Abstract
In many patients presenting with hair loss, diagnosis can be made (or at least suspected) through a detailed history and clinical examination. In doubtful cases, some diagnostic tools such as trichoscopy and trichogram may help to confirm diagnosis and, many times, avoid invasive methods, such as a cutaneous biopsy. When a biopsy is needed, trichoscopy is also helpful in selecting the best site for the procedure. This chapter will cover the basics of trichoscopic examination, trichoscopy-guided biopsies, and the trichogram.
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References
Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. 2012;67(5):1040–8.
Olszewska M, Rudnicka L, Rakowska A, Kowalska-Oledzka E, Slowinska M. Trichoscopy. Arch Dermatol. 2008;144(8):1007. https://doi.org/10.1001/archderm.144.8.1007.
Pirmez R, Tosti A. Trichoscopy tips. Dermatol Clin. 2018;36(4):413–20. https://doi.org/10.1016/j.det.2018.05.008.
Rudnicka L, Rusek M, Borkowska B. Introduction. In: Rudnicka L, Olszewska M, Rakowska A, editors. Atlas of trichoscopy: dermoscopy in hair and scalp disease. 1st ed. London: Springer-Verlag; 2012. p. 3–8.
Verzì AE, Lacarrubba F, Micali G. Use of low-cost videomicroscopy versus standard videodermatoscopy in trichoscopy: a controlled, blinded noninferiority trial. Skin Appendage Disord. 2016;1(4):172–4.
Tosti A. Dermoscopy guided biopsy. In: Tosti A, editor. Dermoscopy of the hair and nails. 2nd ed. Boca Raton: CRC Press; 2016. p. 136–41.
Miteva M, Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia. J Eur Acad Dermatol Venereol. 2013;27(10):1299–303. https://doi.org/10.1111/j.1468-3083.2012.04530.x.
Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations. J Am Acad Dermatol. 2014;71(3):431.e1–431.e11. https://doi.org/10.1016/j.jaad.2014.05.008.
MartÃnez-Velasco MA, Vázquez-Herrera NE, Misciali C, Vincenzi C, Maddy AJ, Asz-Sigall D, et al. Frontal fibrosing alopecia severity index: a trichoscopic visual scale that correlates thickness of peripilar casts with severity of inflammatory changes at pathology. Skin Appendage Disord. 2018;4(4):277–80. https://doi.org/10.1159/000487158.
Baquerizo Nole KL, Nusbaum B, Pinto GM, Miteva M. Lichen planopilaris in the androgenetic alopecia area: a pitfall for hair transplantation. Skin Appendage Disord. 2015;1(1):49–53. https://doi.org/10.1159/000381588.
Lanuti-Lanuti E, Miteva M, Romanelli P, Tosti A. Trichoscopy and histopathology of follicular keratotic plugs in scalp discoid lupus erythematosus. Int J Trichology. 2012;4(1):36–8. https://doi.org/10.4103/0974-7753.96087.
Tosti A, Torres F, Misciali C, Vincenzi C, Starace M, Miteva M, et al. Follicular red dots: a novel dermoscopic pattern observed in scalp discoid lupus erythematosus. Arch Dermatol. 2009;145(12):1406–9.
Miteva M, Tosti A. Dermatoscopic features of central centrifugal cicatricial alopecia. J Am Acad Dermatol. 2014;71(3):443–9.
Waśkiel A, Rakowska A, Sikora M, Olszewska M, Rudnicka L. Trichoscopy of alopecia areata: an update. J Dermatol. 2018;45(6):692–700. https://doi.org/10.1111/1346-8138.14283.
de Lacharrière O, Deloche C, Misciali C, Piraccini BM, Vincenzi C, Bastien P, et al. Hair diameter diversity: a clinical sign reflecting the follicle miniaturization. Arch Dermatol. 2001;137(5):641–6.
Miteva M, Tosti A. Flame hair. Skin Appendage Disord. 2015;1(2):105–9. https://doi.org/10.1159/000438995.
Bergfeld W, Mulinari-Brenner F, McCarron K, Embi C. The combined utilization of clinical and histological findings in the diagnosis of trichotillomania. J Cutan Pathol. 2002;29(4):207–14.
Miteva M, Romanelli P, Tosti A. Pigmented casts. Am J Dermatopathol. 2014;36(1):58–63. https://doi.org/10.1097/DAD.0b013e3182919ac7.
Tosti A, Miteva M, Torres F, Vincenzi C, Romanelli P. Hair casts are a dermoscopic clue for the diagnosis of traction alopecia. Br J Dermatol. 2010;163(6):1353–5.
Pereira JM, Pereira FCN, Pereira VCN, Pereira IJN. Abordagem do paciente com tricose. In: Pereira JM, Pereira FCN, Pereira VCN, Pereira IJN, editors. Tratado das doenças dos cabelos e couro cabeludo – tricologia. Rio de Janeiro: DiLivros; 2016. p. 21–86.
Tosti A. Hair root evaluation. In: Tosti A, editor. Dermoscopy of the hair and nails. 2nd ed. Boca Raton: CRC Press; 2016. p. 133–5.
Pereira JM. The trichogram – part II – results and interpretation. An Bras Dermatol. 1993;68(4):217–22.
Aschieri M, Lopez E. Le trichogramme, aide au diagnostic et à la prise en charge des patients présentant une alopécie. Paris: MSD; 2003.
Blume-Peytavi U, Hillmann K, Guarrera M. Hair growth assessment techniques. In: Blume-Peytavi U, Tosti A, Whiting D, Trüeb R, editors. Hair growth and disorders. Berlin Heidelberg: Springer Verlag; 2008. p. 124–57.
Braun-Falco O, Fisher C. [On the effect of hair washing on the hair root pattern]. Arch Klin Expe Dermatol 1966;226:136-143 APUD Pereira JM, Pereira FCN, Pereira VCN, Pereira IJN. Abordagem do pciente com tricose. In: Pereira JM, Pereira FCN, Pereira VCN, Pereira IJN, editors. Tratado das doenças dos cabelos e couro cabeludo – tricologia. Rio de Janeiro: DiLivros; 2016. p. 21–86.
Pereira JM. The trichogram – parte I – significance and method of performing. An Bras Dermatol. 1993;68(3):145–52.
Serrano-Falcón C, Fernández-Pugnaire MA, Serrano-Ortega S. Hair and scalp evaluation: the trichogram. Actas Dermosifiliogr. 2013;104(10):867–76. https://doi.org/10.1016/j.ad.2013.03.004.
Tosti A, Piraccini BM. Loose anagen hair syndrome and loose anagen hair. Arch Dermatol. 2002;138(4):521–2.
Suggested Reading
Rudnicka L, Olszewska M, Rakowska A. Atlas of trichoscopy: dermoscopy in hair and scalp disease. 1st ed. London: Springer-Verlag; 2012.
Tosti A. Dermoscopy of the hair and nails. 2nd ed. Boca Raton: CRC Press; 2016.
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Pirmez, R., Tosti, A. (2020). How to Best Confirm Diagnosis Before Starting Treatment. In: Tosti, A., Asz-Sigall, D., Pirmez, R. (eds) Hair and Scalp Treatments. Springer, Cham. https://doi.org/10.1007/978-3-030-21555-2_1
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DOI: https://doi.org/10.1007/978-3-030-21555-2_1
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