Type of publication:
Conference abstract
Author(s):
*Mehra S.
Citation:
British Journal of Dermatology. Conference: 105th Annual Meeting of the British Association of Dermatologists, BAD 2025. Glasgow United Kingdom. 193(Supplement 1) (pp i54), 2025. Date of Publication: 01 Jul 2025.
Abstract:
Trichoscopy has emerged as a pivotal diagnostic tool for evaluating scalp disorders. This systematic review assesses its diagnostic sensitivity, specificity and accuracy for various scalp conditions, proposing refinements to clinical protocols based on National Institute for Health and Care Excellence (NICE) and British Association of Dermatologists (BAD) guidelines. The aim is to provide recommendations for integrating trichoscopy into routine dermatology practice to optimize patient outcomes and diagnostic pathways. A systematic review was conducted following the PRISMA guidelines. The PubMed, MEDLINE and Embase databases were searched for studies published between 2010 and 2023. Keywords included 'trichoscopy', 'scalp disorders', 'diagnostic accuracy', 'sensitivity' and 'specificity'. Inclusion criteria encompassed studies evaluating the diagnostic performance of trichoscopy for common scalp conditions such as alopecia areata, androgenetic alopecia, telogen effluvium, scalp psoriasis, seborrhoeic dermatitis and tinea capitis. Only multicentre or single-centre studies with quantitative data were included. Exclusions included case reports and studies lacking statistical metrics. Data were analysed within the framework of the BAD and NICE recommendations to assess real-world applicability. Thirty-six studies involving 11 250 patients were included. Trichoscopy consistently demonstrated high diagnostic accuracy, surpassing traditional methods. (i) In alopecia areata, exclamation-mark hairs and black dots yielded 94% sensitivity and 92% specificity, aligning with BAD recommendations. (ii) In androgenetic alopecia, hair shaft diameter variability and perifollicular pigmentation showed 91% sensitivity and 89% specificity, supporting diagnostic integration. (iii) In telogen effluvium, empty follicles and short regrowth hairs demonstrated 86% sensitivity and 84% specificity, enabling earlier interventions. (iv) In tinea capitis, comma hairs and corkscrew hairs achieved 95% diagnostic accuracy, emphasizing the superiority of trichoscopy. (v) In scalp psoriasis and seborrhoeic dermatitis, differentiation was achieved using red dots, diffuse white scales and arborizing vessels, with 92% sensitivity. Reproducibility across centres was evident. Artificial intelligence (AI)-based algorithms were highlighted for enhancing diagnostic standardization, clinician training and accessibility. A national registry of trichoscopic images is proposed to improve data sharing and compliance with guidelines. In conclusion, trichoscopy is indispensable for diagnosing scalp disorders, offering a noninvasive, accurate alternative to biopsies. It enables earlier diagnosis, precise differentiation and improved outcomes, aligning with NICE and BAD guidelines. The results support the following recommendations. (i) Develop standardized trichoscopic criteria for scalp disorders. (ii) Include trichoscopic education in dermatology training. (iii) Invest in AI-based tools for image standardization. (iv) Establish a national trichoscopy registry for collaborative research. For application to clinical practice, this review provides actionable insights for enhancing diagnostic pathways and advancing the role in dermatology in trichoscopy, offering a foundation for improved patient care.
DOI: 10.1093/bjd/ljaf085.105
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