Basic elements of examination:
- Examination of the scalp
- Recording the pattern of hair loss
- Performing a pull test
- Counting follicular units
The scalp should be examined for scaling and scarring.An inflamed scaling scalp can be seborrhoeic along with micro inflammation by transient flora like staphylococcus propionibacterium.
Pattern of hair loss gives immediate clues.
Alopecia areata can have smooth bald single, multiple or confluent reticulate patchy pattern.
Traction pattern is common in women and in those who use hair pieces.
An irregular traumatic patch could be trichotillomania or pruritogenic alopecia.
A moth eaten pattern may warrant a serological test for syphilis and HIV.
Performing a pull test is a very simple. About 20 hairs are firmly grasped between the thumb and the index finger and pulled perpendicular to the scalp surface. Pulled hairs are examined against bright light. A club root in the shape of an ear bud denotes telogen. A long root with the sheath indicates anagen. Absent root indicates broken hairs of weathering or dystrophic hairs of alopecia areata and chemical damage.
Counting the hair per follicular units reveal hair density. Each follicle shows three hairs in adolescents and young adults, two hairs in the middle aged and one hair in the elderly. A mosaic of these follicular units can be seen in a scalp that is losing hair.
Essential Equipments for a Trichology Setup
- Magnifying lens
- Light microscope
- Digital camera
- Polarized light microscopy- some dermascopes have polarized light facility which enables better depth of visualization and accurate diagnosis of most of the scalp and hair disorders.
To set up a trichology practice one does not require expensive equipments to start with. Once the practice is established therapeutic facilities like photo therapy, laser hair removal, hair surgery, photo trichograms can be added on.