Scalp analysis and trichoscopy: what a close-up can show

If you visit a dermatologist or hair clinic, you may have your scalp examined with a small handheld magnifier or a camera that shows enlarged images on a screen. This is called trichoscopy (also called scalp dermoscopy). It is now considered a fundamental tool in diagnosing hair and scalp disorders ¹.

What trichoscopy is

Trichoscopy uses a dermatoscope, a lighted magnifying device, to look at the scalp skin, the openings of hair follicles and the hair shafts. Some devices are handheld and viewed by eye, while others are digital and capture images for comparison over time ².

It is non-invasive. Nothing is cut or injected, and it usually takes only a few minutes.

What it can show

Under magnification, clinicians look at:

• Hair shaft thickness. In pattern hair loss, hairs of very different thickness are mixed together, because some follicles are shrinking ¹.
• Follicle openings. Healthy scalp shows openings with hairs coming out. Missing openings can suggest scarring.
• Number of hairs per follicle unit. Usually several hairs grow from one opening. Fewer can suggest thinning.
• Signs of inflammation such as redness or scaling around follicles.
• Broken hairs and specific hair shapes that point to certain conditions.
• Blood vessel patterns and the colour of the scalp.

Examples of what it can help identify

Trichoscopy features can support a diagnosis of conditions such as ^{1 2}:

• Pattern hair loss, with varying hair thickness and more single-hair units, often more marked on the top than the back of the head.
• Alopecia areata, with features such as short broken hairs that taper towards the scalp and yellow or black dots. See alopecia areata.
• Scarring hair loss, such as lichen planopilaris or frontal fibrosing alopecia, with loss of follicle openings and scaling around hairs. See scarring alopecia and lichen planopilaris.
• Fungal infection of the scalp, where some broken hairs have characteristic shapes.
• Hair pulling (trichotillomania), with hairs broken at different lengths. See trichotillomania.
• Scalp conditions such as seborrhoeic dermatitis and psoriasis.

What it cannot do

• It does not replace the history and examination. It is one part of the assessment.
• It does not measure hormones, iron or thyroid function. Blood tests may still be needed (see blood tests for hair loss).
• It does not always give a final answer. When scarring hair loss is suspected, a review in Anais Brasileiros de Dermatologia notes that a biopsy is suggested, and trichoscopy can help choose the best spot to take it ¹.
• It does not predict exactly how your hair will respond to treatment.

Trichoscopy for tracking progress

Digital systems can save magnified images of the same scalp areas, sometimes with marked points or small tattoo dots to find the same place again. Comparing these images over months can show changes in hair thickness and density that are hard to notice in the mirror. It works best alongside standard overall photos (see tracking hair loss with photos).

Medical trichoscopy vs a "scalp scan" sales tool

Many salons and shops offer free scalp scans with a camera. The device may be similar, but the purpose can be different. A medical assessment interprets images in the context of your history and examination to reach a diagnosis. A sales scan may simply show enlarged images of oil, flakes or "clogged follicles" as a lead-in to buying products.

Be cautious if:

• normal scalp features are described as alarming
• a diagnosis is made without any questions about your health or history
• the scan always leads to an expensive package
• you are told that hair loss is caused by "blocked pores" without further assessment

See hair product claims: red flags.

How to prepare

• Wash your hair as usual before the visit.
• Avoid hair fibres, sprays, oils and heavy styling products on the day.
• Do not dye your hair just before the visit if you can avoid it, as dye can make the scalp harder to assess.
• Tell the clinician about any scalp treatments you use.

The bottom line

Trichoscopy is a simple, painless magnified examination that helps clinicians tell different types of hair loss apart and track change over time. It is most useful as part of a full assessment, not on its own. If anything suggests scarring or an unusual pattern, ask whether a dermatologist referral or biopsy is needed (see when to see a dermatologist).

Frequently asked questions

Is trichoscopy painful?

No. It is a non-invasive magnified look at the scalp and usually takes a few minutes ².

Can trichoscopy diagnose all hair loss?

It is a fundamental tool, but it supports rather than replaces history, examination and sometimes blood tests or biopsy ¹.

Is a free scalp scan at a shop the same?

The camera may be similar, but a medical assessment interprets images alongside your history to reach a diagnosis.

How should I prepare?

Wash as usual and avoid fibres, oils and heavy styling products on the day.

Educational content. Not medical advice.