Digital trichoscopy in Valencia

Digital trichoscopy uses a videodermatoscope to magnify structures invisible to the naked eye, allowing image capture and comparison and measurement of hair density or diameter.

It allows examination of follicular openings, the number of hairs per unit, shaft thickness and shape, broken hairs, different types of dots, scaling, redness and vessel patterns. Miniaturisation in androgenetic alopecia is recognised indirectly through greater variation in thickness and more fine hairs.

One distinction matters: it does not reveal inflammatory cells or deep collagen. It detects surface signs compatible with inflammation — redness, scaling — or fibrosis — lost openings, white areas — which require biopsy for confirmation.

History and distribution

First, we take your history and assess the distribution of hair loss.

Dermatoscope against the skin

We part the hair and bring the dermatoscope close: comfortable, with no radiation, anaesthetic or hair plucking.

The magnified view

Follicular openings, hairs per unit, shaft thickness, scaling, redness and vessels.

Comparison over time

Comparable images to measure treatment response, at intervals of at least six months.

Its main use is the differential diagnosis of alopecia, as different types may look alike to the naked eye:

• It identifies miniaturisation in androgenetic alopecia, particularly in early stages.
• It recognises signs of alopecia areata — yellow and black dots, exclamation-mark hairs — with preserved openings.
• It suggests scarring alopecia through loss of follicular openings and inflammation at the edges.
• It helps with tinea, trichotillomania and treatment monitoring.

Direct inspection identifies the overall pattern of loss, but cannot distinguish miniaturised hairs, fine scaling around follicles or early loss of follicular openings. This magnified information helps avoid unnecessary biopsies and, when biopsy remains necessary, directs sampling to an active edge where follicles are still present.

Overall, it changes decisions: confirming early androgenetic alopecia that might otherwise be missed, avoiding treatment of effluvium or scarring disease as androgenetic alopecia, and providing an objective baseline to assess whether treatment is working. It refines clinical judgement rather than replacing it.

Digital trichoscopy is comfortable, uses no radiation, needs no anaesthetic and requires no hair plucking. We part the hair and bring the dermatoscope close to different areas. Digital trichoscopy and general clinical photography are different: the former records detail in a small area and the latter the overall appearance.

It is not a treatment: it does not stop shedding or stimulate growth.

It does not always establish diagnosis alone: findings are integrated with medical history, examination, the hair pull test and, where needed, blood tests or biopsy. Many signs are non-specific.

It does not replace biopsy when scarring alopecia is suspected or findings conflict, because it examines the surface while histology examines deeper tissue. Nor can it alone identify whether shedding is caused by a deficiency, thyroid condition or medicine: targeted tests are needed.

The examination forms part of the hair lossconsultation. We first take your history and assess the distribution of loss, then examine several affected areas and a reference area, because one image is insufficient for diffuse shedding.

Please attend without hair fibres, colour sprays or scalp make-up: these obscure the structures we need to see.

The consultation ends by correlating clinical and trichoscopic findings — a diagnosis or several likely possibilities, the need for blood tests or biopsy, or the absence of alopecia signs — and agreeing a follow-up and treatment plan. Alopecias usually progress and improve slowly, so follow-up examinations are normally performed at intervals of at least six months.

It is part of our hair medicine service in Valencia, available in Spanish, English and Italian, and you can meet the medical team before your visit.