Diagnosing Hair Loss With Scalp Exams and Trichoscopy

Oyetewa Asempa, MD, a dermatologist based in Houston, Texas, presented 3 sessions on hair loss and pigmentary disorders at Elevate Derm Summer 2026. Her presentations covered diagnostic approaches for complex hair loss, counseling patients on hair care practices during treatment, and practical management strategies for pigmentary disorders. In an interview with Dermatology Times, Asempa emphasized that careful scalp examination, trichoscopy, and asking questions instead of making assumptions can significantly improve diagnostic accuracy and patient trust.¹

Diagnosing Hair Loss With Scalp Exams and Trichoscopy

Many patients with hair loss tell Asempa that previous clinicians never physically examined their scalp before making a diagnosis.

The last person didn't even touch me.

She recommends touching and inspecting the entire scalp before reaching a diagnosis. She also routinely performs trichoscopy using a dermatoscope to capture magnified images of the scalp for closer evaluation.¹ "You cannot diagnose hair loss without it," said Asempa. She also added how trichoscopy should be considered a routine part of every hair loss evaluation because magnified visualization often reveals diagnostic clues that are not visible with the naked eye. Without a dermatoscope, she said, clinicians are more likely to misclassify common forms of alopecia.¹

Outside of alopecia, Asempa noted that pigmentary disorders remain among the most challenging conditions to manage. Rather than relying on a single therapy indefinitely, she recommends maintaining multiple treatment options—including agents such as hydroquinone and tranexamic acid—that can be alternated over time when prolonged use becomes impractical or undesirable.¹

Avoiding Assumptions About Hair Care Practices

Asempa said one of the biggest mistakes clinicians make is assuming how often a patient washes their hair based on hairstyle or appearance. Instead, she asks patients directly in a neutral tone before beginning the scalp examination.

"I don't make any assumptions. I just ask questions," — Oyetewa Asempa, Md

A patient presenting with seborrheic dermatitis may already be washing their hair appropriately, meaning washing frequency is not necessarily contributing to the condition.¹²

Building Rapport Across Race-Concordant and Race-Discordant Relationships

Asempa said race concordance can naturally help establish rapport because many patients of color assume she understands their hair care experiences. For clinicians caring for patients whose backgrounds differ from their own, she recommends using educational resources created by physicians with expertise in hair disorders affecting patients of color. She said acknowledging those resources can help build trust while demonstrating a commitment to culturally informed care.²³

I like to use the term appealing to authority, — Oyetewa Asempa, Md

Rather than relying solely on their own expertise, clinicians can reference educational materials developed by physicians of color or other experts with experience treating hair disorders in diverse patient populations. Asempa said sharing those resources demonstrates that providers have sought guidance from clinicians with lived experience and specialized knowledge, which can help patients feel heard and understood.

She said those resources also give clinicians practical tools to continue conversations beyond the office visit. By pairing evidence-based treatment recommendations with written educational materials, providers can build trust while helping patients make informed decisions about hair care and styling without spending valuable appointment time covering every detail.¹²

Extending Patient Education Beyond the Clinic Visit

Asempa said clinic visits are not the ideal setting for lengthy discussions about hairstyling because clinicians are not hairstylists. Instead, she developed a hairstyle grading guide that allows providers to continue those conversations outside the exam room.¹

"Having written things to hand to patients ends up being a huge hack in building rapport with patients," said Asempa.

The 9-page resource assigns letter grades to common hairstyles worn by patients with curly and coily hair, explaining how each may support scalp health or contribute to traction-related damage. It also includes photographs, practical explanations, and suggestions for modifying higher-risk styles when patients choose to continue wearing them.²

Asempa said the guide has become one of the educational resources she shares most frequently with both clinicians and patients. Rather than attempting to cover detailed styling recommendations during a time-limited visit, providers can use the booklet to continue the conversation outside the exam room while reinforcing treatment recommendations. She also shares the resource freely with providers who may be less familiar with braids, locks, and other textured hairstyles.⁴

References:

1. Asempa O. Interview with Dermatology Times. Presented at: Elevate Derm Summer 2026; July 30, 2026; San Diego, CA.
2. Asempa O, Carrington A. Best Practices for Hair Care and Styling in Patients with Alopecia. American Academy of Dermatology. January 26, 2026. Accessed July 30, 2026. https://assets.ctfassets.net/3l981im5dunw/7IOwpyBrVCRjMc5kdZxSMW/d0f7e1ac39ec005a76197522ca1b09e8/Hair_Care_and_Styling_in_Patients_with_Alopecia.Jan_26.pdf
3. American Academy of Dermatology. Best Practices for Hair Care and Styling in Patients with Alopecia (CME course). Accessed July 30, 2026.
4. Baylor College of Medicine. Oyetewa B. Asempa, MD, FAAD. Accessed July 30, 2026.