Reply to "response to Pathoulas Et Al's 'evaluation of Standardized Scalp Photography on Patient Perception of Hair Loss Severity, Anxiety, and Treatment'".

To the Editor: We appreciate the opportunity to respond to the letter by Karim et al1Karim M. Klein E. Oh C. Shapiro J. Lo Sicco K. Response to Pathoulas et al.’s “Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment.”.J Am Acad Dermatol. 2022; 87: e167-e168Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar regarding our study, “Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment.”2Pathoulas J.T. Flanagan K.E. Walker C.J. Wiss I.M.P. Azimi E. Senna M.M. Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment.J Am Acad Dermatol. 2021; 85: 1640-1641https://doi.org/10.1016/j.jaad.2020.12.059Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar In our previous study of 119 patients, standardized global scalp photography decreased alopecia-related anxiety and improved congruence between physician assessment and patient self-perception of hair density. Karim et al1Karim M. Klein E. Oh C. Shapiro J. Lo Sicco K. Response to Pathoulas et al.’s “Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment.”.J Am Acad Dermatol. 2022; 87: e167-e168Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar highlighted how the use of trichoscopy is optimal in establishing a baseline and documenting interval change. We agree with the authors that obtaining trichologic measurements at each patient visit provides an advantage over global scalp photography alone in allowing for direct determination of hair density and diameter. Traditional trichoscopy involved the use of specialized camera systems, scalp tattooing, hair clipping, and manual counting, which was time consuming.3Canfield D. Photographic documentation of hair growth in androgenetic alopecia.Dermatol Clin. 1996; 14: 713-721https://doi.org/10.1016/s0733-8635(05)70397-1Abstract Full Text Full Text PDF PubMed Google Scholar Digital trichoscopy has improved upon the traditional process by generating computer-aided hair counts and diameters. Despite the advantages of digital trichoscopy, many patients with pattern hair loss receive treatment in the primary care setting, where these devices are not readily available. Furthermore, it is unlikely that most general dermatologists outside specialty hair or cosmetic clinics routinely use serial trichoscopy due to time constraints or the lack of dedicated devices. As such, we wanted this article to highlight how global photography can be included in any clinical setting to improve compliance and reduce anxiety in patients with alopecia. Widespread use of trichoscopy could be furthered by emerging technology that leverages machine learning. Artificial intelligence (AI)-aided trichoscopy is now commercially available. AI-aided trichoscopy provides real-time hair counts, diameter, and ratio of vellus to terminal hairs.4Sacha J.P. Caterino T.L. Fisher B.K. et al.Development and qualification of a machine learning algorithm for automated hair counting.Int J Cosmet Sci. 2021; 43: S34-S41https://doi.org/10.1111/ics.12735Crossref PubMed Scopus (5) Google Scholar Next generation AI-aided trichoscopy provides physicians with objective values that can be used to determine treatment and guide discussion when used in combination with global photography. Patients with hair loss can experience psychosocial distress and perceive worse hair loss than that determined by their physician.2Pathoulas J.T. Flanagan K.E. Walker C.J. Wiss I.M.P. Azimi E. Senna M.M. Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment.J Am Acad Dermatol. 2021; 85: 1640-1641https://doi.org/10.1016/j.jaad.2020.12.059Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Global photography is a quick and inexpensive method of documenting interval changes that can improve congruence between patient and physician assessments. Karim et al1Karim M. Klein E. Oh C. Shapiro J. Lo Sicco K. Response to Pathoulas et al.’s “Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment.”.J Am Acad Dermatol. 2022; 87: e167-e168Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar correctly point out that serial trichoscopy and global photography are superior to global photography alone. The time and cost limitations of trichoscopy have prevented its widespread use in the diagnosis and treatment of alopecia. However, new AI-aided technology may make low-cost, high-throughput trichoscopy available to more patients and improve quality of care. None disclosed. Response to the article, “Evaluation of standardized scalp photography on patient perception of hair loss severity, anxiety, and treatment,” by Pathoulas et alJournal of the American Academy of DermatologyVol. 87Issue 5PreviewTo the Editor: We read with great interest the letter by Pathoulas et al,1 in which the effect of standardized scalp photography on patients’ self-perceived alopecia severity, anxiety, and motivation to pursue treatment was discussed. Due to time restraints, standardized scalp photography is often the only technique implemented in clinical practice for assessing the progression of alopecia. This important technique helps dermatologists communicate with patients who often have anxiety regarding their alopecia. Full-Text PDF