I decided to turn to a trichologist when I faced hair loss last fall. I know that the problem is, unfortunately, not uncommon, but this was the first time for me. There are frequent posts on Beautician about special remedies for hair loss, which many women clutch at like the last straw, hoping that if it helped someone, it will help them too. I myself am like that, but for rational reasons I still went to the doctor, because the causes of hair problems often lie in a state of health.
In this post, I will not describe the procedure from the theoretical side, such a description can be found on a bunch of different sites and copying information will not bring much benefit. I will tell you how it was in practice.
So, I made an appointment with a trichologist and a trichoscopy procedure. Before going to the doctor, I did not apply any lotions, masks and other things to my hair, since most likely this could interfere with the doctor. After talking about hair loss, its intensity, duration and other things, the doctor began to study.
For trichoscopy, such a small portable device is used:
He will take a macro shot of a small area of the scalp. The doctor selects several different zones on the head, at least two: parietal and occipital, and literally for a couple of seconds brings the device closer to the head to obtain an image. All data is immediately transferred to the computer. My participation in the procedure took about a minute, I took two pictures.
Next, the doctor manually processes the images obtained, it is noted how many hairs are single, doubled, and even growing at the same time 3-4 from one bulb. This stage also passes quickly, if you do not distract the doctor with conversations.
The rest of the study is automated using special software, resulting in a report that can probably look different depending on the program used.
For each zone (the place where the scalp was photographed, in my case, the occipital and parietal), general characteristics are studied, in particular the number of hairs, and their thickness is studied. All data obtained are compared with the norm on the graphs. At the end of the report, there will also be a conclusion about the presence or absence of diseases of the scalp, for example, that seborrhea is absent, insignificant, etc.
I have attached photos of one of the studied areas. As you can see, first there are calculations for the number of hairs: per 1 sq. cm and 20 sq. mm (apparently this is the area that is captured in the picture). The calculation is carried out separately for terminal hair (this is strong dense healthy hair), vellus-like hair (thinner in diameter and weaker hair), as well as their total number, which is the sum. Do not confuse only vellus-like hair and the telogen stage (hair loss stage), because terminal hairs can also be in the telogen, and vellus-like hair does not always fall out immediately. Further, from the total number of hairs, how many of them grow single, double, and even three or four at a time are calculated. This is called a follicular unit, or more simply, like a “bush”, in which there can be a different amount of hair.
Based on the results of counting the number of hairs, a diagram is drawn up in which you will see three columns: the first reflects the total number of hairs, the second - the number of terminal, the third - vellus. They are crossed by a dark horizontal line, which represents the norm. You can immediately see if everything is in order or not. I seem to be fine, the doctor said.
Further in the report you will see a study on the thickness of the hair. The average hair diameter will be calculated as well as the terminal hair and vellus separately. The result of the calculation can also be seen graphically in the diagram. To be honest, I didn’t really go into this part of the study, because I already knew that I have thin hair, this is heredity and it has always been like that. But sometimes thinning is caused by a disease, so this part of the report is no less important for the doctor.
Well, at the end of the report there is a photo of a fragment of the area under study, it was unusual for me, I have never seen my head in such an approximation.
So, why does the doctor need everything that is in the report:
1. The total amount of hair.
Naturally, if it is below the norm, we can talk about alopecia. However, even if the amount of hair in different zones is normal, it can still be of diagnostic value for a competent trichologist, since there are some “correct” ratios of the number of hair in different zones, and their violation, even with a general norm, can serve as a call to the existence of a problem on the very initial stage. For example, hair on the parietal part of the head grows more than on the back of the head. However, if the cause of the hair loss is due to its inhibition by dihydrotestosterone (androgenetic alopecia), then the hair will fall out mainly in the parietal part and the parietal hair/occipital hair ratio may be disturbed.
A decrease in hair in the parietal part will tell the doctor about androgenetic alopecia. Hair reduction in all areas - about diffuse. In the first case, the reason lies in hormonal disorders or in the increased sensitivity of hair follicles to dihydrotestosterone. Hair loss all over the head has a wide range of causes from stress to a variety of health problems.
2. The ratio of terminal and vellus-like hair can characterize the health of the hair to the doctor. A lot of strong hair is good, an increase in the number of vellus-like hair will tell the doctor about the existence of a pathology.
3. Hair diameter is also an important diagnostic parameter.
For example, the action of dihydrotestosterone causes not only hair loss, but also their thinning. This hormone makes hair thin, even colorless, like fluff. Therefore, the diameter of the hair, in combination with other data obtained, helps the doctor in making a diagnosis.
In the treatment of any disease, timely and competent diagnosis is the basis of success. In trichology, the effectiveness of patient treatment will also depend not only on the practical experience of a specialist, but, no less important, on the success of his mastery of modern diagnostic methods.
STAGES OF PROVIDING TRICHOLOGICAL CARE
First of all, it should be noted that the methods of managing trichological patients in the CIS countries and abroad differ significantly, since in the West trichology has been developing for a long time and now it is a structured industry, and the stages of providing "trichological care" to the population are quite clearly distributed among specialists of different level, while in our case these stages are “blurred” and do not have clear boundaries. It is typical for non-CIS countries: after discovering a hair problem (on their own or with the help of relatives, friends), the patient seeks specialized trichological, most often non-medical help (trichologist-consultant) and only then, if necessary, for highly specialized medical care (doctor- dermatologist / dermatocosmetologist-trichologist).
This feature is associated both with the low availability of trichologists and the high cost of their services in Western countries, and with the presence of a well-developed network of near-medical trichologists who have received appropriate training and qualifications and are able to provide services in demand at a high level. In addition, the relationship between the trichologist and the trichologist improves the range of services provided and increases patient compliance (the degree of correspondence between the patient's behavior and the recommendations received from the doctor). So, if there is a specially trained hairdresser with the skills of a trichologist-consultant in the trichological center, the patient can visually improve the condition of his hair even at the initial stage of treatment by selecting a hairstyle that increases volume, selecting nanofibers that mask thinning, and also, if necessary, using an overlay, individually selected according to the color and structure of your own hair.
To work successfully in modern conditions, a trichologist needs to be aware of global trends in the field of diagnosis and treatment of diseases of the hair and scalp, master new diagnostic and therapeutic techniques, constantly improving their professional level. At the current stage, a specialist involved in the diagnosis and treatment of diseases of the hair and scalp needs to navigate in areas of medicine adjacent to dermatology, such as therapy, endocrinology and gynecological endocrinology, psychoneurology, psychoneuroimmunology and psychodermatology.
