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 in Washington, DC.

The presenter, Maria Hordinsky, MD, was interviewed by HCPLive’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 alopecia.

“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 latest conference coverage.

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