Focal alopecia in parietal area in adult women — assessment of usefulness of trichoscopy in making a proper diagnosis
DOI:
https://doi.org/10.20883/jofa.33Keywords:
trichoscopy, skin ultrasonography, HF-USG, alopeciaAbstract
Introduction. Focal alopecia in the parietal area is one of the types of hair loss that can be found in dermatological practice. Trichoscopy is a non-invasive and easily accessible diagnostic method widely used in scalp disorders.
Aim. The aim of this study was to assess the usefulness of trichoscopy in the non-invasive diagnosis of focal hair loss in adult women.
Material and Methods. The study included 40 adult women. The study group consisted of 30 patients including 10 patients with alopecia areata (AA), 10 patients with discoid lupus erythematosus (DLE) and 10 with classical form of lichen planopilaris (LPP). The control group consisted of 10 healthy volunteers. Four groups of structures observed in trichoscopic examination were evaluated: hair follicle openings, hair shafts, vessels, perifollicular and interfollicular skin surface.
Results. Among patients with AA the most frequently observed trichoscopic structures were: yellow dots in 100% (10/10), broken hairs in 90% (9/10), hairs resembling exclamation marks in 90% (9/10). DLE patients most often presented white / white-pink structureless areas and prominent, interfollicular scaling in 100% (10/10) and 90% (9/10) of cases, respectively. On the other hand, in the group of patients with LPP, the most frequent findings were: fine perifollicular scaling in 100% (10/10) and linear, slightly branched vessels arranged concentrically around the follicular openings - both features observed also in 100% (10/10) of cases.
Conclusion. Trichoscopy as a non-invasive diagnostic method may be helpful in differentiating non-scarring and scarring alopecia in the parietal area in women. Moreover, there are some trichoscopic features typical for AA, DLE and LPP, which allow for differentiation and facilitate the diagnosis of these entities.
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References
Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in Northern India. Int J Dermatol 1996;35:22–27.
Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern and profile of alopecia areata in Singapore–a study of 219 Asians. Int J Dermatol 2002; 41:748–753.
Tan E, Martinka M, Ball N, Shapiro J. Primary cicatricial alopecias: clinicopathology of 112 cases. J Am Acad Dermatol. 2004;50:25–32.
Whiting DA. Cicatricial alopecia: clinico‑pathological findings and treatment. Clin Dermatol. 2001;19:211–225.
Trachsler S, Trueb RM. Value of direct immunofluorescence for differential diagnosis of cicatricial alopecia. Dermatology. 2005;211:
–102.
Torres F, Tosti A, Misciali C, Lorenzi S. Trichoscopy as a clue to the diagnosis of scalp sarcoidosis. Int J Dermatol. 2011;50:358–361.
Borgia F, Giuffrida R, Lentini M, Palazzo R, CANNAVò SP. Follicular mucinosis with diffuse scalp alopecia treated with narrow‑band UVB phototherapy: the role of trichoscopy in monitoring therapeutic outcomes. G Ital Dermatol Venereol. 2016;151:212–215.
Ravaioli GM, Starace M, Alessandrini AM, et al. Trichoscopy of Scalp Metastases. Int J Trichol. 2019;11:86–87.
Castelo‑Soccio L. Diagnosis and management of alopecia in children. Pediatr Clin North Am. 2014;61:427–442.
Olszewska M, Rudnicka L, Rakowska A, Kowalska‑Oledzka E, Slowinska M. Trichoscopy. Arch Dermatol. 2008;144:1007.
Jain N, Doshi B, Khopkar U. Trichoscopy in alopecias: diagnosis simplified. Int J Trichol. 2013;5:170–178.
Thakur BK, Verma S, Raphael V. Clinical, Trichoscopic and Histopathological Features of Primary Cicatricial Alopecias: A Retrospective Observational Study at a Tertiary Care Centre of North East India. Int J Trichology. 2015;7:107–112.
Karadag Köse Ö, Güleç AT. Evaluation of a Handheld Dermatoscope in Clinical Diagnosis of Primary Cicatricial Alopecias. Dermatol Ther (Heidelb). 2019;9:525–535.
Ross EK, Vincenzi C, Tosti A. Videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol. 2006;55(5):799–806.
Waśkiel A, Rakowska A, Sikora M, Olszewska M & Rudnicka L. Trichoscopy of alopecia areata: An update. The Journal of Dermatology. 2018;45:692-700.
Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases. Int J Dermatol. 2008;47:688–693.
Mathur M, Acharya P. Trichoscopy of primary cicatricial alopecias: an updated review. J Eur Acad Dermatol Venereol. 2020;34:473–484.
Duque‑Estrada B, Tamler C, Sodre CT, Barcaui CB, Pereira FB. Dermoscopy patterns of cicatricial alopecia resulting from discoid lupus erythematosus and lichen planopilaris. An Bras Dermatol 2010;85: 179–183.
Rakowska A, Slowinska M, Kowalska‑Oledzka E et al. Trichoscopy of cicatricial alopecia. J Drugs Dermatol 2012;11:753–758.
Abedini R, Kamyab Hesari K, Daneshpazhooh M, Ansari MS, Tohidinik HR, Ansari M. Validity of trichoscopy in the diagnosis of primary cicatricial alopecias. Int J Dermatol 2016;55:1106–1114.
Lanuti E, Miteva M, Romanelli P, Tosti A. Trichoscopy and histopathology of follicular keratotic plugs in scalp discoid lupus erythematosus. Int J Trichol 2012;4:36–38.
Miteva M, Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia. J Eur Acad Dermatol Venereol 2013;27:1299–1303.
Nikam VV, Mehta HH. A nonrandomized study of trichoscopy patterns using nonpolarized (contact) and polarized (noncontact) dermatoscopy in hair and shaft disorders. Int J Trichol 2014;6:54–62.
Ramos‑e‑Silva M, Pirmez R. Red face revisited: disorders of hair growth and the pilosebaceous unit. Clin Dermatol 2014;32:784–799.
Chiramel M, Sharma V, Khandpur S, Sreenivas V. Relevance of trichoscopy in the differential diagnosis of alopecia: a cross‑sectional study from North India. Indian J Dermatol Venereol Leprol 2016;82:
–658.
Tosti A, Torres F, Misciali C et al. Follicular red dots: a novel dermoscopic pattern observed in scalp discoid lupus erythematosus. Arch Dermatol 2009;145:1406–1409.
Güngör Ş, Topal IO, Göncü EK. Dermoscopic patterns in active and regressive lichen planus and lichen planus variants: a morphological study. Dermatol Pract Concept. 2015;5:45–53.
Lacarrubba F, Dall’ Oglio F, Rita Nasca M, Micali G. Videodermatoscopy enhances diagnostic capability in some forms of hair loss. Am J Clin Dermatol. 2004;5:205–208.
Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases. Int J Dermatol 2008;47:688–693.
Rudnicka L, Olszewska M, Rakowska A. Atlas of Trichoscopy: Dermoscopy in Hair and Scalp Disease. London: Springer: 2012.