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

Abstract

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.

Trichoscopy – a useful tool in the preliminary differential diagnosis of autoimmune bullous diseases

“…The latter feature occurred only in pemphigus vulgaris. In 4/26 (15.4%) dotted vessels in linear arrangement, forming so called “string of pearls” pattern, were observed . The presence of dotted vessels, dotted vessels with whitish halo, dotted vessels in clusters, dotted vessels forming “string of pearls”, and lace‐like vessels correlated positively with PDAI scalp activity score.…”

“…In 10/26 (38.5%) patients with PV, yellow dots with whitish halo, so called “fried egg sign”, was observed …”

“…Literature data on trichoscopy and autoimmune bullous diseases are scarce. Our literature search revealed two papers on the usability of trichoscopy in pemphigus . There are neither literature data on the use of trichoscopy in BP nor in DH.…”

“…It has been successfully used in such diseases as alopecia areata, androgenetic alopecia, cicatricial alopecia, tinea of the scalp, and many other . According to our literature search, to date there is one case report and one original paper concerning trichoscopic features of pemphigus . There are no literature data on the usefulness of trichoscopy in bullous pemphigoid and dermatitis herpetiformis.…”

The diagnostic value of trichoscopy in systemic sclerosis

“…Its' main advantages are diagnostic accuracy, repeatability, and opportunity to register outcomes. Trichoscopy is being used in different alopecias including scalp psoriasis, 26 syphilis, 27 pemphigous, 28 trichotillomania, 14 discoid lupus erythematosus. 14 There are some papers focusing on hair disorders in autoimmune diseases, however, systemic sclerosis was not yet adequate examined.…”