DIAGNOSTIC METHODS IN TRICHOLOGY
The effectiveness of patient treatment will depend not only on the practical experience of a specialist, but, no less important, on the success of his mastery of modern diagnostic methods in trichology, the importance of which is growing every day.
Depending on the aspects of trichological diagnostics under consideration, methods for assessing the condition of the hair and scalp can be divided into:
- specialized and non-specialized;
- methods intended primarily for research purposes and practical work;
- in terms of manipulations performed with the patient - non-invasive, semi-invasive and invasive.
Non-specialized methods include ultrasound examination of the human body, as well as methods of laboratory (clinical) diagnostics, which allow obtaining data on the state of health of the patient based on the study of the biomaterial of the human body in vitro using hematological, biochemical, immunological, serological, molecular biological, bacteriological, genetic, cytological and other methods. These methods give an idea of the general state of the human body and can be prescribed to the patient both by a trichologist and by relevant specialists of a narrow profile.
Laboratory diagnostic methods make it possible to exclude such conditions as iron deficiency anemia or latent iron deficiency, deficiency of vitamins and / or chemical elements, dysfunction of the thyroid gland and hyperandrogenemia, which can be both the main cause of hair loss and factors that aggravate this problem.
It should be remembered that the main task of a specialist is to treat not the disease, but the patient, that is, to correctly interpret the received laboratory information and, comparing it with the patient's picture of the disease, use it for further effective clinical use of the results obtained.
SPECIALIZED METHODS OF TRICHOLOGICAL DIAGNOSIS
Today, the range of modern methods for examining a patient with hair and scalp problems, in addition to the classical history taking and physical examination of the patient, may include trichoscopy, trichogram and phototrichogram with contrast, specialized diagnostic computer programs that measure hair, their thickness and density, the number of follicular units per unit area, biopsy and numerous types of microscopy, as well as the survey photograph method.
Let us dwell in more detail on those specialized techniques that are of the greatest practical importance for daily practice and are most accessible to the practitioner - these are trichoscopy, phototrichogram and the survey photograph method.
Trichoscopy- Today, trichoscopy has become a necessary tool in the examination of a trichological patient and in the differential diagnosis of diseases of the hair and skin of the scalp. This non-invasive method, which has become widespread since the beginning of the 21st century, is based on the use of a manual dermatoscope or video dermatoscopy of the hair and skin of the scalp and is actively used by trichologists due to its accessibility, simplicity and non-invasiveness, combined with a fairly high information content.
There are trichoscopy with the use of an immersion liquid (immersion) and without the use of immersion (“dry”). The use of immersion trichoscopy helps to assess the condition of the vessels and skin of the scalp, while "dry" trichoscopy is the most informative for assessing the presence of peeling, manifestations of seborrhea, perifollicular hyperkeratosis.
This method is an important tool in practical work. It allows differential diagnosis for various types of alopecia. During trichoscopy, lenses with various magnifications are used - from 10 to 1000 - times, lenses with a magnification range from x 20 to x 70 are most often used. The method allows you to assess in vivo the state of trichoscopic structural units, namely: hair shafts - their structure and diameter, the condition of the mouths of hair follicles and blood vessels of the skin of the scalp, perifollicular epidermis. Trichoscopy is used in the differential diagnosis between alopecia areata and trichotillomania, scarring and non-scarring alopecia. The method has also proven to be effective in diagnosing seborrhea and psoriasis of the scalp. Visualization of structural disorders of the hair shafts during trichoscopy makes it possible to diagnose genetic diseases of the hair shafts, such as Netherton Syndrom, moniletrix and others.
Trichoscopy makes it possible to distinguish normal terminal hair from vellus (vellus-like) hair, which is no more than 0.03 mm thick, and also allows distinguishing hair in the form of an exclamation mark, characteristic of alopecia areata, whose length is no more than 1-2 mm.
The method allows you to assess the state of the mouths of the hair follicles, the changes observed in this case are usually described using the term "point". Described are black dots (cadaverized hair) characteristic of alopecia areata (AA) (photo 1), yellow dots that occur in both alopecia areata and androgenetic forms of alopecia (AA) (photo 2), as well as yellow dots of the “3D” format in cicatricial alopecia and red dots characteristic of discoid lupus erythematosus.
With the help of trichoscopy, it is also possible to assess the features of skin microvascularization. So, twisted and lacy vascular loops are a characteristic sign of scalp psoriasis, and branching vessels inside the yellow dots are found in discoid lupus erythematosus.
The structural disorders and discoloration of the scalp skin, which are visualized during trichoscopy, include hyperpigmentation in the form of "honeycombs", indicating excessive exposure to insolation on the skin of the scalp (photo 3), peripilar (perifollicular) signs that appear in the early stages of androgenetic alopecia (photo 4), as well as perifollicular fibrosis, characteristic of various forms of fibrous alopecia.
Characteristic trichoscopic signs of cicatricial alopecia are areas of milky red (mainly with lichen planus) or ivory (in the initial stage of frontal fibrous alopecia) in combination with the absence of hair follicle orifices, as well as perifollicular hyperkeratosis in the form of rays resembling a star (characteristic for folliculitis decalvans), or in the form of concentric scales around the mouths of the follicles (occurs with lichen planus).
Trichoscopy helps to identify anisotrichosis - the presence of hair of different diameters: terminal, interdeterminate and vellus (a specific sign of androgenetic alopecia), as well as the number of hairs in follicular units and their location relative to each other. Of clinical importance is an increase in the number of single follicular units and a decrease in the number of follicular units with 2, 3 or more hairs, as well as an increase in the distance between follicular units (photo 5).
Visually, this will be manifested by progressive thinning and a decrease in hair volume, which is typical for androgenetic alopecia. An increase in the number of follicular units with 4 or more hairs is characteristic of cicatricial alopecia, in particular, lichen planus and folliculitis decalvans.
Not so long ago, trichoscopes appeared that make it possible to conduct research using UV rays with a wavelength corresponding to the spectrum of a Wood's lamp. Their use is intended to facilitate the diagnosis of suspected superficial mycoses (dermatomycosis) of the scalp, folliculitis caused by fungi of the genus Pityrosporum, various types of porphyria.
