Normal Scalp

Caucasian Scalp_2.JPG
  • Variety of curl pattern seen

  • Terminal::vellus hair ratio greater than 4:1

  • Few miniaturized hairs

  • Uniform caliber hair shafts

  • Mostly 2-3 hairs per follicular unit (range 1-5)

  • Uniformly pale white scalp 

  • Small red macules, representing dilated/arborizing blood vessels

  • Yellow dots (few)

  • Follicular ostia 

Interfollicular Space
  • Usually no findings (“pristine” scalp)

  • Mild flaking/scaling is normal



Normal scalp trichoscopy for caucasians reveals multiple curl patterns ranging from very straight to tightly kinked curly hair. To distinguish from the most common trichoscopic change, the ratio of terminal to vellus hairs should be greater than 4:1 in normal hair.  Miniaturization is a sign of androgenic alopecia and less common in younger individuals. Expect to see hair shafts exhibit uniform caliber, and some individuals have naturally very “fine hair” (caliber 60-80 microns). Follicular units range from 1-5 hairs per follicular unit, with the majority of units made up of 2-3 hairs. With age, the average number of hairs per follicular unit decreases. Scalp appears uniformly pale white with occasional small, red macules (represent dilated or arborizing blood vessels). Follicular ostia are sometimes seen and are a normal finding. Few yellow globules/dots may be seen. The interfollicular space is normally unremarkable with no significant findings. This is referred to as a “pristine” scalp. Mild white flaking/scaling is normal.