion: Most hair shaft abnormalities can be reliably diagnosed with high accuracy using a handheld dermoscope in an office setting. Skillful knowledge of Dermoscopy is an important aid in diagnosis of hair and scalp disorders.