Do not forget that, despite all the advantages, the described method has its limitations and does not give the specialist the right to make a diagnosis based only on the signs detected during trichoscopy.
In addition, the trichoscopic picture is far from always obvious and unambiguous. If scarring alopecia is suspected, as well as in difficult cases and if differential diagnosis is necessary, a biopsy comes to the aid of the trichologist, allowing you to look “inside” the hair follicle.
Biopsy refers to highly specialized diagnostic methods and requires appropriate qualifications not only from a trichologist who takes material for further research, but also from a pathologist/histologist who will evaluate scalp biopsy specimens.
Phototrichogram
Non-invasive methods include a standard phototrichogram and a phototrichogram with contrast (using specialized computer programs).
This method is generally recognized and widely used in clinical trichological practice due to its high accuracy and availability.
An important feature of the phototrichogram (FTG) method is the ability to use it to detect the subclinical form of androgenetic alopecia already at the early stages of the disease, to carry out differential diagnosis between AGA and diffuse telogen effluvium, and to evaluate the effectiveness of the treatment of alopecia in dynamics.
The phototrichogram method allows you to study the in vivo hair growth cycle and measure its various parameters, including density and diameter, the percentage of hair in the growth phase (anagen) and in the shedding phase (telogen), the average growth rate, as well as the number of terminal and vellus (thinned) hair. In addition, the program allows you to calculate such an important parameter, which is of great importance for the differential diagnosis of androgenetic alopecia, as the percentage of vellus in telogen, that is, those hairs that become thinner and prematurely enter the shedding phase under the influence of androgens.
ALGORITHM FOR THE EXAMINATION OF A TRICHOLOGICAL PATIENT
Stage 1
Initial consultation: after collecting an anamnesis and conducting a physical examination, an initial specialized examination is performed - trichoscopy.
The issue of the need to use additional methods of examination (laboratory, instrumental diagnostics) and the appointment of consultations of related specialists is being addressed.
Stage 2
A phototrichogram is carried out, the purpose of which is to establish or clarify the diagnosis, monitor the effectiveness of treatment.
The specialist uses the overview photo method:
- using a stereotaxic device, if necessary;
- using diagnostics using UV rays to record the patient's condition at the time of initial treatment and the possibility of monitoring the effectiveness of treatment in the future.
Making a preliminary diagnosis.
Stage 3
Repeated consultation based on the results of these clinical and laboratory studies.
Making a final diagnosis.
Development of a treatment and follow-up plan.
To conduct a phototrichogram, a specialist selects a site for subsequent measurements, usually located at a standard point in the fronto-parietal zone or in another zone of pronounced thinning of the hair. At the first stage of FTG, in the selected areas, the hair is shaved with a trimmer in areas of 10x10 mm in size. If further observation is required in the phototrichogram area, it is necessary to put a tattoo mark for repeated phototrichograms in the same area. During the second stage, after 2-3 days, among the shaved hair, it will be possible to detect regrown anagen and remaining telogen hair of the same length. The area is tinted with a special coloring composition, and then, using a trichoscope connected to a computer, the images made at 40-60-fold magnification are entered into a specialized computer program.
It is diagnostically important that the majority of hairs in the telogen phase are vellus-like (the “vellus among telogen hair” parameter), that is, sensitive to androgens, which makes the diagnosis of androgen-dependent alopecia obvious. In addition, this phototrichogram clearly shows an increase in the number of single follicular units, the presence of peripilar signs, yellow dots, areas of focal atrichia, which also indicates the presence of androgenetic alopecia.
It should be noted that the phototrichogram method is highly accurate and reproducible only if the procedure is carried out by a qualified specialist with appropriate practical skills and sufficient practical experience while observing the protocol of the diagnostic technique, since the calculation of data in the program occurs in a semi-automatic mode and requires the specialist to have the appropriate qualifications. .
So far, attempts to exclude the human factor from the phototrichogram procedure, replacing it with an automatic calculation of the studied parameters, have not been successful. Thus, the automated program for carrying out phototrichograms presented on the Western market, despite the convenient automatic counting mode, causes numerous complaints from specialists due to insufficient calculation accuracy. Since in automated mode two or three thin hairs located close to each other can be recognized by the program as one thick hair, then when using such a fully automated counting method, its accuracy cannot be guaranteed.
Survey photography method
This method has long been used both in dermatology and trichology to study the condition of the skin and hair, as well as to evaluate the effectiveness of the treatment. This method has become widespread after its use in clinical studies to evaluate the effectiveness of finasteride.
In clinical studies, not only photographs of problem areas are carried out using stereotaxic devices, but further photographs obtained during observation (before and after treatment) are evaluated with the involvement of a panel of independent experts.
A stereotaxic device (SU) for photography is a device that combines a device that fixes the patient's head in one position, a camera with a specially configured flash system and a special panel or ruler that measures and fixes the distance between the device and the patient. The main task of a stereotaxic device is to create reproducible shooting conditions for the area under study. SU allows you to reproduce the specified parameters during subsequent sessions and evaluate the results of treatment in dynamics, subject to standardized conditions. It is recommended to evaluate the results after 3-4, 6 and 12 months from the start of treatment.
When using a stereotaxic device in clinical practice, a specialist will be guaranteed to receive high-quality images and avoid errors in assessing the patient's condition due to incorrectly selected shooting parameters and related problems (insufficient sharpness, “flare”, excessive glare, incorrectly set ISO parameters, etc.). d.).
In addition to the method of standard overview photographs, it is also interesting to photograph the lesion site on the skin of the scalp and smooth skin using luminescent diagnostics using rays of the narrow long-wavelength spectrum of the ultraviolet range. The method is effective not only for the diagnosis of dermatomycosis, but is also of interest for the detection and visualization of porphyria, seborrhea, folliculitis and other diseases.
CONCLUSION
It is important to understand that when making a diagnosis, a combination of methods should be used, combining the available specialized diagnostic techniques with anamnesis data and the clinical picture. Taking into account the results obtained on the basis of the use of only one of the methods - for example, when interpreting only trichoscopic data without conducting a phototrichogram in the differential diagnosis of androgenetic alopecia and diffuse telogen hair loss - a specialist may make a serious mistake in making a diagnosis and will not be able to timely prescribe an adequate treatment. The presence in the doctor's arsenal of such basic specialized methods as trichoscopy, phototrichogram and survey photographs, combined with practical experience, is the key to correct diagnosis and treatment effectiveness.
