Abstract
When treating patients with scalp diseases, it is essential to be able to evaluate treatment response. Treatment response will allow further decision-making such as increasing or decreasing treatment dose, changing the treatment vehicle, changing therapy, or adding adjuvant treatments. Sometimes, hair disorders have multifactorial causes, so response to treatment may be affected not only by the prescribed therapy but also by other factors.
Follow-up must include photographic and trichoscopic documentation, as well as inquiring about patient coping and expectations. Treatment goals must be clear to the patient. We should consider that a patient might have more than one disease or a new disease can appear such as contact dermatitis, impetigo, or tinea. If there is no response after 3–6 months of therapy with good patient compliance, a trichoscopy-guided biopsy might reveal valuable information. Another important challenge to be considered is cicatricial alopecia; even to the most trained eye, cicatricial diseases can mimic noncicatricial pathologies, and cicatricial alopecias tend to have an initial inflammatory phase in which no cicatricial findings are found.
Dynamic trichoscopy is the best way to evaluate treatment response since it allows the assessment of trichoscopic signs of active disease. This assessment will benefit therapeutic decision and selection of a biopsy area. Knowledge of trichoscopic signs of active inflammation and signs of fibrosis in each disease will enable the clinician to understand that trichoscopy allows to identify the mechanisms of the disease rather than pathognomonic and unchanging signs.
In this chapter, we will describe every step to be taken in all the possible presentations that a physician could face during treatment of hair disorders. The authors have tried to summarize and explain step by step what to expect, how to evaluate, and what to do when treatment is not working, trying to offer a guidance for all those who help patients with hair disorders.