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Abstract Background: Trichoscopy is a simple, non-invasive tool used in the diagnosis of different hair/scalp diseases at many fold magnification. It has unveiled a plethora of signs helping in decoding the underlying condition. Structural hair defects can provide important clues not only to diagnose hair/scalp diseases, but also complex syndromes. Therefore, detection of hair defects became a valuable issue. Objectives: To describe the structural hair defects among different hair and/or scalp diseases and syndromes using hand-held dermoscope, light Microscope and to lesser extent folliscope and digital dermoscope, and to determine the utility of each in the diagnosis of the presented diseases. Methods: A non-randomized, observational study for structural hair defects, performed on 807 patients attending Dermatology Outpatient Clinic, Kasr Al-Ainy Hospital, Cairo University, between March 2017 to August 2017, with hair/scalp complaint. Results: Seven hundred and ninety patients (97.9%) of our recruited patients were diagnosed as acquired hair/scalp diseases and 17 patients (2.1%) were diagnosed as hereditary syndromes. The diagnosis was made on the basis of a detailed history and clinical examination, and confirmed by biopsy and relevant investigations in some cases as LPP, DLE and TC. FPHL, TE, Co-existence of FPHL and TE, were the most common diagnoses, followed by PS, AA, Dandruff, Traction alopecia and TTM |