- BIOREVITALIZATION
- MESOTHERAPY OF THE FACE
- HIRSUTISM - solution method - LASER EPILATION
Good day! Today I will talk about the diagnostic procedure for hair. One of the very, very few that actually help with the problem of hair loss, and not just pulling money out of pocket without any benefit to their owner.
Lyrical digression or a little thought out loud...
I am endlessly amazed by the backwardness of most people regarding hair. Moreover, this purely selective one remains, because very few can complain about the lack of logic.
If you, God forbid, take a kidney, will you run to the store for an obscure over-the-counter liquid to immediately begin the "treatment"? Or will you stubbornly, week after week, rub a miraculous mixture of onion broth and mustard into your side just because you have come across a similar “recipe” somewhere on the Internet?
No, you will probably still go to the doctor, do an ultrasound, and first find out if something needs to be treated at all. And if necessary, then what.
And what about hair?
Logic suddenly disappears.
Faced with hair loss, we will be perplexed for years, what is it that hair has grown again: autumn again planted a trick on us or what vitamins the body asks for. Rubbing eggs, then onions or other soup sets into the scalp, it is not known how to buy working (and more often not working at all) funds, and to make conspiracies to the moon.
Instead of finding out what the actual problem is.
Perhaps this situation has developed due to the fact that the procedures that help diagnose the type of hair problem are somehow not well known.
And it’s always so convenient to speculate on ignorance, so shampoos from falling out, miracle serums “to increase density” and other unrealities breed endlessly and without edge.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
What is a phototrichogram (FTG)?
This is a diagnostic method that provides an answer to the question about the type of hair loss that you are facing - reactive* or chronic = androgenetic alopecia (AGA).
* associated with the action of some reactive factor, for example, a skew in the hormonal part (hormonal / hormone-dependent / androgenic / postpartum loss, loss due to uncompensated problems with the thyroid gland, the effects of stress (post-stress loss, loss against the background of taking serious medications, the consequences of surgery), etc.
The main difference between these two types of dropout is if in case of reactive prolapse, the cause needs to be treated, that is, to eliminate the factor that causes hair loss (and not to buy lappings that are useless in this case), after which the loss ends by itself, then in the second case the cause (factor) is irremovable, and therefore The hair needs to be treated.
That is why the FTG is carried out - in order to direct our forces and energy in the right direction in time. Instead of rushing about, wasting precious time, grabbing one thing, then another.
I did FTG twice.
For the first time - in 2009, when I received my disappointing diagnosis - "AHA", and recently - just out of interest: what is left on my head after 8 years on minoxidil, while he, judging by the horror stories on the net, " it only works for 2 years, and then it depletes the follicles and they die."
Visually, I did not see any deterioration, but it is always interesting to know for sure. And then you never know, maybe all the hair under minoxidil still died, but I don’t notice?
How FTG is carried out
This procedure is carried out in clinics (trichological centers). The price strongly depends on the location of the clinic, and on the greed of the center - how actively additional services will be sold to you (other tests, consultations before and after FTG, etc.).
Do not confuse FTG with other types of diagnostics also offered by clinics (and non-clinics): FTG is always performed in 2 stages (on 2 different days) and it is not enough to simply shine a flashlight into the scalp.
At the first stage of FTG, the hair on the patient's head is shaved in 2 places, and a micro-tattoo is placed on the skin. The area of the shaved area with a well-made FTG is at least 0.5 sq. cm, and better - more (1 cm). Analysis of data on microscopic areas (like 16 sq. mm.) is not representative.
Micro-splashes, of course, do not look very attractive, but after a few days they are difficult to notice. Standard location:
the first point - at a distance of 2 cm from the frontal line and 2 cm from the midline of the head, as the second point, the area located 2 cm to the right / left of the occipital protuberance is used.
At the first stage, a syringe and a coloring mixture are used (photo on the left), at the second - only a camera (photo on the right).
The second stage is usually scheduled after 2 days - macro-images are taken from the shaved areas, which are entered into a special program. The results can be seen in the printout received on hand, and in order to decipher them, it is not necessary to be a trichologist.
The Trichoscience program is intended for professional use in trichology and dermatocosmetology, as well as for research work in the field of trichology.
To work with the program, any optical equipment can be used that allows you to get an enlarged image of the investigated area of the scalp. Individual training in working with the Trichoscience program is carried out upon purchase of the program, as well as as part of study groups at specialized trichology courses at the Peoples' Friendship University of Russia, Moscow.
Trichoscience (version 1.4) has the following features:
Maintaining a database of patients and outpatient records.
There is a standard outpatient card, compiled specifically for the work of a trichologist, with all the data necessary for collecting an anamnesis.
All databases can be saved, edited or deleted. It is possible to transfer the database when reinstalling the program on another computer.
Calculation of hair density per square centimeter in androgen-dependent and androgen-independent areas of the scalp. Calculation of the percentage of terminal and vellus hairs.
Counting of peripilar marks in several fields of view - “yellow dots”, “white dots”, “follicles with hyperpigmentation”, “black dots”, hair in the form of an “exclamation mark”. The measurement data is reflected in the graphs.
If necessary, counting can be carried out in several fields of view, which significantly increases the accuracy of the results.
It is possible to memorize the coordinates of those areas of the scalp on which the study was carried out.
Evaluation of the number of hairs per square cm, comparison with the norms for this type of hair. Comparison of hair diameters in androgen-dependent and androgen-independent zones. Calculate the percentage of terminal and vellus hair. Evaluation of perifolicular signs in the visual fields (yellow dots, white dots, black dots, spiky hairs...)
Measurement of hair diameter in androgen-dependent and androgen-independent zones, determination of the percentage of thin, thick and medium-sized hair, calculation of the percentage of vellus hair. The diameter is measured in microns, and the standard deviation is also calculated. The calculation is carried out in different areas of the head, the data obtained in the form of graphs are compared with the norm for each type of hair (blonds, brunettes, redheads, brown-haired). Calculation of the ratio of measured parameters in androgen-dependent and androgen-independent zones.
Assessment of hair diameters in androgen-dependent and androgen-independent zones. Calculation of the average hair diameter, the average terminal hair diameter, the percentage of thin, medium and thick hair, the ratio of indicators for different areas. Calculation of the percentage of vellus hair.
