Low-Cost Standardization of Photography in Pattern Hair Loss with “Chin–Nose–Brow Rest”

INTRODUCTION

Pattern hair loss (PHL), previously known as androgenetic alopecia, is the most common cause of hair loss in both men and women. Management of PHL requires prolonged and sequential follow-up visits to document treatment efficacy. Serial gross scalp photography is the most practical way of progressively assessing the treatment response.[1] Moreover, scalp photography also plays a crucial role in patient counseling.[2] The purpose of clinical photography in PHL is not single time documentation, but is a part of serial reproducible photographs during subsequent visits where all the variables, i.e., background, hair combing, the position of the head, lighting, camera settings, position, and distance of the camera from the scalp, must be kept constant.[3] The only variable which can be changed should be the condition of hair over the scalp which needs to be assessed. Of all the above variables, the most difficult to achieve is the consistent position of the head in serial follow-up visits. Stereotactic cameras are considered ideal for scalp photography; however, its high cost limits its use in the clinical setup. The suggestion of the resting of the head over the hands has also never been consistent in our experience due to change in the patient's hand position.[4] We, therefore, devised an innovative cost-efficient technique to circumvent these limitations.

TECHNIQUE

Four standard views have been described for gross scalp photography – frontal, mid-pattern, vertex, and temporal.[3] Frontal view depicts the frontal hairline and frontal scalp, mid-pattern view focuses the frontal and mid-scalp area, vertex view shows the vertex, and temporal views display the temporal recession. For the vertex view, the patient is asked to tilt his/her head back and see the ceiling, but for the frontal, mid-pattern, and temporal views, Ashique and Kaliyadan.[4] have suggested resting the patient's head over his/her own interlocked hands, which has never been consistent in our experience. We have crafted a simple headrest to produce consistent standardized images for the frontal and mid-pattern views. The chin–nose–brow rest is a modification of an open wooden box (12 cm width × 18 cm length × 9 cm height), which contains two grooves and edges, a broader groove (6 cm width × 2 cm maximum depth) for resting the patient's chin, a narrower groove (3.5 cm width × 2.5 cm maximum depth) for placing the nose and any of the edges to place the forehead at the level of the eyebrows [Figure 1a]. Positioning the patient in these respective slots gives us three standard views, namely, first the facial framing view [Figure 1b], second the frontal view [Figure 1c], and third the mid-pattern view [Figure 1d]. This makes now a total of five views. A disposable plastic wrap/cling film may be used to cover the headrest to maintain hygiene. Standardization of the distance between the patient, the focal point of the lens and the background can be done by keeping the position of background, camera tripod, and patient's chair constant. Background is kept constant against a wall, and camera tripod and patient's chair are kept constant by positioning them on permanent markings made on the floor.

Figure 1.

(a) Chin–nose–brow rest showing an open wooden box with two grooves, a broader groove (black arrow) for the chin rest and a narrower groove (red arrow) for the nose rest, and the edges for the forehead rest at the level of eyebrows. (b) Facial framing view with the chin placed in the broader groove. (c) Frontal view with the nose placed in the narrower groove. (d) Mid-pattern view with the forehead placed on the edge at the level of the eyebrows

We believe that this is a simple and inexpensive tool, which could be constructed by any carpenter and will prove valuable in documenting gross scalp photography for maintaining consistency in head positions for serial reproducible photography.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.