Can you diagnose hair loss from a photo?

Photos: Can you diagnose hair loss from a photo?

With the widespread availability of smartphones, it’s remarkably easy nowadays to take photos.  It’s also remarkably easy to post these on various forums and remarkably easily to send these via email.  For these reasons, photo use is widespread among patients with hair loss. Despite this, there is a common assumption that is being made that is not correct. Many people wrongly assume that one can properly diagnose hair loss with use of a photo.

 

Photographs for Hair Loss: Helpful but not the entire story

There are many hair loss conditions that mimic each other.  For example, I can show you a photo of androgenetic alopecia, diffuse alopecia areata, and lichen planopilaris that look identical. Can one be confident from the photo alone as to what the diagnosis is? No.

Because genetic hair loss is common, one will often be correct by guessing genetic hair loss in many photographs of hair loss. Nearly 1 out of every 2 women will have genetic hair loss by age 50 compared to approximately 1 out of 7,000 who will have (0.01%) have lichen planopilaris.  Clearly, guessing that a photo is showing genetic hair loss is more likely to be the correct answer.

PRINCIPLES OF USING PHOTOS

Here are some important principles of photographs in the diagnosis of hair loss

1. One can never be 100 % confident of any diagnosis with a photo alone.  

2. The lighting and background must ideally be the same if photos are to be compared. 

3. The length of the hair must also be the same. 

4. With a very detailed clinical history about the patient’s hair loss and medical history, one can move from being "uncertain" about the diagnosis to "somewhat confident." But that's about the maximum one can be. One can never be 100 % certain. There are many conditions that can mimic each other.

Conclusion

Photographs are wonderful to document the degree and pattern of hair loss. However, one must not assume that one can confidently determine the diagnosis of hair loss with photographs alone.