A Comment on the Role of Trichoscopy beyond Hair and Scalp Diseases

Rudnicka et al . suggest that dermatologists may suspect some systemic diseases on the basis of trichoscopic findings. Indeed, dermoscopy of the hair and scalp or trichoscopy has gained a particular popularity among dermatologist as a tool in the differential diagnosis primarily of hair and scalp disorders, with an ever-growing literature and online courses on the respective signature patterns. However, trichoscopy is being overestimated as a single diagnostic method for the sake of publicity with a plethora of descriptive terms with a fertile imagination to describe morphological features with undetermined sensitivities and specificities for the respective underlying pathologies. We have warned that caution is warranted not to elevate trichoscopy to something like a fetish status. As a diagnostic procedure, trichoscopy remains to be understood as representing an integral part of a more comprehensive dermatological work-up. As with any medical problem, a patient complaining of hair loss requires a comprehensive medical history, physical examination, and appropriate laboratory evaluation, and this particularly holds true for dermatologic conditions as they may relate to systemic diseases. In fact, narrowing our perspective to the dimensions of trichoscopy while dealing with dermatologic patients is like viewing a pointillistic painting of Seurat at the museum with a magnifying glass, while expecting to recognize the whole picture.