Is trichoscopy a reliable tool to diagnose early female pattern hair loss?

BACKGROUND: Female pattern hair loss (FPHL) presents with visible patterns of hair loss, thus making a bedside diagnosis possible. However, there are cases of FPHL presenting without any visible hair thinning, making it necessary to subject them to a scalp biopsy to make a diagnosis.

AIM: The aim of the following study is to determine if trichoscopy can be used as a bedside tool to diagnose Early FPHL in women presenting without any visible thinning of hair, using >20% hair diameter diversity - anisotrichosis, as the diagnostic criteria.

MATERIALS AND METHODS: Trichoscopy was performed on 20 cases of early FPHL (biopsy proven), 63 normal controls and 29 Grade 2 FPHL Controls.

RESULTS AND DISCUSSION: In the biopsy proven FPHL cases, 75% showed anisotrichosis on trichoscopy. This finding was significantly higher in FPHL Cases compared to normal controls. As expected, 93% of Grade 2 FPHL controls also showed the same finding. Trichoscopy was found to be 75% sensitive and 61.54% specific in diagnosing early FPHL. Thus, a negative result would be more indicative of absence of disease, however, a positive result would not always indicate the presence of disease.