Trichoscopy Features Research Articles

Papulosquamous scalp dermatoses: key aspects of differential diagnosis and treatment

Psoriasis and seborrheic dermatitis are common papulosquamous dermatoses. When localized only on the scalp, they often have very similar clinical manifestations and require a comprehensive differential diagnostic approach. The article presents the main comparative clinical and diagnostic characteristics of psoriasis and seborrheic dermatitis of the scalp, including trichoscopy features and pathomorphological markers. Topical therapy with glucocorticosteroids, keratolytics and agents with antifungal activity is of key importance in the treatment of papulosquamous diseases. Modern topical drugs with a fixed combination of active ingredients provide an effect on several pathogenetic mechanisms at once, are stable, compatible, and convenient for use by patients. One of the main drugs for the treatment of psoriasis and seborrheic dermatitis is a solution of betamethasone dipropionate and salicylic acid (trade name – Akriderm SK), which in terms of anti-inflammatory activity is comparable to the highest strength topical corticosteroids, while providing a faster response to therapy and effectively relieving symptoms of itching and peeling. This is confirmed by the authors’ own clinical experience and demonstrated in the clinical cases described in the article.

Trichoscopic Features of Scalp Discoid Lupus Erythematosus versus Lichen Planopilaris: A Systematic Review.

Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are primary scarring alopecias that pose diagnostic challenges clinically, where trichoscopy features may provide benefit in delineating these two cicatricial alopecia, and also helps in assessing the evolution and therapeutic response. To date, there are few reviews on dermoscopic findings in differentiating these two alopecias. A systematic literature review was conducted using the PubMed and Google Scholar databases. The search terms included for scalp DLE were 'lupus' OR 'discoid lupus' OR "scalp lupus" and for scalp LPP were "lichen planopilaris" OR "scalp follicular lichen planus" OR "lichen planus follicularis" and were combined with "dermoscopy" OR "dermatoscopy" OR "videodermoscopy" OR "video dermatoscopy" OR "trichoscopy". The differences in the prevalence of dermoscopic features in scalp DLE and LPP were calculated using the Chi-square test. Of 52 articles, 36 (17 LPP, 19 DLE) were eligible for quantitative analysis. We found predominant peripilar tubular casts and perifollicular erythema with the presence of arborizing vessels in the vicinity of these changes, indicating early LPP. In contrast, follicular red dots, speckled brown pigmentation, and hair diameter variability indicated active DLE. Shiny white areas were common in both the groups in late stages. The target pattern of distribution of blue-grey dots, milky red areas, and irregular white fibrotic dots were seen in LPP, and pink-white background, follicular plugs, perifollicular and interfollicular scale, rosettes, chrysalides, and red spider on yellow dots were detected in DLE. Features such as yellow dots and blue-grey structureless areas were nonspecific and did not have a major role in differentiating DLE from LPP. This article provides a comprehensive review of the literature and delineates the trichoscopic differences and peculiarities of scalp DLE and LPP, including the correlation of dermoscopic features with histopathological findings.

Correlation of clinical and trichoscopy features with the degree of histologic inflammation in lichen planopilaris and frontal fibrosing alopecia in a cross-sectional study

Correlation of clinical and trichoscopy features with the degree of histologic inflammation in lichen planopilaris and frontal fibrosing alopecia in a cross-sectional study

Non-scarring alopecia in systemic lupus erythematosus patients at the Lagos State University Teaching Hospital: a cross-sectional study of prevalence, pattern, trichoscopy features and histopathological analysis.

trichoscopic and histopathological evaluation of non-scarring systemic lupus erythematosus (SLE) alopecia is uncommon. We aimed to document the prevalence, pattern of hair loss, trichoscopic and histopathologic differences between systemic lupus erythematosus patients with and without hair loss. this was a cross-sectional comparative study of 75 systemic lupus erythematosus patients, 36 with hair loss from February to December 2020. Trichoscopic evaluation was conducted on all 75 patients. Twenty-three patients (12 with hair loss and 11 without) had scalp biopsies with mucin deposit evaluation. Disease activity was documented using the SLE disease activity index. Data was analyzed using SPSS 22. the mean age of the patients was 33.7 ± 12.4 years. Non-scarring alopecia was observed in 48%. The pattern of hair loss was <4 patches in 44.4%, mild diffuse in 25%, and severe diffuse in 30.6%. Disease activity was mild in 38.9%. Hair shaft changes included thin hair (97.2%), decreased number of hairs per follicular unit (97.2%), hypopigmented hair (85.7%), and follicular red dots (27.8%). Significant differences between the two groups were; a reduction in size and number of sebaceous glands on histopathology, hair shaft, and scalp pigmentary changes in the hair loss group. the prevalence of non-scaring alopecia is high in SLE patients with patchy type as the commonest pattern. Trichoscopic and histopathologic differences exist in SLE patients with and without hair loss and the normal-appearing scalp in SLE patients is involved in the inflammatory process. Hair shaft thinning, hypopigmentation, and scalp pigmentary changes occur in SLE.

