Trichoscopy Provides Clearer Differentiation of Alopecia Subtypes, With Amy Spizuoco, DO, FAOCD

At the 2025 Society of Dermatology Physician Assistant (SDPA) annual summer meeting in Washington, DC, Amy Spizuoco, DO, FAOCD, a board-certified dermatologist at True Dermatology and a clinical instructor at Mount Sinai, presented the dermoscopy track, “The Role of Trichoscopy in Clinical Hair Loss Evaluation” on Friday, June 27th.

HCPLive spoke with Spizuoco at the meeting about how trichoscopy changed the diagnostic landscape for hair loss, key trichoscopic features that physician assistants and clinicians should be looking for when evaluating common types of alopecia, and the barriers to using trichoscopy.

“Barriers are just not knowing the patterns to look for and what each pattern relates to, just like with dermoscopy when we use it for recognition of melanoma or for basal cells,” Spizuoco said.

For physician assistants or clinicians not familiar with trichoscopy, Spizuoco said they should learn basic patterns that are seen with trichoscopy for alopecia. For instance, trichoscopy will show black or yellow dots, exclamation hairs, white halos, and some pigment networks.

Scarring and non-scarring alopecia present different patterns. Scarring alopecia will show a loss of follicular ostia, or in other words, a loss of hair by the scalp or the follicular opening. However, with non-scarring alopecia, you will still see the follicular ostia, but it may just be smaller or sparser than you would see in individuals with no hair loss disorders.

The main features seen in specific alopecia subtypes include exclamation mark hairs in alopecia areata, yellow dots indicating follicular plugging in telogen effluvium, and miniaturized or vellus hairs in androgenetic alopecia. These features can help dermatologists distinguish between the main non-scarring alopecias.

For instance, by the eye, alopecia areata and tinea capitis look very similar, but trichoscopy can distinguish these disorders. With alopecia areata, examination of hairs is present, but with tinea capitis, there is a black dot pattern. It is important to be able to distinguish these conditions since they are treated in a completely different way.

“[Trichoscopy is] a great tool to be able to utilize with our patients with hair loss,” Spizuoco said. “It's very effective, it's cost-effective, it's time-effective, and it's a great diagnostic tool.”

References

Spizuoco, A. Hair Loss Track: Understanding Non-Scarring Alopecia: Patterns, Pathophysiology, and Practice. Presented at SDPA 2025 on Friday, June 27, 2025, in Washington, DC.