International Journal of Trichology

LETTER TO EDITOR
Year
: 2020  |  Volume : 12  |  Issue : 3  |  Page : 140--141

A proposed system for redefining of the zones of the scalp


Conor T Boylan, Michaela S Gaston, Puja Merwaha 
 College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom

Correspondence Address:
Mr. Conor T Boylan
14 Bideford Drive, Selly Oak, Birmingham, B296QG
United Kingdom




How to cite this article:
Boylan CT, Gaston MS, Merwaha P. A proposed system for redefining of the zones of the scalp.Int J Trichol 2020;12:140-141


How to cite this URL:
Boylan CT, Gaston MS, Merwaha P. A proposed system for redefining of the zones of the scalp. Int J Trichol [serial online] 2020 [cited 2022 Dec 3 ];12:140-141
Available from: https://www.ijtrichology.com/text.asp?2020/12/3/140/292095


Full Text



Sir,

We enjoyed reading a recent article entitled, ̶S0;Scalp hair whorl patterns in patients affected by Neurofibromatosis Type 1: a casecontrol study” and found its conclusions to be particularly interesting.[1] However, we felt it was limited by an issue frequently seen in publications in this field. That is, there was an element of ambiguity as to what areas of the scalp were being referred to in text. In describing locations of hair whorls, the authors used terms such as “apical,” “parietal region,” “vertex,” and “midline” without definition. Using the parietal region as an example, different authors appear to define it in different ways. Rojhirunsakool and Suchonwanit define the parietal region as “7 cm above both external auditory ear canals,”[2] whereas Prodigner et al.describe a squamous cell carcinoma on the topmost part of the scalp as being in the parietal region.[3] This heterogeneity is common throughout all zones of the scalp and leads to difficulty in interpreting the findings of papers in this field.

We propose a redefining of the zones of the scalp using a nomenclature adapted from Beehner's 2001 paper on scalp landmarks, with input from a 2015 paper by Chopra et al.[4],[5] The redefined zones are expressed pictorially in [Figure 1]. Using these papers, the areas of the scalp can be defined as:{Figure 1}

Forehead: The area between the anterior hairline superiorly, supraorbital ridge inferiorly, and temporal ridges laterallyFrontal scalp: The area on the top of the head from roughly in line with the midpoint of the zygomatic arch to the anterior hairlineMidscalp: The area between the frontal scalp and vertex, bordered laterally by the temporal/parietal hair fringesVertex: A somewhat oval-shaped region in the posterior scalp overlying the lambda that is the typical site of the hair whorl in menPosterior scalp: The area overlying the occiput from vertex superiorly to superior nuchal line inferiorly and laterally to the mastoid portion of the temporal boneTemporal scalp: The lateral area of the head superior to the zygomatic arch and between the forehead and posterior scalpPosterior auricular area: From the posterior of the ears to the anterior margin of the posterior scalp.

These zones reflect differences in hair stream directions, neurovascular supply, outward appearance, and practices of plastic surgeons in terms of hair transplantation and reconstructive flap design. It should be noted that these definitions are not absolute, and comments and adaptations are encouraged to improve their applicability. Ultimately, however, we believe that this nomenclature can provide a foundation to begin to more accurately describe the zones of the scalp and to create a greater homogeneity in how authors and clinicians define the locations of their findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Sechi A, Neri I, Patrizi A, Starace M, Savoia F, Leuzzi M, et al. Scalp hair whorl patterns in patients affected by neurofibromatosis type 1: A case-control study. Int J Trichology 2020;12:56-61.
2Rojhirunsakool S, Suchonwanit P. Parietal scalp is another affected area in female pattern hair loss: An analysis of hair density and hair diameter. Clin Cosmet Investig Dermatol 2018;11:7-12.
3Prodinger CM, Koller J, Laimer M. Scalp tumors. J Dtsch Dermatol Ges 2018;16:730-53.
4Beehner ML. Nomenclature proposal for the zones and landmarks of the balding scalp. Dermatol Surg 2001;27:375-80.
5Chopra K, Calva D, Sosin M, Tadisina KK, Banda A, De La Cruz C, et al. A comprehensive examination of topographic thickness of skin in the human face. Aesthet Surg J 2015;35:1007-13.