Background: Trichoscopy is a simple, noninvasive procedure practiced in the diagnosis of a multitude of scalp and hair disorders. Hair shaft abnormalities usually represent a diagnostic challenge to dermatologists. Objectives: The aim of the study was to determine the practicality, versatility, and value of using the handheld dermoscope in the 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 handheld 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 a 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 to be 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 the diagnosis of hair and scalp disorders.

Itin PH, Fistarol SK. Hair shaft abnormalities: clues to diagnosis and treatment. Dermatology. 2005;211(1):63–71.
Sinclair RD. Healthy hair: what is it? J Investig Dermatol Symp Proc. 2007 Dec;12(2):2–5.
Garcia Bartels N, Jahnke I, Patzelt A, Richter H, Lademann J, Blume-Peytavi U. Hair shaft abnormalities in alopecia areata evaluated by optical coherence tomography. Skin Res Technol. 2011 May;17(2):201–5.
Mirmirani P. Ceramic flat irons: improper use leading to acquired trichorrhexis nodosa. J Am Acad Dermatol. 2010 Jan;62(1):145–7.
Grover C, Jakhar D. Hand-held dermatoscope or videodermatoscope: which one to buy? Indian J Dermatol Venereol Leprol. 2021 Sep–Oct;87(5):739–41.
Gutenev A, Skladnev VN, Varvel D. Acquisition-time image quality control in digital dermatoscopy of skin lesions. Comput Med Imaging Graph. 2001 Nov–Dec;25(6):495–9.
Sheeler I, Koczan P, Wallage W, de Lusignan S. Low-cost three-channel video for assessment of the clinical consultation. Inform Prim Care. 2007;15(1):25–31.
McDonald KA, Shelley AJ, Colantonio S, Beecker J. Hair pull test: evidence-based update and revision of guidelines. J Am Acad Dermatol. 2017 Mar;76(3):472–7.
Haake HM, Marten S, Seipel W, Eisfeld W. Hair breakage: how to measure and counteract. J Cosmet Sci. 2009;60(2):143–51.
Caserio RJ. Diagnostic techniques for hair disorders. Part I: microscopic examination of the hair shaft. Cutis. 1987 Sep;40(3):265–70.
Kowalska-Oledzka E, Slowinska M, Rakowska A. Sensitivity and specificity of the trichoscopy Indian. J Dermatol Venereol Leprol. 2012 Sep–Oct;78(5):636–7.
Inui S, Nakajima T, Itami S. Scalp dermoscopy of androgenetic alopecia in Asian people. J Dermatol. 2009 Feb;36(2):82–5.
Nikam VV, Mehta HH. A nonrandomized study of trichoscopy patterns using nonpolarized (contact) and polarized (noncontact) dermatoscopy in hair and shaft disorders. Int J Trichology. 2014 Apr;6(2):54–62.
Chiramel MJ, Sharma VK, Khandpur S, Sreenivas V. Relevance of trichoscopy in the differential diagnosis of alopecia: a cross-sectional study from North India. Indian J Dermatol Venereol Leprol. 2016 Nov–De c;82(6):651–8.
Shim WH, Jwa SW, Song M, Kim HS, Ko HC, Kim BS, et al. Dermoscopic approach to a small round to oval hairless patch on the scalp. Ann Dermatol. 2014 Apr;26(2):214–20.
Abraham LS, Torres FN, Azulay-Abulafia L. Dermoscopic clues to distinguish trichotillomania from patchy alopecia areata. Bras Dermatol. 2010;85(5):723–6.
Malakar S, Mehta PR. “i hair”: a prognostic marker in alopecia areata & trichotillomania. Indian J Dermatol. 2017;62(6):658–60.
Lallas A, Apalla Z, Lefaki I, Sotiriou E, Lazaridou E, Ioannides D, et al. Dermoscopy of discoid lupus erythematosus. Br J Dermatol. 2013 Feb;168(2):284–8.
Rudnicka L, Rakowska A, Kerzeja M, Olszewska M. Hair shafts in trichoscopy: clues for diagnosis of hair and scalp diseases. Dermatol Clin. 2013;31(4):695–708.
Albers LN, Maley AM, MacKelfresh JB. Blowing bubbles: dermoscopy of bubble hair. Int J Trichology. 2017 Jul–Sep;9(3):122–3.
Ghodake NB, Singh N, Thappa DM. Plica neuropathica (polonica): clinical and dermoscopic features. Indian J Dermatol Venereol Leprol. 2013;79(2):269.
Sandoval AB, Ortiz JA, Rodríguez JM, Vargas AG, Quintero DG. Dermoscopic pattern in tinea capitis. Rev Iberoam Micol. 2010;27(3):151–2.
Almazán-Fernández FM, Fernández-Crehuet Serrano P. Trichomycosis axillaris dermoscopy. Dermatol Online J. 2017 Jun 15;23(6):13030/qt5hp5x1kz.
Rakowska A, Slowinska M, Czuwara J, Olszewska M, Rudnicka L. Dermoscopy as a tool for rapid diagnosis of monilethrix. J Drugs Dermatol. 2007;6(2):222–4.
Gupta V, Sharma VK. Four views of trichomycosis axillaris: clinical, Wood’s lamp, dermoscopy and microscopy. Indian J Dermatol Venereol Leprol. 2018 Mar;84(6):748–9.
Khamaiseh AM. Head lice among governmental primary school students in southern Jordan: prevalence and risk factors. J Glob Infect Dis. 2018 Jan–Mar;10(1):11–5.
Kibar M, Aktan Ş, Bilgin M. Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair. Indian J Dermatol. 2015 Jan–Feb;60(1):41–5.
Grimalt R, Ferrando J, Grimalt F. Trichodynia. Dermatology. 1998;196(3):374.
Willimann B, Trueb RM. Hair pain (trichodynia): frequency and relationship to hair loss and patient gender. Dermatology. 2002;205(4):374–7.
Rebora A. Trichodynia: a review of the literature. Int J Dermatol. 2016 Apr;55(4):382–4.
You do not currently have access to this content.