Trichoscopy Features of Indonesian Males with Androgenetic Alopecia in Association with Disease Severity.

Androgenetic alopecia (AGA) is a progressive loss of terminal hairs in a specific pattern distribution related to androgen. The dermoscopy of hair and scalp, known as trichoscopy, is a noninvasive method for diagnosing alopecia and other hair and scalp disorders. This study aims to report the correlation between the severity of males with AGA based on Hamilton-Norwood's scale with the clinical characteristics found in trichoscopy. This study included 40 patients aged 25-58 years who visited the dermatology outpatient clinic in a tertiary health facility in Indonesia. Clinical diagnosis was determined through history taking, physical examination, and trichoscopy. Based on Hamilton-Norwood's criteria, patients were divided into two groups: early and late stage. Parameters examined in trichoscopy include yellow dots, white dots, peripilar sign, vellus hair, hair diameter diversity, single-hair follicles, and empty follicles. The Chi-square test and Fisher's exact test were used to analyze the statistical significance between the groups. All participants presented with hair diameter diversity, vellus hair, and empty follicles (100%). None of the study participants had yellow dots. White dots and single-hair follicles were seen in 32 (80%) and 30 cases (75%), respectively. In the late-stage group, these features were more prevalent. Peripilar sign was found in 25 participants (62.50%), and it was more common in the early-stage group. No significant association was found between disease severity and trichoscopy features. The most common trichoscopy findings in particular order were hair diameter diversity, vellus hair, and empty follicles, followed by white dots, single-hair follicles, and peripilar signs. No significant association between alopecia severity and trichoscopy parameters was observed. Studies with a larger number of participants, including a control group, should be conducted to yield more significant results.

Patterns of noncicatricial alopecia in children: a cross-sectional study

Background and aim Hair loss in children is an unpleasant complaint. It represents a challenge for the treating physician, is extremely upsetting to the parents, and has a psychosocial complication for the growing child. Our study aims to clarify the causes and forms of noncicatricial alopecia in a sample of pediatric patients and to identify the common trichoscopic features of each illness. Patients and methods This study was conducted on 300 children who attended the outpatient dermatology clinics at Al-Azhar University in Assiut. Their ages ranged between 2 and 18 years old and they complained of scalp disorder and hair loss. Results Tinea capitis (TC) was the most common form of pediatric alopecia (136 patients, 45%), while alopecia areata (AA) and marginal traction alopecia were the second most common causes with a frequency of 57 (19%) and 56 (18.7%), respectively. Toxic alopecia was identified in 30 (10%) of the patients, telogen effluvium in 11 (3.7%), while six (2%) patients presented with female pattern hair loss, three (1%) patients had short anagen syndrome and only one patient presented with Trichotillomania. The most common trichoscopic features in patients who had TC were comma hair and short, broken hair, while microexclamation marks were the most common trichoscopy features among AA patients. Conclusion TC was the most common cause of pediatric alopecia, followed by AA and marginal traction alopecia. Diagnosis of hair and scalp disorders enhances the diagnostic power beyond basic clinical examination and exposes unique aspects of the diseases, leading to better management.

Trichoscopy of pemphigus vulgaris in remission. A tool for treatment-cessation decision making. Preliminary results

Background: One of the controversies in the treatment of Pemphigus Vulgaris (PV), is the time of treatment cessation. Scalp involvement is often the most stubborn to treatment human area and may reflect disease activity. Trichoscopy (Dermoscopy of hair and scalp) features have not been studied in clinically “healthy-looking” skin of PV patients in full remission. Aims and Objectives:To find out if there are any trichoscopy features in PV patients in clinical and immunologic remission, and accommodate treatment decision. Methods: The age and disease duration of 3 women with PV were correspondingly 62, 63, 55 and 5, 6, 15 years. Treatment at examination was 2,5 mg prednisone(Pr), for the last 22, 5 and 7 months. The 2nd patient was also taking 1 mg/kg/d of Azathioprine. Anti Desmoglein antibodies turned to negative since Oct/2017, Feb/2017, Sept/2015. Contact dermoscopy and hand lens X10 magnifier for clinical evaluation, were used. Results: A red hue background, peripillar scales and tubular casts were observed by trichoscopy in the first 2 patients. Only peripilar scales on a small brown round area were the features in the 3rd patient. Treatment cessation was decided only in this patient, since casts observed in the other two patients, were considered as a consequence of outer root sheath acantholysis and a sign of disease activity. Patients’ follow up justified the aforementioned treatment decisions. Conclusions: Areas of red hue skin background and movable cylindical scales (casts) around hair shafts may be observed, even in the absence of apparent scalp clinical involvement, in PV patients in remission. Since these features may drive physicians to treatment continuation, dermoscopy of the scalp is required in clinically “healthy-looking” PV patients, before a decision of treatment cessation is made. Future studies with greater number of patients, furtherly validated by long term disease course outcome, are needed.