Carrying out a phototrichogram in a semi-automatic mode answers the question about the number of hair falling out per day. Comparison of the intensity of hair loss in the parietal (androgen-dependent) and occipital (androgen-independent) areas of the scalp allows a differential diagnosis between diffuse telogen and androgen-dependent types of hair loss. Hair growth stages (anagen or telogen, young) are automatically assessed. It is possible to calculate the percentage of vellus and terminal hairs among anagen and telogen hairs, which is important for differential diagnosis between different types of alopecia and evaluation of treatment results over time.
Phototrichogram in semi-automatic mode, calculation of the percentage of growing (anagen) and falling out (telogen) hair in androgen-dependent and androgen-independent areas of the head.
The “evaluation of hair distribution in follicular units” function allows you to calculate the number of single, double, triple units.
Evaluation of the condition of the skin of the scalp and comparison of the obtained image with those available in the database. The database can be replenished and formed at the expense of one's own observations.
Ability to create your own database (according to the condition of the scalp, hair shafts, hair roots)
Assessment of the condition of the roots and hair shafts. Comparison of the received image with those available in the database. The database can be replenished and formed at the expense of one's own observations.
Evaluation of overview photographs of the scalp (problem areas) of the patient in dynamics during treatment
Automatic mental status assessment function in the section “Hospital Anxiety and Depression Scale”
There is an "Auto Diagnosis" function. A comparative table allows you to assess the likelihood of a particular diagnosis.
The “Trichometry” functions for fallen and growing hair allow for a retrospective count of hair that has fallen out within 5, 4, 3, 2 months before treatment, as well as to assess the activity of hair loss and thinning at the time of treatment.
According to the diagnostic results, additional laboratory and instrumental diagnostic tools are selected, recommendations for treatment from the database are carried out. All databases can be formed independently. Printing the results of diagnosis and treatment. The doctor, at his own discretion, determines the amount of information printed and given to the client with the results of the diagnostics.
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Liliya Ivanova, trichologist certified by The International Association of Trichologists, dermatologist, doctor of the highest category at the Golden Standard Medical Center, Ph.D., Lipetsk
In the West, trichology as a separate direction was formed back in the 50s of the twentieth century and is currently represented by national associations and societies involved in the training of specialists in the diagnosis and treatment of hair. The market of trichological services in Russia is now going through certain stages of recovery, it can be called spontaneous. There are no uniform methodological materials for the diagnosis, treatment and management of patients who seek help from a trichologist. There are few scientific articles highlighting the need for microdiagnostics to assess the condition of the hair. But timely professional diagnostics gives the trichologist the opportunity to make the correct clinical diagnosis and draw up an effective treatment program.
Clinical example No. 1. The patient is 37 years old, occupation - administrative work. She complained of intense hair loss, thinning of the central parting and a decrease in hair volume more in the fronto-parietal region with a duration of the pathological process of less than six months. She treated herself with folk remedies, took vitamins, underwent a course of mesotherapy with a cosmetologist, but without effect, after which she was recommended to consult a trichologist to clarify the diagnosis.
- single follicular units 16.7%, double - 75.0%, triple - 8.3%;
– average diameter of all hairs 52 +/-3.2 microns;
– average diameter of all terminal hairs (>40 µm) 62 +/-3.7 µm;
– vellus hair (<40 мкм) 45%;
– among terminal hairs: fine hair (40–60 µm) 42%, medium hair (60–80 µm) 50%, thick hair (>80 µm) 8%;
– anisotrichosis 52 +/-14.5 microns.
From the conclusion of the FTG of the fronto-parietal area:
– anagen only 32%;
– telogen only 68%;
– terminal among anagen 100%;
– terminal among telogen 100%;
– average diameter of all hairs 58 +/-2.1 microns;
– average diameter of all terminal hairs (>40 µm) 59 +/-2.0 µm;
– vellus hair (<40 мкм) 2%;
– among terminal hairs: fine hair (40–60 µm) 50%, medium hair (60–80 µm) 39%, thick hair (>80 µm) 11%;
– anisotrichosis 58 +/-16.1 microns.
At the initial appointment, two preliminary diagnoses were questionable: DTA or AGA. Anisotrichosis, difference in diameter between anagen and telogen, 45% of vellus hairs were in favor of androgenetic alopecia; the following signs testified to telogen loss: hair density in the occipital region is greater than in the parietal region, 75% of double follicular units and a small number of triple ones. Anisotrichosis can occur due to spiky hair.
A differential diagnosis was necessary, and the phototrichogram made it possible to make a final clinical diagnosis in favor of diffuse telogen hair loss. As a result, a number of laboratory tests were ordered, as a result of which latent anemia and a significant deficiency of vitamin D3 were revealed. After corrective therapy, hair loss stopped after four months.
Clinical example No. 2. Patient, 31 years old, occupation - hairdresser. She complained of hair loss in bunches (especially when washing), which began two months after childbirth. There was even a fear of washing the hair. She began to wash them once a week, refused to dye, stopped blow-drying. Didn't do any treatment. I turned to a trichologist on the recommendation of a gynecologist.
From the conclusion on trichoscopic signs:
- single follicular units 52.9%, double - 41.2%, triple - 5.9%;
– average diameter of all hairs 46 +/-7.7 microns;
– average diameter of all terminal hairs (>35 µm) 58 +/-5.6 µm;
– vellus hair (<35 мкм) 30%;
– among terminal hairs: fine hair (35–60 µm) 57%, medium hair (60–80 µm) 29%, thick hair (>80 µm) 14%;
– anisotrichosis 46 +/-21.8 microns.
From the conclusion of the FTG:
– anagen only 57%;
– telogen only 43%;
– terminal among anagen 92%;
– terminal among telogen 58%;
– vellus among anagen 8%;
– vellus among telogen 42%;
– average diameter of all hairs 57 +/-3.2 microns;
– average diameter of all terminal hairs (>40 µm) 66 +/-2.8 µm;
– vellus hair (<40 мкм) 20%;
– among terminal hairs: fine hair (40–60 µm) 40%, medium hair (60–80 µm) 33%, thick hair (>80 µm) 28%;
– anisotrichosis 57 +/-23.4 microns.
At the initial appointment, a preliminary diagnosis was made: diffuse telogen hair loss against the background of the early postpartum period (trichoscopic signs were in favor of DTA). However, anisotrichosis and 30% of vellus hair were embarrassing. As a result of the FTG, androgenetic alopecia was diagnosed at an early stage.
