Practice Gaps—Trichoscopy in Clinical Care: Comment on “Corkscrew Hair” | Dermatology | JAMA Dermatology | JAMA Network
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Tosti  A Dermoscopy of Hair and Scalp Disorders With Clinical and Pathological Correlations.  London, England: Informa Healthcare Books; 2007
Research Letter
March 2011

Practice Gaps—Trichoscopy in Clinical Care: Comment on “Corkscrew Hair”

Author Affiliations

Author Affiliations: Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida.

Arch Dermatol. 2011;147(3):356. doi:10.1001/archdermatol.2011.19

The role of dermoscopy in the evaluation of pigmented lesions is largely accepted worldwide, and most dermatologists today use a dermoscope in their daily practice. The role of dermoscopy in the diagnosis of hair disorders is also established, but only a few dermatologists use their dermoscope to look at the scalp of their patients. This is a professional practice gap.

Hughes et al show that dermoscopy is a fast, noninvasive, and reliable tool in the screening of children with endothrix tinea capitis. This is just 1 of the possible applications of hair dermoscopy, also known as trichoscopy, in the evaluation of hair disorders. There is evidence that trichoscopy allows for all of the following:

  1. Fast diagnosis of hair-shaft disorders;

  2. Immediate differentiation between cicatricial and noncicatricial alopecia;

  3. Diagnosis and information on short-term prognosis of alopecia areata; and

  4. Differential diagnosis between telogen effluvium and androgenetic alopecia.

These are just the most common applications; many others are being developed.1

Why then do dermatologists not use this technique? Barriers to routine use of trichoscopy may include lack of knowledge, necessity of training, costs, and possibly disbelief in the technique. Trichoscopy is a relatively new field, and most dermatologists are not aware that it is useful to look at the hair and scalp with a dermoscope. They are not familiar with hair and scalp trichoscopy patterns and have few resources to acquire specific training. Most dermatology meetings do not offer a single session on scalp dermoscopy.

Another barrier to broader application is possibly that dermatologists may believe that the cost-benefit ratio of purchasing the instrument and the time for training yields very little to their practice, owing to the relative rarity of hair disorders. Perhaps the best way to dispel this misconception is to state the facts: (1) trichoscopy does not require expensive tools—in fact, most dermatologists already have a dermoscope; (2) trichoscopy is useful for the evaluation of every patient with hair disorders; (3) trichoscopy is noninvasive and very well accepted by patients; and (4) its routine use may improve the quality of care for patients with hair and/or scalp conditions and reduce the necessity for such invasive procedures as scalp biopsies.

How can we narrow this gap and convince dermatologists to use their dermoscope as a tool to evaluate the hair and scalp of their patients? Trichoscopy training is relatively fast and simple and should be offered at continuing medical education (CME) conferences and workshops as well as through CME articles and Web-based training modules. These venues would offer training to all dermatologists and would close the gap.

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Article Information

Correspondence: Dr Tosti, Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB, Room 2023-A, Miami, FL 33136 (

Financial Disclosure: None reported.

Tosti  A Dermoscopy of Hair and Scalp Disorders With Clinical and Pathological Correlations.  London, England: Informa Healthcare Books; 2007