Maria Hordinsky, MD, is an R.W. Goltz Professor of the Department of Dermatology at the University of Minnesota.

Maria Hordinsky, MD

Trichoscopy’s Role in Differentiating Alopecia Types, with Maria Hordinsky, MD

A session titled ‘Spotting Scarring Alopecia Early: Clues, Challenges, and Clinical Pearls’ was presented during the 

2025 SDPA Annual Summer Dermatology Conference

The presenter, Maria Hordinsky, MD, was interviewed by 

’s editorial team on the major highlights described in her talk. Hordinsky is an R.W. Goltz Professor at the University of Minnesota Department of Dermatology. Hordinsky was asked in this segment of her interview about how dermoscopy—or more specifically, trichoscopy—helps differentiate early-stage scarring alopecias from mimickers like telogen effluvium or traction 

“The trichoscopy of the scalp is amazing,” Hordinsky said. “With that instrument called the dermatoscope, one can take a look at the skin of the scalp and see if there's inflammation present, whether it's diffuse and loose like you would see in dandruff. Is it kind of a loose scale, or is there hugging of the scale? Is the scale hugging the hair fiber as it exits out of the skin, which goes along more with the scarring alopecia? With trichoscopy, you can also see if scarring has already occurred.”

Hordinsky noted that particularly in more richly-pigmented skin types, the network of the skin can face injury and scarring due to such alopecia. Occurred. In terms of density, with dermoscopy or trichoscopy, Hordinsky noted that one can also note the quality of the hair fibers.

“So, a good picture of the scalp would show you that most of the hair fibers are very uniform,” Hordinsky explained. “They're of the same diameter. But if there's pattern hair loss occurring, or abnormal hairs are coming back, there's going to be a lot of variation in fiber diameter and also perhaps in the quality of the hair.”

Hordinsky was asked about any other clinical pearls worth mentioning that were featured in her presentation on scarring alopecias.

“I think it's really important to recognize that when you're working with a patient as a scarring alopecia, and you are doing all the right things that are in the algorithm for the treatment of a scarring alopecia, if your patient does not get better, then you have to think about allergic contact dermatitis,” Hordinsky said. “Because sometimes the treatments that we prescribe, or the injections that we do, have chemicals in them that your patient might be allergic to. It's very important to recognize if you're doing everything you can and the patient's not getting better. Then it's time to investigate with testing, to figure out if there's something the patient's coming in contact with that's driving this process.”

For any further information on scarring alopecia covered in Hordinsky’s presentation at SDPA 2025, view her full interview segment posted above. To find out more about alopecia and other dermatologic diseases highlighted at the meeting, view the 

The quotes used in this interview summary were edited for the purposes of clarity.

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Maria Hordinsky, MD, spoke at SDPA regarding her talk highlighting a variety of clinical pearls for spotting scarring alopecia early.

Clinical Pearls for Spotting Alopecia Scarring Early, with Maria Hordinsky, MD

 editorial team interviewed Maria Hordinsky, MD, regarding the biggest takeaways from her conference talk titled ‘Spotting Scarring Alopecia Early: Clues, Challenges, and Clinical Pearls.’

Hordinsky, an R.W. Goltz Professor at the University of Minnesota Department of Dermatology, discussed some of the points of her session on spotting alopecia scarring early, highlighting different aspects for clinicians to keep in mind. First, given that scarring alopecia is notoriously difficult to catch early, Hordinsky was asked what the earliest clinical or patient-reported signs that raise red flags for clinicians would be.

“Some of the early signs might be symptoms like pain, burning, or itch in a certain part of the scalp,” Hordinsky explained. “And then clinically, when one looks at the scalp, one may see inflammation around the hair follicles and perhaps only redness in the general area of involvement, as well as scalp hair loss. Catching things early, before they spread, is really important.”

 team also asked Hordinsky about how subtle symptoms can be differentiated from more common non-scarring conditions.

“That is a great question, because many people have what's called seborrheic dermatitis, or dandruff, so to speak,” Hordinsky said. “So they could have dandruff or seborrheic dermatitis all over their scalp just as an underlying baseline. Then when they get a scarring alopecia, there is even more inflammation in a certain area of the scalp where that inflammatory scarring alopecia is occurring. So basically, you have to treat the whole scalp when you approach patients with these conditions.”

Hordinsky was also asked what clinicians now understand about the earliest stages of follicular destruction in scarring alopecias and about ways this may inform earlier intervention.

“We've known for decades that the inflammation in scarring alopecia is in the stem cell region, or the bulge region of the hair follicle,” Hordinsky explained. “So that's in the upper third of the hair follicles. We've all known that for a long time, and now people are understanding what those cells are that are coming in there. We've known also for years that these are primarily cells called lymphocytes. But now people are starting to understand what kind of lymphocytes these are…So the science is moving forward to understand better what these cells are and how to better target them, and what these cells release, so that this also could be targeted in treatments.”

In her SDPA interview,  Maria Hordinsky, MD, spoke about her session regarding clinical pearls for clinicians seeking to spot alopecia early in patients.

Maria Hordinsky, MD

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