The patient was explained the principles of therapeutic and preventive care, including the frequency of shampooing in order to avoid hair accumulation syndrome. Thus, to make a phototrichogram in a timely manner means to save the hair and keep it healthy, since the problems identified at the initial stage can be eliminated in a short time by applying the right treatment.
Clinical example No. 3. A 39-year-old patient, occupation - a laboratory assistant in a clinical laboratory. For two years, he has been under dynamic observation with ongoing maintenance therapy (once every six months). The diagnosis is androgenetic alopecia of the 1st stage.
In this example, we can track the positive dynamics of the treatment.
And the use of a computer program allows you to track the ongoing changes and the progress of the treatment. Since hair treatment is usually a very long process, the first results can be seen only 6-12 months after the necessary therapy. And the ability to record the results of treatment is a very important task.
The specialist should always remember that the human body, controlled by the nervous and endocrine systems, is largely controlled by emotions. And just microdiagnostics will help the trichologist to build an evidence base for establishing a more trusting and effective relationship with each patient.
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What is trichoscopy
Trichoscopy (computer diagnostics of hair) is an indispensable method for diagnosing and properly treating hair and scalp using a special device called a trichoscope. The device is equipped with a video camera with magnifying optics, which allows you to examine the problem area of the scalp under high magnification. The data obtained are processed by a special computer program that allows you to most accurately assess the condition of the hair and scalp.
Trichoscopy allows:
- Set hair type
- Get an opinion on the condition of the scalp
- Examine the condition of the hair throughout its length
- Set scalp type
- Find out the size of the hair follicle
- Determine the degree of hair loss
- Diagnose diseases of the scalp
- Examine the condition of the entire hair growth system
- Explore the seboregulatory process
Equipment
Doctors trichologists of our scientific center for diagnosing hair and skin of the scalp use modern, professional, diagnostic equipment - Aramo SG video camera (ARAM HUVIS Co, Ltd - Korea) with special computer diagnostic programs.
Video camera Aramo SG (ARAM HUVIS Co, Ltd - Korea).
Special computer diagnostic programs:
- XairXPPRO program. The program allows you to determine the condition of the scalp, hair density, diameter of the hair shaft, assess the condition of the hair shaft.
- Trichoscience program. The program allows you to determine the density of hair per square centimeter in androgen-dependent and androgen-independent areas of the scalp; percentage of thick pigmented hair and vellus hair; measure the diameter of the hair in different areas; determine the percentage of thin, thick and medium-sized hair; perform a phototrichogram, etc.
Indications for trichoscopy
Today, trichoscopy, which is the most informative and fastest diagnostic method in trichology, is recommended for all diseases of the hair and scalp:
- all types of alopecia (androgenetic, focal, diffuse, cicatricial)
- all types of seborrhea (dry and oily)
- all kinds of aesthetic problems with hair: dry, split ends, damaged, etc.
- any pathological conditions of the hair and scalp after aggressive exposure
There are no contraindications for trichoscopy.
Preparation for trichoscopy
Trichoscopy technique
Trichoscopy technique: with a special trichoscope sensor, the trichologist examines the scalp step by step (both problem areas and healthy areas for comparison). During the examination and data recording to the computer, the doctor can comment on the results of the diagnostic examination to the patient, as well as change the magnification of the device to increase the effectiveness of the examination.
Control trichoscopy before, during and after treatment allows you to most accurately determine the condition of the hair and skin of the scalp, fix and objectively evaluate the results of therapy.
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On-line consultation of a trichologist - Page #2
On-line consultation of a trichologist
Good afternoon! Please tell me, hair has been shedding for 3 years, 400-500 pieces each, half a year ago I started drinking eutiroks, tk. TSH was 5.8, on eutirox it dropped to the norm of 1.1. But the hair flew like 400 pieces and fly for 3 years. I thought it was in the thyroid gland, but why then, when the TSH is normalized, the hair does not stop falling out in huge quantities? all trace elements and vitamins are normal, checked 4-5 times in different laboratories. What else to check? Why does hair fall out when TSH normalizes? 3 years of torment, a bunch of doctors, trichologists, endocrinologists, but no one can help me stop this. In your clinic, I did FTG, according to which I have diffuse prolapse. She was examined by Illarionova E.V. But no vitamins, expensive sprays, DSD ampoules, etc., reduced the loss by a single gram. What should I do??? really need help! Read answer
Hello. I am 24 years old. Hair began to fall out quite a long time ago, at the age of 16. They put diffuse alopecia, they climb evenly all over the head. At times it gets better and the fallout stops. But from time to time everything is renewed and even more active. Every time it gets worse. New hairs grow pretty fast, but very thin and soft like guns. The skin is not oily, you can even say dry. There is dandruff, no itching. She treated in various ways, took ferretab, as prescribed by a tpochologist, because. ferritin was low (8) iron was normal. I drank half a year. Then the hematologist canceled it, explaining that iron accumulates in tissues and organs and then you can’t get it out. At one time, I used generolon as prescribed by a trichologist, although I read that it is used for androgenism. Has handed over all analyzes which it was possible to hand over. But the reason was never found out Read the answer
Good evening. I have problems with my stomach, gastritis and pancreatitis, for 4 years I have been falling out profusely without stopping. Hair, almost everything has fallen out. New ones don't grow. Is it possible to restore my hair and the bulbs have already all died? (((Read the answer
Good afternoon! Please tell me exactly what parameters you calculate during the FTG procedure? I'm interested in the whole spectrum: % anagen, % telogen, % terminal hair, vellus among anagen, vellus among telogen, average hair diameter, density per square cm, number of follicular units, anisotrichosis. Is it possible to do such FTG in your clinic? Read answer
Good afternoon！I have a problem with hair loss. It started in winter. I thought it would pass in the summer, because the sun, vegetables, fruits, but no .. it continues to fall out ... There was stress in the spring, I took a cook, but now I don’t drink anything for 2 months. Handed over analyzes, what are written on your site. Everything is okay. What to do, tell me please？ Thanks in advance！ Read reply
Hello, a tuft of short hair appeared on my head right on the top of my head, you can clearly see it in a decent size, it’s not broken hair, no one cut it off for me, I just noticed it one day, and now when it has grown it’s impossible to disguise it, before that I had this about 4 years ago, but lower in the back of the head, then grew back to this length, cut off all my hair, I thought it would not appear again, but no. It can be seen that this is new hair, why is this happening? Maybe this is some kind of violation, none of my friends have hair growing like that (in one place). Thanks in advance for your reply.
