Trichoscopy is an established component of the hair loss consultation, yet two related documentation gaps persist: there is no widely accepted set of standardized anatomic points for trichoscopic image capture on the scalp, and no widely adopted shorthand for labeling captured images within the electronic medical record (EMR). In our experience, free-text descriptions vary between clinicians and between visits, limiting longitudinal comparison. This narrative review summarizes existing anatomic terminology and sampling frameworks relevant to clinical trichoscopy, identifies the practical gap, and presents a region-anchored framework that pairs a set of specific scalp imaging points with a corresponding alphanumeric shorthand for direct EMR entry. The framework combines bone-anchored zonal terminology with a single-letter regional prefix, a numerical suffix, and an “L” (left) or “R” (right) designation, producing concise labels of two to five characters. These labels accommodate the variable imaging needs of common alopecias and are intended to complement, not replace, existing sampling protocols. The framework has been used to document approximately 150 patients with hair loss in a single tertiary referral hair clinic since 2025 but has not been formally validated for inter-observer reproducibility; a multi-centre validation study would be a useful next step.
- Open Access
- Review
Anatomic Points and Labels for Trichoscopic Scalp Imaging: A Narrative Review and Proposed Framework
Author Information
Received: 23 May 2026 | Revised: 21 Jul 2026 | Accepted: 24 Jul 2026 | Published: 28 Jul 2026
Abstract
Keywords
trichoscopy | dermoscopy | hair loss | alopecia | scalp anatomy | medical recordkeeping | scalp mapping
References
- 1.
Workman, K.; Piliang, M. Approach to the patient with hair loss. J. Am. Acad. Dermatol. 2023, 89, S3–S8. https://doi.org/10.1016/j.jaad.2023.05.040.
- 2.
Pirmez, R. The dermatoscope in the hair clinic: Trichoscopy of scarring and nonscarring alopecia. J. Am. Acad. Dermatol. 2023, 89, S9–S15. https://doi.org/10.1016/j.jaad.2023.04.033.
- 3.
Jayasree, P.; Thomas, N.; Kaliyadan, F. Five-point trichoscopy to diagnose and assess treatment response in hair loss disorders. J. Am. Acad. Dermatol. 2021, 84, e27–e28. https://doi.org/10.1016/j.jaad.2020.08.036.
- 4.
Mehra, S. P077 Updates on Trichoscopy in Diagnosing Scalp Disorders: A Systematic Review of Diagnostic Accuracy, Sensitivity and Specificity. Br. J. Dermatol. 2025, 193 (Suppl. 1), i54. https://doi.org/10.1093/bjd/ljaf085.105.
- 5.
Beehner, M.L. Nomenclature proposal for the zones and landmarks of the balding scalp. Dermatol. Surg. 2001, 27, 375–380. https://doi.org/10.1046/j.1524-4725.2001.00289.x.
- 6.
Wohltmann, W.E.; Sperling, L. Histopathologic diagnosis of multifactorial alopecia. J. Cutan. Pathol. 2016, 43, 483–491. https://doi.org/10.1111/cup.12698.
- 7.
Beltrami, E.J.; Gronbeck, C.; Jain, N.; et al. Surface anatomy in dermatology: Part I—Clinical importance, diagnostic utility, and impact on medical management. J. Am. Acad. Dermatol. 2024, 91, 207–220. https://doi.org/10.1016/j.jaad.2023.07.001.
- 8.
Kasprzak, M.; Sicińska, J.; Tosti, A. Follicular Map: A Novel Approach to Quantitative Trichoscopy. Skin Appendage Disord. 2019, 5, 216–220. https://doi.org/10.1159/000497193.
- 9.
Seeck, M.; Koessler, L.; Bast, T.; et al. The standardized EEG electrode array of the IFCN. Clin. Neurophysiol. 2017, 128, 2070–2077. https://doi.org/10.1016/j.clinph.2017.06.254.
- 10.
O’Brien, J.X.; Ashton, M.W.; Rozen, W.M.; et al. New perspectives on the surgical anatomy and nomenclature of the temporal region: Literature review and dissection study. Plast. Reconstr. Surg. 2013, 131, 510–522. https://doi.org/10.1097/PRS.0b013e31827c6ed6.
- 11.
Hyakutake, Y.; Shibahara, I.; Toyoda, M.; et al. Frontotemporal Craniotomy with Skin Incision along the Superior Temporal Line outside the Hairline in Bald Male Patients with Temporal Gliomas. Neurosurg. Rev. 2023, 46, 296. https://doi.org/10.1007/s10143-023-02212-z.
- 12.
Lee, K.L.; Choi, Y.J.; Gil, Y.C.; et al. Locational relationship between the lateral border of the frontalis muscle and the superior temporal line. Plast. Reconstr. Surg. 2019, 143, 293e–298e. https://doi.org/10.1097/PRS.0000000000005202.
- 13.
Davidge, K.M.; van Furth, W.R.; Agur, A.; et al. Naming the soft tissue layers of the temporoparietal region: Unifying anatomic terminology across surgical disciplines. Neurosurgery 2010, 67 (Suppl. 3), ons120–ons130. https://doi.org/10.1227/01.NEU.0000383132.34056.61.
- 14.
Ebeling, U.; Rikli, D.; Huber, P.; et al. The coronal suture, a useful bony landmark in neurosurgery? Craniocerebral topography between bony landmarks on the skull and the brain. Acta Neurochir. 1987, 89, 130–134. https://doi.org/10.1007/BF01560378.
- 15.
Chen, F.; Chen, T.; Nakaji, P. Adjustment of the endoscopic third ventriculostomy entry point based on the anatomical relationship between coronal and sagittal sutures. J. Neurosurg. 2013, 118, 510–513. https://doi.org/10.3171/2012.11.JNS12477.
- 16.
Tsutsumi, S.; Ono, H.; Ishii, H. Correlation of the External Occipital Protuberance with Venous Sinuses: A Magnetic Resonance Imaging Study. Surg. Radiol. Anat. 2022, 44, 999–1006. https://doi.org/10.1007/s00276-022-02969-w.
- 17.
Allanson, J.E.; Cunniff, C.; Hoyme, H.E.; et al. Elements of morphology: Standard terminology for the head and face. Am. J. Med. Genet. A 2009, 149A, 6–28. https://doi.org/10.1002/ajmg.a.32612.
- 18.
Cummins, D.M.; Marshall, C.; Asfour, L.; et al. Frontal fibrosing alopecia: Survey of severity assessment methods in routine clinical practice and validation of the International Frontal Fibrosing Alopecia Cooperative Group measurement guidance. Clin. Exp. Dermatol. 2022, 47, 903–909. https://doi.org/10.1111/ced.15035.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Suite 4002 Level 4, 447 Collins Street, Melbourne, Victoria 3000, Australia
General Inquiries: info@sciltp.com