Clinico-dermoscopic features and treatment responsiveness in pediatric alopecia – Experience from a tertiary care pediatric dermatology clinic

Abstract

Background: Data on clinical and epidemiologic profile on pediatric alopecia is relatively scarce. Aims and Objectives: We aimed to study the clinical, epidemiological, and dermoscopic profile of children presenting with alopecia, and assess the responsiveness to different treatment modalities in a real-life setting. Materials and Methods: This cohort study involved analyzing children presenting with hair loss during the study period. After a detailed history, clinical, and trichoscopic examination, treatment offered to patients and follow-up response to treatment along with relapse of symptoms were noted. Results: Around 119 children were included. Nearly 90% were of acquired etiology. The most common cause of alopecia was alopecia areata (AA) in 85 (71%) patients followed by tinea capitis 9 (7.5%), lichen planopilaris 4 (3.3%), and other less common causes. In patients of AA, dermoscopy showed the presence of black dots in 68% cases, exclamation mark hair in 54% of patients followed by off-white dots, yellow dots, and vellus hair. Patients with an acute course and black dots on dermoscopy responded better to treatment. Relapse was common in patients with early age of onset and longer disease duration. Conclusions: Hair loss is frequently seen in pediatric dermatology clinics. Dermoscopy of pediatric AA shows scarce yellow dots while off-white dots are more frequent; the presence of black dots is a good prognostic indicator.

Dermoscopy of Hair and Scalp Disorders (Trichoscopy) in Skin of Color—A Systematic Review by the International Dermoscopy Society “Imaging in Skin of Color” Task Force

“…A total of nine instances of traction alopecia (TA) with trichoscopic description have been reported in the literature (two case-control studies [ 8 , 10 ] and a single case series [ 43 ]), with peripilar casts and single hair follicular units being the most common features (44% and 40% of cases, respectively). Peripilar casts have also been reported to be present in case of diffuse TC at the margins of the patches.…”

“…Twelve instances of folliculitis decalvans (FD) have been investigated on trichoscopy by five case-control studies [ 8 , 10 , 12 , 52 , 53 ]. In general, loss of follicular openings, perifollicular scaling, follicular pustules and hair tufting were the most common features, being detected in more than 50% of cases.…”

“…According to the study by Abedini et al , follicular pustules may also be observed in dissecting cellulitis of the scalp, yet the prevalence was higher in FD [ 52 ]. Another hallmark of FD was hair tufting, defined as tufts of ≥ 6 hair shafts emerging from one follicular opening [ 8 , 10 , 12 , 52 , 53 ]. Of note, pustules were found to be a marker of active FD, whereas hair tufting turned out to be an indicator of disease severity [ 53 ].…”

“…Seven case-control studies [ 8 , 10 – 12 , 52 – 54 ] and a single case-report [ 57 ] on trichoscopy of lichen planopilaris (LPP) were retrieved, for a total of 107 instances. Similarly to other cicatricial alopecias, loss of follicular openings was the most prevalent finding (98% of cases).…”

“…A total of 13 cases of pseudopelade of Brocq with trichoscopic description were available from the literature (five case-control studies [ 8 , 10 – 12 , 53 ] and one single case-report [ 61 ]). Loss of follicular ostia was a constant finding, while other common features included white dots (eccrine openings) and cicatricial white patches (both observed in 46% of cases) as well as and perifollicular scales (39% of cases).…”