Hello, I was prescribed Revivogen 3 times a week and Regain. Will there be an effect if I apply Revivogen only for 3 months? Read answer
Hello, I am 16 years old, my hair began to fall out a lot, I suppose that after dyeing, but this has not happened before. I don't know what to do Read the answer
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Causes of diffuse hair loss at a young age
Gadzhigoroeva A.G., Egorova Yu.Yu., Markova Yu.A.
LLC "Institute of Beautiful Hair"
In the wild, full-fledged plumage, shiny coat of birds and animals perform a number of survival-important functions (heat exchange, protection) and make it possible to indirectly judge the health of individuals. For people, beautiful well-groomed hair, first of all, is an important component of external attractiveness. And if seasonal molting for animals is an evolutionary physiological process aimed at the survival of the species, then increased hair loss for humans is an unpleasant situation that every person faces at least once in a lifetime. Most of the patients consulted by trichologists are women and men of young reproductive age. Hair loss can be a manifestation of a wide range of transient or long-term conditions, as well as the implementation of a genetic predisposition. Often problems begin gradually and do not immediately make you turn to a specialist. The patient, as a rule, associates a periodic increase in hair loss with seasonality, stress, poor-quality haircuts, coloring, shampoo, lack of vitamins. The most common type of hair loss is reactive hair loss; as a rule, hair growth recovers on its own after 4-6 months, so this type of hair loss is not often treated by a doctor. Basically, patients turn to a specialist who are concerned about the intensity of hair loss, the duration of hair loss, the ineffectiveness of independently taken measures aimed at stopping hair loss, as well as with a noticeable decrease in hair density.
Normally, the duration of the hair growth phase on the head is 3-8 years. This is the time of active division and differentiation of hair follicle matrix cells, which ensures rapid hair growth in length, keratinization and hair pigmentation. These processes are carried out due to the high rates of metabolic reactions and energy exchange, which makes actively dividing matrix cells especially sensitive to various external influences, homeostasis disturbances. The follicle receives the nutrients necessary for the processes of synthesis through the network of capillaries of the papilla of the hair, reproducing the main product - the sulfur-containing protein keratin. At the same time, failures in the supply of “raw materials” and violations of technological conditions and keratinization processes can lead to a violation of the quality of the final product and interruptions in the operation of the entire factory for the production of keratin. The mechanisms that can disrupt the normal hair growth cycle are not always clear, as they are realized in the process of a complex of intercellular and intracellular biochemical interactions. Also, the difficulty lies in assessing the impact on the hair follicle of certain factors in the conditions of the whole organism.
The most common variant of hair loss in young people is reactive diffuse hair loss, which can be acute and chronic, with a duration of more than 6 months, in nature. As a rule, such prolapse is a response to a wide range of adverse trigger factors, including stress, endocrine disorders (hypo- and hyperthyroidism, hyperprolactinemia), fever of various origins, taking certain medications, and alimentary insufficiency. The consequence of this exposure is the premature interruption of anagen and the simultaneous entry into the telogen phase of many hair follicles. In this case, diffuse telogen hair loss is not an independent diagnosis, but is one of the symptoms of a pathological condition. Reactive hair loss occurs 2-3 months after exposure to a factor that provokes the interruption of the growth phase. Delayed prolapse is determined by the sum of catagen and rest periods, averaging 2-4 weeks and 2-3 months, respectively.
One of the proven and common causes of reactive hair loss is nutritional and general protein-energy malnutrition. Most often, these are the consequences of an unbalanced diet that the patient maintains in order to lose weight. For normal hair growth, nutrition should be energetically complete, balanced in terms of macronutrients (proteins, fats, carbohydrates), and also provide the necessary micronutrients (vitamins, microelements). Various diseases of the gastrointestinal tract, leading to impaired digestion and absorption of nutrients, can also be the cause of the development of deficient conditions.
One of the important components of the diet that contribute to normal hair growth is a sufficient protein content. It is known that hair shafts are 15.9% composed of the sulfur-containing amino acid cysteine. The formation of disulfide bonds plays an important role in the formation of the spatial structure of keratin, the main protein of the hair. Inadequate dietary intake of amino acids, especially sulfur-containing ones (cysteine, methionine), can lead to hair loss, as well as a deterioration in their quality.
One of the common causes of diffuse telogen hair loss in women of young reproductive age is iron deficiency. This trace element is involved in many important metabolic processes in the body, and therefore, iron deficiency negatively affects the function of many organs and systems. In addition to hair loss and deterioration in hair quality, patients may develop and worry about general weakness, lethargy, shortness of breath, tachycardia, dry skin, changes in taste, smell, nail dystrophy and other disorders. The development of iron deficiency in women may be associated with heavy menstruation, as well as an increased need for iron during special periods of pregnancy and lactation. Insufficient iron intake is observed, as a rule, with diets for weight loss, as well as with eating behaviors with restriction of animal protein (in vegetarians). In such cases, in order to compensate for the intake of a trace element, the intake of iron-containing supplements is indicated, sometimes on an ongoing basis. When prescribing iron preparations, the initial level of hemoglobin, ferritin and serum iron should be taken into account, as well as periodically monitoring these indicators. It is worth remembering that with long-term use of iron preparations, the development of zinc deficiency, which is no less important for normal hair growth, is possible. Parenteral nutrition and various diseases of the gastrointestinal tract that contribute to malabsorption also lead to zinc deficiency. To establish zinc deficiency, its level in the blood is determined.
Vitamins are important participants in the processes of cell growth and differentiation. Deficiency of B vitamins (biotin, pantothenic acid) can cause hypoenergetic conditions and contribute to disruption of the hair growth cycle, since vitamins of this group are important participants in metabolic reactions and the respiratory chain as coenzymes. The role of vitamin A - retinol - in the regulation of the hair growth cycle is twofold. It is known that this vitamin is necessary for normal proliferation and differentiation of keratinocytes, participates in antioxidant protection and immune response. However, the use of high doses of retinoids in the treatment of acne inhibits the proliferation of keratinocytes, induces apoptosis of hair follicle matrix cells and causes a premature onset of catagen, which is manifested by diffuse telogen hair loss at 2-3 months of taking this group of drugs. Due to the widespread use of isotretinoin preparations in the treatment of acne and the need for its long course administration, this fact should be taken into account when collecting anamnesis in young people.
