Increase in fine, miniaturized hairs compared to thick terminal hairs.

Rising ratio of vellus (peach fuzz-like) hairs to normal hairs.

Early reduction in overall hair density before visible thinning.

“Exclamation mark” hairs — thin at the base, thicker at the tip.

Broken or short dystrophic hairs.

Black dots (hairs broken at the scalp surface).

Yellow dots (keratin/follicular debris in empty follicles).

Patterns indicating whether the disease is active or regressing.

Loss of follicular openings along the frontal hairline and temples.

Perifollicular redness (erythema).

White perifollicular scaling around remaining hairs.

Progressive band-like recession across the forehead.

Early identification critical to slow scarring progression.

Absent or “erased” follicular openings.

Tufted hairs (multiple hairs emerging from one follicle opening).

Perifollicular scaling or redness, often with inflammation.

Shiny, scar-like scalp areas where follicles are permanently lost.

Changes that indicate inflammation is actively destroying follicles.

Normal-looking follicular openings, without inflammation or scarring.

Reduced proportion of thick terminal hairs.

Increased number of empty follicles (recent shedding).

Uniform shedding pattern without localized miniaturization.

Absence of hallmark disease-specific markers.

Broken hairs → often linked with hair-pulling (trichotillomania).

Black dots → fractured hairs within follicles.

Yellow dots → empty follicles filled with keratin/sebum.

Pustules or scaling → signs of infection or inflammation (e.g., folliculitis decalvans).

Tunnels or sinus tracts → dissecting cellulitis clues.

Redness and perifollicular scale → suggestive of lichen planopilaris or other scarring types.

Other rare disorders → e.g., tinea capitis, lupus, or inflammatory scalp diseases.