Trichoscopy of pemphigus vulgaris in remission. A tool for treatment-cessation decision making? Preliminary results

Background One of the controversies in the treatment of Pemphigus Vulgaris (PV), is the time of treatment cessation. Scalp involvement is often the most stubborn to treatment body site and may reflect disease activity. Trichoscopy (Dermoscopy of scalp) features have not been studied in clinically “healthy-looking” skin of patients in full remission. Aims and Objectives To find out if there are any trichoscopy features in PV patients in clinical and immunologic remission, and accommodate treatment decision Methods The age and disease duration of 3 women with PV were correspondingly 62, 63, 55 and 5, 6, 15 years. Treatment at examination was 2,5 mg prednisone(Pr), for the last 22, 5 and 7 months. The 2nd patient was also taking 1 mg/kg/d of Azathioprine. Anti Desmoglein antibodies turned to negative since Oct/2017, Feb/2017, Sept/2015. Contact dermoscopy and hand lens X10 magnifier for clinical evaluation, were used. Results A red hue background, peripillar scales and tubular casts were observed by trichoscopy in the first 2 patients. Only peripilar scales on a small brown round area were the features in the 3rd patient. Treatment cessation was decided only in this patient, since casts observed in the other two patients, were considered as a consequence of outer root sheath acantholysis and a sign of disease activity Conclusions Areas of red hue skin background and movable cylindical scales (casts) around hair shafts may be observed, even in the absence of apparent scalp clinical involvement, in PV patients in remission. Since these features may drive physicians to treatment continuation, dermoscopy of the scalp is required in clinically “healthy-looking” PV patients, before a decision of treatment cessation is made. Future studies with greater number of patients, furtherly validated by long term disease course outcome, are needed

Visualization of Hair Bulbs through the Scalp: A Trichoscopic Feature of Erosive Pustular Dermatitis of the Scalp.

Erosive pustular dermatitis of the scalp (EPDS) typically affects elderly people with scarring alopecia. Videodermoscopy (VD) of the scalp has never been assessed in the diagnosis of EPDS. To evaluate the trichoscopy features of EPDS, we carried out a retrospective analysis of VD images obtained in the scalp of ten patients who affected by EPDS and were compared with those obtained from a series of thirty patients who affected by other type of scarring alopecia. The most specific VD feature was thus represented by evident hair bulb in the scarring scalp, observed in all patients.

Trichoscopy findings in loose anagen hair syndrome: rectangular granular structures and solitary yellow dots.

Loose anagen hair syndrome (LAHS) is typically diagnosed in girls older than 2 years who present with hair that "will not grow". Hair microscopic examination shows absent inner and outer root sheaths, ruffling of the cuticle on the proximal hair shaft and deformed pigmented anagen bulbs. The aim of the study was to assess whether there are characteristic trichoscopic features favoring the diagnosis of LAHS. Eighty nine children patients were included into the study (24 girls with LAHS, 25 with alopecia areata, 20 with telogen effluvium and 20 healthy children). In all groups trichoscopy was performed. Trichoscopy images were analyzed for abnormalities in the hairs shafts, the hair follicle openings and the interfollicular area. Dirty dots were present in all groups. A unique feature of LAHS was the presence of rectangular black granular structures which differs from dense black dots seen in patients with alopecia areata. This feature was observed in 71% of patients with LAHS. Follicular units with single hairs constituted 92,9% of hair units in these patients (65,5% in telogen effluvium and 53% in the control group). Solitary yellow dots were found in 50% of patient with LAHS and in 24% of patients with alopecia areata, but was not found in control group or in patients with telogen effluvium. The trichoscopy features favoring the diagnosis of LAHS are: rectangular black granular structures, solitary yellow dots and major predominance of follicular units with single hairs.

The value of trichoscopy in the differential diagnosis of scalp lesions in pemphigus vulgaris and pemphigus foliaceus.

