Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2012:78:5;636-637
doi: 10.4103/0378-6323.100591

Sensitivity and specificity of the trichoscopy

Elzbieta Kowalska-Oledzka, Monika Slowinska, Adriana Rakowska
 Department of Dermatology CSK MSWiA, Warsaw, Poland

Correspondence Address:
Elzbieta Kowalska-Oledzka
ul. Bony 34a, 02-496 Warsaw
Poland
How to cite this article:
Kowalska-Oledzka E, Slowinska M, Rakowska A. Sensitivity and specificity of the trichoscopy. Indian J Dermatol Venereol Leprol 2012;78:636-637
Copyright: (C)2012 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Chronic hair loss frequently affects female patients, but there is little or no objective technology available to aid the dermatologist in setting a proper diagnosis and monitoring treatment efficacy. Nowadays the diagnosis of alopecia is made on the basis of medical history of hair loss, clinical examination (the presence of hair thinning evaluated by the three-point Ludwig scale, the Olsen scale, or the Hamilton-Norwood scale in female androgenic alopecia (FAGA)), diffuse hair loss in telogen effluvium (TE), pull test, trichogram, and histopathology. [1],[2] Trichoscopy is a noninvasive method which could be used as a diagnostic tool in hair and scalp disorders and limits the necessity of performing the biopsy. [3],[4] In order to determine the specificity and sensitivity of the trichoscopy in a diagnosing process of hair loss in female patients, we examined 296 female patients with hair loss including 141 patients with FAGA, 54 with TE, 97 with FAGA coexistent with TE (FAGA + TE), and 50 healthy controls without any medical history about hair loss. The mean age of patients was 36.1 years (18-65, SD 12.5) [Figure - 1] and [Figure - 2]. The mean age of healthy controls was 36.4 (19-64, SD 12.1). All patients and the control group were examined by trichoscopy with the use of Fotofinder II (Teachscreen Software, Bad Brinbach, Germany) according to the standard procedure. [5] A typical trichoscopic pattern for FAGA showed reduced number of terminal hairs in the frontal area vs. occipital area, increased number of vellus hairs and empty follicular orifices in the frontal area, reduction of mean thickness of hair shafts, reduction of the percentage of triple-hair units with simultaneous increase of percentage of single-hair units, and increased percentage of thin hairs with concomitant decreased percentage of thick hairs and the presence of perifollicular discolorations in the frontal area. TE was characterized by early regrowth of new terminal hairs, few vellus hairs, and empty follicular orifices, reduction of the percentage of triple-hair units with simultaneous increase of percentage of single-hair units, and increased percentage of thin hairs with concomitant decreased percentage of thick hairs. Due to conducted analysis, we proved that the trichoscopic diagnosis and the clinical diagnosis showed high compliance (P for a marginal homogeneity test ≤0.0001). Cohen′s kappa coefficient, a standard, statistical measure of the compatibility of two diagnostic methods, for the trichoscopic diagnosis and the clinical diagnosis was 0.8262 and achieved the satisfactory level. We diagnosed FAGA by trichoscopy in 145 cases (vs. 141 cases as a clinical diagnosis), 47 cases of TE (vs. 54 cases as a clinical diagnosis), 43 cases of FAGA + TE (vs. 97 cases as a clinical diagnosis), 40 cases of FAGA with regrowth (vs. 0), and 19 cases without any abnormalities in trichoscopy (vs. 0). We also calculated the sensitivity and specificity of the trichoscopic diagnosis vs. clinical diagnosis for FAGA and TE. Trichoscopy as a diagnostic method for FAGA was characterized by very high sensitivity and achieved 96% and also high specificity reached 98%. Very high PPV (positive predictive value) and NPV (negative predictive value) coefficients indicated 1% of false-positive results and 7% false-negative results. Likelihood ratios for positive and negative results proved important role of the trichoscopy to confirm the diagnosis of FAGA (LR + 60.06) and usefulness to the excluding of the androgenic alopecia. Lower values of sensitivity of the trichoscopy were detected in the diagnosis of TE and revealed 85%. The value of specificity for TE was comparable and revealed 98%. These results were verified by high PPV (4% false-negative results) and NPV (10% false-negative results).

Figure 1: Androgenic alopecia. Trichoscopy of the frontal area of the scalp (a: 20-fold and b: 70-fold). Blue arrows - yellow dots, red arrows - vellus hairs
Figure 2: Telogen effluvium. Trichoscopy of the frontal area of the scalp (c: 20-fold and d: 70-fold). Thin- and medium-sized hairs, single-hair and double-hair units

The comparison of the diagnosis compliance for the trichogram and the trichoscopy was also performed and showed that only 82 from 116 cases of FAGA diagnosed by trichoscopy confirm the diagnosis by trichogram (70, 6%). Of 39 patients with trichoscopic diagnosis of FAGA + TE, 16 (41%) were positively verified by the trichogram. There is no possibility to confirm the diagnosis of FAGA with hair regrowth by trichogram (35 patients in the trichoscopy vs. 0 in the trichogram). Fifty percentage of cases diagnosed as TE in the trichogram maintain the diagnosis in trichoscopy.

Cohen′s kappa coefficient was 0.0997 and revealed the nonsatisfactory level. Sensitivity of the trichoscopy vs. trichogram reached 93% for diagnosing FAGA and 54% for TE. Specificity achieved lower values: 34% for FAGA and 62% for TE. Trichoscopy can also precise the diagnosis of coexistence of FAGA and TE. Presented data proved that the trichoscopy is characterized by high sensitivity and specificity in the diagnosis of FAGA and TE and could be consider as a reference test for the diagnostic purposes.

References
1.
Blume-Peytavi U, Blumeyer A, Tosti A, Finner A, Marmol V, Trakatelli M, et al. S1 guidelines for diagnostic evaluation in androgenic alopecia in men, women and adolescents. Br J Dermatol 2011;164:5-15.
[Google Scholar]
2.
Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. J Am Acad Dermatol 2004;51:189-99.
[Google Scholar]
3.
Rudnicka L, Olszewska M, Rakowska A, Kowalska-Oledzka E, Slowinska M. Trichoscopy: A new method for diagnosing hair loss. J Drugs Dermatol 2008;7: 651-4.
[Google Scholar]
4.
Ross EK, Vincenzi C, Tosti A. Videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol 2006;55:799-806.
[Google Scholar]
5.
Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Rudnicka L. Dermoscopy in female androgenic alopecia: Method standarization and diagnostics criteria. Int J Trichology 2009;1:123-30.
[Google Scholar]

Fulltext Views
3,178

PDF downloads
2,064
Show Sections