Trichoscopy & Scalp Analysis in London

What is Trichoscopy?

Trichoscopy is a specialist examination of the hair and scalp using a dermatoscope — a magnifying, polarised-light device that provides detailed visualisation of follicular structures. It is the dermatological equivalent of dermoscopy, but focused on scalp and hair. Unlike standard photography, trichoscopy highlights key diagnostic clues such as yellow dots, black dots, exclamation mark hairs, miniaturised follicles, perifollicular scaling, erythema, tufting, and absence of follicular openings.

At Skinhorizon Clinic, trichoscopy is performed by our consultant dermatologist as part of a structured hair and scalp assessment. It allows us to diagnose a wide range of hair loss conditions — from androgenetic (pattern) alopecia to alopecia areata, lichen planopilaris, frontal fibrosing alopecia, telogen effluvium, and scarring alopecias. The procedure is painless, quick, and provides immediate diagnostic value without invasive sampling in most cases.

When is it recommended?

Trichoscopy is indicated in almost all cases of unexplained hair loss, scalp disease, or suspected inflammatory alopecia. It is particularly valuable when:

• You are experiencing diffuse thinning and need to distinguish between pattern hair loss and shedding disorders.
• Patchy hair loss suggests alopecia areata, tinea capitis, or traction alopecia.
• Symptoms of scalp inflammation are present — redness, itching, scaling, pustules.
• We suspect scarring alopecia (e.g., lichen planopilaris) where early diagnosis is crucial to prevent permanent loss.
• You require baseline documentation before starting treatment, to track response objectively (e.g., with digital hair analysis).

For many patients, trichoscopy avoids the need for an immediate scalp biopsy. Where biopsy is required, it ensures accurate site selection.

How it works

1. History & examination: Your consultant reviews your symptoms, timeline, and medical background.
2. Trichoscopy capture: A dermatoscope with polarised light is applied to the scalp at multiple regions (frontal, vertex, occiput, temporal). See also dermatoscopy.
3. Magnified visualisation: Structures such as follicular openings, shaft calibre, perifollicular scale, and pigmentation are visualised at 10–70x magnification.
4. Diagnostic interpretation: Patterns (dots, broken hairs, tufting, miniaturisation, loss of ostia) are matched to recognised disease features.
5. Documentation: Digital images are stored for comparison at follow-up visits.
6. Plan: Findings are explained immediately and linked to next steps, whether blood tests, topical/oral treatments, light therapies, or biopsy if required.

What can it help assess?

• Androgenetic alopecia: Miniaturised follicles, hair shaft diversity, and preserved openings.
• Alopecia areata: Exclamation mark hairs, yellow dots, black dots, broken shafts.
• Telogen effluvium: Preserved follicular openings, uniform shaft diameter, empty ostia.
• Lichen planopilaris / frontal fibrosing alopecia: Perifollicular erythema, perifollicular scale, absence of ostia, tufting.
• Tinea capitis: Comma hairs, corkscrew hairs, broken stubs.
• Traction alopecia: Reduced density in distribution, broken hairs, preserved but stressed openings.
• Trichotillomania: Broken shafts of variable length, coiled hairs, black dots.

These features provide diagnostic certainty that is not possible with the naked eye alone.

Preparation

• Wash hair the day before with a mild shampoo; avoid heavy styling products.
• Do not dye hair immediately before examination as pigment can obscure detail.
• Continue regular prescription treatments unless instructed otherwise.
• Bring a list of your medications and supplements.

Safety & limitations

Trichoscopy is safe, painless, and non-invasive. There is no downtime. Limitations include cosmetic camouflage products interfering with visibility; in advanced scarring alopecia, loss of follicles may reduce diagnostic yield. In such cases, trichoscopy guides biopsy rather than replacing it.

Results & follow-up

Results are immediate. Your consultant will explain findings during the same appointment. Images are saved for baseline documentation and future comparison. Follow-up trichoscopy is often scheduled at 8–16 weeks during active treatment, particularly in inflammatory alopecia, to assess activity and remission. This ensures objective monitoring and timely treatment adjustments.

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Disclaimer: Diagnostic tests at Skinhorizon are provided only where clinically appropriate and must be interpreted by a qualified healthcare professional. Results alone do not replace a medical diagnosis, and further consultation may be required.