\n<\/p>\n
We need to forget about formal terminology for a few moments- and just observe, observe, observe.<\/p>\n
One of the mistakes many practitioners make is trying to match every trichoscopic image to a known list of \u201ctrichoscopic signs.\u201d<\/p>\n
Although this cataloguing is important, true trichoscopic skill starts somewhere much simpler:<\/p>\n
State what you see!<\/p>\n
The terminology comes later. The difficult part of trichoscopy (and in fact, all of hair loss diagnosis) is developing the power of simple observation.<\/p>\n
The detective Sherlock Holmes once said<\/p>\n
\u201cYou see, but you do not observe.\u201d<\/p>\n
Indeed, many people look at things without truly processing what they are seeing.<\/p>\n
When I perform trichoscopy, I don\u2019t begin with trying to find terms that fit with textbook terms. I begin with observing:
\u2022 shapes
\u2022 loops
\u2022 colors
\u2022 symmetry<\/p>\n
Only afterwards do I attach terminology – and then seek to link what I observe with disease pathogenesis and ultimately a diagnosis.<\/p>\n
As an example, consider this image.<\/p>\n
I ask practitioners\u2026. What do you see?<\/p>\n
In nearly all situations, I hear some wonderful answers about vascular patterns and bleeding.<\/p>\n
After listening to a few answers, I let the audience know that to my eye, it looks like \u201ca fairy holding a bucket.\u201d<\/p>\n
That may sound silly \u2014 but it\u2019s actually incredibly useful.<\/p>\n
By describing the image in a simple term, I am forcing myself to state what I see not what I think matches some textbook definition of vascular patterns.<\/p>\n
Yes, these are likely thin loops (vascular structures) related to seborrheic dermatitis\u2026but I allow my brain to reach that conclusion only later.<\/p>\n
To me, trichoscopy is more than memorization. It is a wonderful form of biologic storytelling. We tell the best stories when we observe – rather than state what we think we are supposed to be seeing\u2260\u2260\u2260<\/p>\n<\/div>\n