Advertisement

How to Best Confirm Diagnosis Before Starting Treatment

  • Rodrigo Pirmez
  • Antonella Tosti
Chapter

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.

Keywords

Trichoscopy Dermoscopy Alopecia Trichogram Anagen Hair Hair loss Lichen planopilaris Lupus Alopecia areata Androgenetic alopecia Telogen effluvium 

References

  1. 1.
    Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. 2012;67(5):1040–8.CrossRefGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    Pirmez R, Tosti A. Trichoscopy tips. Dermatol Clin. 2018;36(4):413–20.  https://doi.org/10.1016/j.det.2018.05.008.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    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.Google Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Martínez-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.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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.CrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    Miteva M, Tosti A. Dermatoscopic features of central centrifugal cicatricial alopecia. J Am Acad Dermatol. 2014;71(3):443–9.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    Miteva M, Tosti A. Flame hair. Skin Appendage Disord. 2015;1(2):105–9.  https://doi.org/10.1159/000438995.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar
  18. 18.
    Miteva M, Romanelli P, Tosti A. Pigmented casts. Am J Dermatopathol. 2014;36(1):58–63.  https://doi.org/10.1097/DAD.0b013e3182919ac7.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefGoogle Scholar
  20. 20.
    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.Google Scholar
  21. 21.
    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.Google Scholar
  22. 22.
    Pereira JM. The trichogram – part II – results and interpretation. An Bras Dermatol. 1993;68(4):217–22.Google Scholar
  23. 23.
    Aschieri M, Lopez E. Le trichogramme, aide au diagnostic et à la prise en charge des patients présentant une alopécie. Paris: MSD; 2003.Google Scholar
  24. 24.
    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.CrossRefGoogle Scholar
  25. 25.
    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.Google Scholar
  26. 26.
    Pereira JM. The trichogram – parte I – significance and method of performing. An Bras Dermatol. 1993;68(3):145–52.Google Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar
  28. 28.
    Tosti A, Piraccini BM. Loose anagen hair syndrome and loose anagen hair. Arch Dermatol. 2002;138(4):521–2.CrossRefGoogle Scholar

Suggested Reading

  1. Rudnicka L, Olszewska M, Rakowska A. Atlas of trichoscopy: dermoscopy in hair and scalp disease. 1st ed. London: Springer-Verlag; 2012.CrossRefGoogle Scholar
  2. Tosti A. Dermoscopy of the hair and nails. 2nd ed. Boca Raton: CRC Press; 2016.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rodrigo Pirmez
    • 1
  • Antonella Tosti
    • 2
  1. 1.Department of Dermatology Santa Casa da MisericordiaRio De JaneiroBrazil
  2. 2.Fredric Brandt Endowed Professor of Dermatology, Dr. Phillip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiUSA

Personalised recommendations