BACKGROUNDTrichoscopy is becoming increasingly popular in diagnosing hair and scalp diseases. Scalp involvement in pemphigus is common. The scalp may be the first or only site of clinical manifestation of the disease.OBJECTIVEThe aim of this study was to analyze whether trichoscopy may be useful in aiding differential diagnosis of scalp lesions in patients with pemphigus vulgaris and pemphigus foliaceus.METHODSTrichoscopy was performed in 19 patients with scalp lesions in the course of pemphigus (9 patients with pemphigus vulgaris and 10 with pemphigus foliaceus). In all patients, the diagnosis of scalp pemphigus was confirmed by histopathology. The working magnification was 20-fold and 70-fold.RESULTSThe most frequently observed trichoscopy features of pemphigus lesions were: extravasations (18/19; 94.7%) and yellow hemorrhagic crusts (11/19; 57.9%). Yellow dots with whitish halo were observed in 6/19 (31.6%) patients with pemphigus. White polygonal structures were observed in pemphigus foliaceus (6/10; 60%), but not in pemphigus vulgaris. Vascular abnormalities were more frequent in pemphigus vulgaris, when compared to pemphigus foliaceus, and were associated with a severe course of disease. Linear serpentine vessels were the most frequent vascular abnormality in patients with pemphigus vulgaris and pemphigus foliaceus (77.8% and 30%, respectively).CONCLUSIONTrichoscopy may serve as a useful supplementary method in the differential diagnosis of pemphigus, especially in cases of desquamative or exudative lesions limited to the scalp. Extravasations, yellow hemorrhagic crusts, yellow dots with whitish halo, white polygonal structures and linear serpentine vessels are trichoscopy features which may suggest the diagnosis of pemphigus.

A nonrandomized study of trichoscopy patterns using nonpolarized (contact) and polarized (noncontact) dermatoscopy in hair and shaft disorders.

Aims:The aim was to study the trichoscopy features of selected hair and scalp conditions by two dermoscopic devices with different modes that is, polarized (noncontact) and nonpolarized (contact) mode.Materials And Methods:The present study included 11 clinical varieties of cases with total 112 patients, attending Sir Takhtasinh Hospital, Bhavnagar in the last 2 years. The clinical history was recorded for each case, and images were taken in both the Heine and DermLite II pro dermatoscope. We used polarized mode of the noncontact device (DermLite II) and the nonpolarized mode of the contact device (Heine) for our study.Statistical Analysis Used:Fisher's exact test to study dermoscopic observations for each mode.Results:We observed different nonscarring alopecia cases such as alopecia areata, androgenetic alopecia, trichotillomania, and tinea capitis. Scarring alopecia included discoid lupus erythematosus, lichen planopilaris, pseudopelade of Brocq, systemic lupus erythematosus. Scaling disorders included the psoriasis and seborrheic dermatitis. Furthermore, infestations like pediculosis capitis were included in the study. Various features were divided into follicular, interfollicular, pigmentary, vascular and hair shaft patterns. Each of the features was correlated in both the Heine (nonpolarized) and DermLite II (polarized) dermoscope, and observational finding was put forward accordingly.Conclusions:Various variations were observed in the documentation of dermoscopic patterns of the two dermatoscopes with certain features such as vascular patterns, scaling, and reticular pigmentation being better appreciated in polarized mode, while certain features were better documented in nonpolarized mode that is, black dots and tapered hair.

New Trichoscopy Findings in Trichotillomania: Flame Hairs, V-sign, Hook Hairs, Hair Powder, Tulip Hairs

Differential diagnosis of trichotillomania is often difficult in clinical practice. Trichoscopy (hair and scalp dermoscopy) effectively supports differential diagnosis of various hair and scalp diseases. The aim of this study was to assess the usefulness of trichoscopy in diagnosing trichotillomania. The study included 370 patients (44 with trichotillomania, 314 with alopecia areata and 12 with tinea capitis). Statistical analysis revealed that the main and most characteristic trichoscopic findings of trichotillomania are: irregularly broken hairs (44/44; 100% of patients), v-sign (24/44; 57%), flame hairs (11/44; 25%), hair powder (7/44; 16%) and coiled hairs (17/44; 39%). Flame hairs, v-sign, tulip hairs, and hair powder were newly identified in this study. In conclusion, we describe here specific trichoscopy features, which may be applied in quick, non-invasive, in-office differential diagnosis of trichotillomania.

Alternaria scalp infection in a patient with alopecia areata. Coexistence or causative relationship?

Alopecia areata is an autoimmune disease that is affecting anagen hair follicles. The triggers of autoimmunity in patients with alopecia areata remain unknown. A 13-year-old boy developed multiple hairless patches of focal hair loss with typical clinical and trichoscopy features of alopecia areata. Mycology examination of the scalp hair and epidermal scrapings reveled massive growth of Alternaria chlamydospora. We hypothesize that fungal antigens (e.g. antigens involved in fungal melanin synthesis) may be possible triggers, contributing to autoimmune reactions in patients with alopecia areata. We discuss research data, which may indirectly support this hypothesis, however the concept has yet to be verified.