Trichoscopy for Dx of LLP and FFA

Trichoscopy, the examination of the scalp with magnification for diagnosis, is critical to be able to detect the presence of diseases that might be a contra-indication to hair transplantation. A hair transplant done on a person with FFA or LLP will fail. A biopsy of the scalp confirms the diagnosis.

The first picture on the left, shows a patient with genetic hair loss and a disease called Lichan Pilnopilaris (LLP). If this patient is not examined with a Trichoscope to make this diagnosis and had a hair transplant, it would fail.  Note the crusting around each of the terminal hairs that are typical of LLP. This is an autoimmune disease of the scalp.

The picture on the right shows a man who is 33 years old, and had corner recession typical of a genetic Norwood Class 3 pattern of balding, but Trichoscopic examination showed Frontal Fibrosing Alopecia (FFA) which is highly unusual in a 33 year old male but if he had a hair transplant, it would fail as the former patient with LLP. The picture shows the absence of vellus hairs which is typical of FFA. This is an autoimmune disease of the scalp that killed off all of the vellus hairs.