The very first examination we perform on every patient who comes to our clinic with hair loss is usually painless and takes only a few minutes: trichoscopy. This method allows us to examine the scalp and hair follicles under high magnification, and it plays a decisive role in establishing an accurate diagnosis.
What is trichoscopy?
Trichoscopy is the examination of the scalp and hair follicles using a handheld magnifying device called a dermatoscope. Thanks to its polarised light source, hair shaft thickness, density, follicle distribution and subtle colour changes on the scalp become visible at the millimetre level. The procedure is entirely painless, requires no preparation and is performed in the examination room within minutes.
What information does it provide?
Trichoscopy reveals not only the presence of hair loss but also its type and severity. Conditions as different as androgenetic alopecia, telogen effluvium, alopecia areata, scarring alopecia and scalp infections can present with similar complaints; the differential diagnosis determines the treatment. During trichoscopy we look for the following signs:
- Hair shaft thickness variation (anisotrichosis) and miniaturisation
- Number of hairs per follicular unit and follicular density
- Redness, scaling or inflammation on the scalp
- Yellow dots, empty follicles or scar tissue
Why does it matter?
The underlying cause of hair loss can sometimes be unexpected. Trichoscopy prevents unnecessary testing and treatment while enabling timely intervention when it is genuinely needed. In androgenetic alopecia, for example, typical miniaturisation is visible, while in telogen effluvium the hair shafts remain normal in thickness but reduced in number. Each pattern requires a different treatment plan.
Tests often combined with trichoscopy
Trichoscopy alone is sufficient for diagnosis in most cases; but when a systemic cause is suspected, we also request blood tests. Iron, ferritin, zinc, B12, thyroid hormones and, when appropriate, a hormonal panel let us personalise treatment. This approach treats hair loss not as a one-dimensional cosmetic issue, but within the context of the body as a whole.
How is follow-up done with trichoscopy?
Trichoscopy is used not only for the initial diagnosis but also to monitor the treatment process. Images captured at the first visit are repeated at the third and sixth months, so changes in hair density, shaft diameter and follicular distribution are measured objectively. This means the success of treatment is judged by numerical data rather than subjective impression. If the response is lower than expected, the plan is updated early, so the process is steered in the right direction without delay. We recommend a follow-up trichoscopy every six months for our patients; this practice provides a far more transparent follow-up than was possible in the past.
Conclusion
Trichoscopy is an inseparable part of modern hair medicine and the foundation of accurate diagnosis and personalised treatment. If you are experiencing hair loss, a clear assessment can be made following a trichoscopic examination. A specialist opinion will save you from unnecessary time and cost. Remember that trichoscopy is used both for the initial diagnosis and for treatment follow-up; this is how we track improvement numerically rather than subjectively. We recommend an annual check; it is the easiest way to safeguard your hair health in the long term. At your first examination we will clearly explain your type of loss, its likely causes and your treatment options. Acting on information rather than hesitation is always the right approach.