Recent studies have shown the important role of vitamin D for the cyclic proliferation of hair follicle cells and the prevention of hair loss. Vitamin D deficiency is a common phenomenon in the general population, especially when living in a zone of low insolation and insufficient intake of the vitamin from food. Suboptimal levels of vitamin D in the body are 30-50 ng/ml, optimal - 50-80 ng/ml. In order to exclude its deficiency, the level of 25-hydroxy-cholecalciferol in the blood serum is determined. The presence of vitamin D receptors on the cells of the hair follicle determines the possibility of developing alopecia with its deficiency. In order to correct its insufficiency, Vigantol or Aquadetrim are prescribed in the appropriate dosage.
True diffuse telogen hair loss is a process of hair loss without a noticeable decrease in density in different areas of the head. In this case, thinning of hair in the temporal zones is possible with the replacement of normal hair with short ones, 3-6 cm long. Usually, such a transformation is observed with long-term telogen hair loss. With dermatoscopy, it is not possible to determine any specific signs. The exception is the presence of seborrhea of the scalp, the signs of which are detected in the form of yellow peripilar points. The diagnosis is based on a pull test (manual hair removal). With a positive test, the researcher has up to 6 or more hairs with light, dense proximal tips in their hands - this is a telogen hair bulb. To confirm the diagnosis, a phototrichogram is performed - a quantitative determination of hair in the telogen and anagen phases with a study of the hair diameter.
Diffuse telogen hair loss can manifest itself as an independent disease, or it can be the initial signs of androgenetic alopecia, which is characterized by a more specific pattern of hair loss with a predominant reduction in the crown area and, necessarily, their thinning. Comparative characteristics of the physical parameters of the hair in the area of the occiput and crown, obtained as a result of phototrichogram, will make it possible to establish the diagnosis of androgenetic alopecia in the early stages of its development. Dermatoscopic signs of female-type hair loss (syn. androgenetic alopecia) are signs of hair thinning in the crown and crown, yellow peripilar points (not always), as well as empty follicle orifices. The detection of such signs allows timely prescribing of etiopathogenetic treatment aimed at maintaining active hair growth and preventing miniaturization of follicles.
In the case of reactive telogen hair loss, treatment should be aimed at eliminating the cause that provoked hair loss, as well as improving the nutrition of the hair follicle. It is important to eliminate the factors that provoke stressful situations, and also, with increased nervous excitability, prescribe sedatives. It is recommended to take multivitamins, amino acids, trace elements and vascular preparations.
An effective method of treatment applicable in an outpatient setting is mesotherapy. Indications for mesotherapy are both acute and chronic telogen hair loss. The method is based on the point delivery of substances necessary for hair growth to the skin of the scalp to a depth of 3-4 mm, to the places where the hair follicles occur. Activation mechanism: reflexotherapeutic (tonization of biologically active points of the scalp), pharmacopuncture, neurohumoral. When the skin is damaged by a needle, active mediators of inflammation (histamine, catecholamines, lysosomal enzymes, etc.) are released, macrophage and fibroblastic stages of the inflammatory process lead to the proliferation of epidermal cells of the cambial zone and the closure of the tissue defect. At the site of the defect, a young connective tissue is formed, which is then rebuilt with the help of fibroblasts in accordance with the characteristics of the dermis of this tissue area. The aseptic inflammatory process lasts from 3-6 days, so the procedure should not be done more than once a week. The course of treatment is 6-10 procedures once a week. Mesotherapy improves microcirculation, trophism and lymphatic drainage of the scalp skin, improves hair structure, accelerates their growth, increases hair density, heals scalp skin and normalizes sebum secretion. The composition of the meso-cocktail should include substances that improve microcirculation (Lofton, Procaine, Buflomedil), trophism (D-panthenol, pyridoxine, biotin, B vitamins, amino acids). Lympholitics and preparations with antioxidant action (rutin-meliloto and gingo-biloba, vit E), oligoelements (zinc, selenium, silicon). In the presence of androgenetic alopecia - substances that block the action of 5a-reductase (finasteride), as well as hair growth stimulants (ATP, minoxidil).
The prognosis of treatment for telogen hair loss depends on the cause that caused the hair loss and the possible association with androgenetic alopecia. Timely initiated therapy gives satisfactory results and allows you to control the progress of androgenetic alopecia in the case of combined forms of hair loss.
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What is a phototrichogram
Phototrichogram is one of the most modern high-precision, affordable and most generally recognized diagnostic methods for hair loss in clinical trichological practice. With the help of this method, the initial forms of androgenetic alopecia are detected already at an early stage, differential diagnosis is carried out between androgen-dependent and diffuse hair loss, and the effectiveness of the treatment of alopecia in dynamics is evaluated.
Phototrichogram allows:
- Count the number of hairs per square centimeter of scalp skin. (Separately considered anagen hair (in the growth stage) and telogen (in the shedding stage), dysplastic (too thin) and rod hair).
- Determine the average hair growth rate.
- Determine the percentage of vellus (vellus hair) among anagen (in the dew stage) and telogen (in the shedding stage) hair.
- Determine the activity of the hair loss process.
- Determine the hair diameter in microns.
- Diagnose androgenetic alopecia and/or diffuse hair loss early.
- Track the effectiveness of treatment in dynamics.
There are no contraindications for phototrichogram
Preparing for a phototrichogram
Phototrichogram technique
To conduct a phototrichogram, it is necessary to correctly select the area in which subsequent measurements will be taken. In selected areas, in the area of 5-10 mm. trimmer (hair removal device) shaves off hair. The areas of cut hair are invisible to others, so the procedure does not cause psychological discomfort. After 2-3 days, when among the shaved hair it will be possible to find regrown by approximately 1 mm. hair, areas are tinted with hair dye, and with the help of a trichoscope connected to a computer, with an increase, they are entered into a specialized computer program (Trichoscience). The program calculates the total number of hairs per square cm, the percentage of vellus-like (vellus hair), anagen (in the growth phase) and telogen (in the shedding phase) hair. The counting is carried out in different places of the scalp and is displayed in the form of graphs. This information is compared with the norm for each hair type.
(on the left - a photograph of the area under study, on the right - the same area after processing by a computer program).
Control phototrichogram is carried out
- after 2-3 days, when among the shaved hair it will be possible to detect and evaluate regrown hair.
- after the treatment to evaluate the results of the treatment
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