# Standardization and Validation of Scalp Surface Area Measurement and Assessment of Interchangeability Between Two Independent Methodologies for Head Crown Area and Total Hair Count Measurement

## TL;DR

This study validates two methods for measuring scalp area and hair count, showing they can be used interchangeably in hair care research.

## Contribution

The study provides empirical validation of interchangeable methods for scalp area and hair count measurements in clinical and cosmetic research.

## Key findings

- Bland-Altman analysis showed minimal bias between measuring tape and Image-Pro for head crown area.
- ICC and CCC values indicated good reliability and moderate agreement between measurement methods.
- CASLite NOVA and Image-Pro showed good agreement in hair count assessments.

## Abstract

Background

Hair loss significantly affects physical appearance and psychological well-being, leading to increased use of hair growth and hair loss prevention treatments. Accurate and reproducible assessment of scalp and head crown surface area and hair count is essential for evaluation in clinical and cosmetic clinical studies with hair care products.

Objective and method

This prospective, single-visit standardization and validation study included adult participants aged 18 to 55 years. Scalp surface area measurements were performed in 25 adult participants using a calibrated measuring tape. Head crown (vertex) surface area measurements, including the frontal and mid-scalp regions, were performed in 25 adult participants using a calibrated measuring tape and photographic image analysis with Image-Pro software. For hair count assessment, global 90° head photographs obtained from in-house data of 50 participants were analyzed using phototrichogram (PTG)-based CASLite NOVA and Image-Pro software. Agreement between the measurement methods was evaluated using appropriate method-comparison statistical analyses.

Result

The scalp surface area mean was 492.36 ± 30.97 cm². For head crown, including frontal and mid-scalp area measurements, Bland-Altman analysis demonstrated minimal systematic bias with acceptable limits of agreement (LoA) between the calibrated measuring tape and Image-Pro analysis. The intraclass correlation coefficient (ICC) of 0.75 indicates good reliability and consistency between the two measurement methods, while the concordance correlation coefficient (CCC) of 0.74 reflects moderate agreement when both precision and accuracy are considered. Hair count assessment using CASLite NOVA and Image-Pro analysis also showed good agreement in hair counts, with small average differences and expected LoA.

Conclusion

This standardization and validation study demonstrated acceptable agreement between measure-tape-based calculated and image-based methods for head crown area assessment, including the frontal and mid-scalp regions. Additionally, acceptable agreement was observed between CASLite NOVA and Image-Pro software for hair count evaluation. These findings support the interchangeable use of measure-tape-based and image-based methods for head crown area measurement, as well as the reliability of CASLite NOVA and Image-Pro-based analyses for hair count assessment in hair care product testing and clinical and cosmetic hair research.