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.