How good are dermatologists and dermatology trainees? — Donovan Hair Clinic

A new study set out to assess the knowledge that dermatologists and dermatology trainees have regarding dermoscopic features of hair disorders as well as nail disorders. Dermoscopy of hair loss disorders is commonly called trichoscopy and dermoscopy of nail disorders is often referred to as onychoscopy.

50 board-certified dermatologists from the US, 50 from Europe and 50 residents from the US and 50 residents from Europe were invited to complete an online survey in June, 2021. Participants viewed seven hair and six nail disorders and were asked to give their diagnosis for each image review. Dermoscopic images that were chosen by study organizers were somewhat specific – meaning that there was less chance of ambiguity about a chosen image.

In total, 50 residents and 46 dermatologists completed the survey. The most familiar hair disorder with the dermoscopic signs was dissecting cellulitis (50; 52%). Among dermatologists, mean familiarity for hair disorders (63%) was lower than that of nail disorders (86%) (P < 0.001). For residents, mean familiarity for hair disorders was 63% was lower than for nail disorders was 76% (P = 0.004).

Dermatologists and Trainees Show Similar Competency

Data revealed that there were no significant differences between dermatologists and residents for hair (62.7% vs. 62.9%; P = 0.98) or nail disorders (86.2% vs. 76.0%; P = 0.066).

US and European Physicians Show Similar Competency

Knowledge was similar when comparing US and European physicians. For example, US and European physicians had similar knowledge for both hair (61.7% vs. 63.8%; P = 0.684) and nail disorders (79.1% vs. 82.6%; P = 0.523). There were no significant differences between US and Italian residents for hair (P = 0.476) or nail disorders (P = 0.498) or between U.S.- and Italian dermatologists for hair (P = 0.116) or nail disorders (P = 0.121).

Overall, about 1 in 5 surveyed respondents stated that they were either “unsure” or “unlikely” to use trichoscopy in their practice.


The authors concluded that dermatologists and trainees have similar knowledge about hair trichoscopy although there are important gaps in knowledge that can be improved.

The details of these participants were not shared in the study. So we don’t know if all the trainees were senior trainees or junior trainees. We don’t know if the dermatologists were experienced or novice. These can sway the results. We don’t even know if the participants own a trichoscope and how many years they have been using it.

It would be helpful to know the amount of instruction residents have received in their training and how much instruction dermatologists have received. If dermatology residents have received thousands upon thousands of hours of training and still turn up the results shared in the study, it simply means trichoscopy is far too difficult to implement into practice. No more teaching or training is going to help in this case. Of course, I suspect this is not the case. However, this type of information needs to be identified and it was not.

Similarly, we don’t really know that US residents and European residents have received similar level of instruction. It would be nice to study how much trichoscopy education dermatology residents actually get, how many books on trichoscopy they actually own and whether or not the physicians that mentor them in their training programs use trichoscopy on a daily basis.

All in all, a helpful study nevertheless that identifies some important gaps. With 1 of 5 physicians not really being all that sure about whether or not they are going to use trichoscopy in their practices, that is potentially a significant number of hair patients and nail patients that may receive inferior evaluation


Kolla et al. Dermatologists’ knowledge of dermoscopic features in hair and nail disorders. J Eur Acad Dermatol Venereol . 2022 Feb 11.

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