fig3

Figure 3. Performing scalp coverage scoring (SCS) in vivo and on computer screen. For illustration purposes, a female patient seen recently agreed to be part of this project showing how SCS can be performed in vivo. Figure 3A shows the investigator’s hand (a1) while adjusting the handheld transparency [(a2) carved out 18 squares] to the frontal headgear worn by the patient (a3). The facial mask indicates that the image was taken during the 2020 SARS-CoV-2 pandemic. The observer starts scoring by analogy with the scale of “difficulty” [shown in (a4)]. Schematically, Figure 3B symbolises the eye of the clinician (b1) who looks through a carved-out transparency (b2). This particular SCS grid illustrates how the clinician should focus on the midline fields in same patient (b3) while referring to a scale of “difficulty”. The latter (b4) displays a series of shaded areas where “5” means “it is very difficult to observe the scalp skin through the hair” while “0” means “no difficulty at all observing the skin through the hair”. We further illustrate the influence of hairstyling on performing SCS on the top of the head of a male patient. This male patient with Hamilton II appeared already with hair combed as spokes of a wheel [Figure 1E, first case on the left graded as II]. Figure 3C shows the same but enlarged image along with 18 numbered fields of the grid (bold and paler italic numbers; left). After combing with midline parting, a new SCS was performed [Figure 3D; p1-p4]. While scalp skin can be barely perceived in Figure 3C (SCS range 4-5), the scalp skin was much more easily visible in between the hair in Figure 3D (SCS range 3-4).