title: Validation and clinical relevance of a novel scalp coverage scoring method.
abstract: OBJECTIVE
  Distinctive patterns of defective scalp skin coverage or alopecia have been identified by clinicians but do not help measuring the dynamics of hair changes over time. Hence, we conceived the scalp coverage scoring (SCS) method that integrates cumulative changes of hair growth or loss. In this paper, we report the results of validation studies demonstrating that the SCS can be applied in real time in the clinic or on global photographs for evaluating the severity of androgenetic alopecia (AGA) of male subjects and for monitoring changes over time.
  
  
  METHODS
  Different panels totalling 38 different male subjects with AGA were classified according to a modified Norwood-Hamilton scale and were evaluated with the SCS system (real time or global photographs). The contrast-enhanced phototrichogram method (CE-PTG), a refined non-invasive and validated analytical technique was used for calibration purposes.
  
  
  RESULTS
  The real time SCS was correlated with SCS on global photographs. The inter- and intra-observer variation of SCS obtained on global photographs was less than 3%. The real time SCS was negatively correlated with the clinical staging of male pattern baldness according to the modified Norwood-Hamilton scale, confirming less scalp coverage in more severly affected subjects. In 12 male subjects with AGA, after SCS evaluation of the top of the head, a 1-cm2 central target site was explored with CE-PTG. There was a significant correlation of real time SCS with the percentage of thick anagen hair (r = 0.53; P < 0.08) and with the density of thin hair (r = -0.68; P < 0.02). Changes over time as documented on global photographs (18 subjects at baseline and after 12 and 60 months) were rated by a panel of independent experts (paired photographs) who were not blinded as to time. Randomised individual photographs were also examined one at a time for SCS. This procedure documents data obtained without control of baseline photographs and establishes blinding as to time. The changes calculated from SCS (after-baseline) were correlated (r = 0.9; P < 0.0001) with the rating of the panel of experts.
  
  
  CONCLUSIONS
  When minimum technical precautions are taken prior to the scoring session, the main points of interest of the SCS method are: Non-invasive quantitative and reproducible technique. Measures dynamics of scalp hair growth and loss. Easily applied in the hair clinic.
authors.affiliation: Skinterface, Tournai, Belgium. skinterface@unicall.be
authors.forename: Dominique
authors.initials: D
authors.lastname: Van Neste
authors.forename: Thérèse
authors.initials: T
authors.lastname: Leroy
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Sandraps
mesh_terms: D000505:Alopecia / Q000473:pathology*; D002138:Calibration; D003199:Computer Systems; D004867:Equipment Design; D005500:Follow-Up Studies; D006197:Hair / Q000473:pathology*; D006801:Humans; D008297:Male; D010781:Photography; D012535:Scalp / Q000473:pathology*; D012720:Severity of Illness Index