Dermoscopic Findings in Radiation-Induced Alopecia after Angioembolization

Abstract

Background: Cases of non-scarring alopecia after endovascular brain surgery have been reported, but dermoscopic findings of these lesions have rarely been published. Objective: To report the dermoscopic findings for alopecic skin lesions that developed after radiation exposure during angioembolization. Methods: Dermoscopic examination was used to evaluate alopecic skin lesions in 10 patients who presented with post-angioembolization alopecia. Results: The male to female ratio was 1:4, mean age 55.0 ± 12.3 years and mean duration to lesion development 3.4 ± 2.5 weeks. The rectangular-shaped lesions mostly occurred at the occiput and temple areas. Both yellow and black dots were the predominant dermoscopic findings in 60% (6/10) of patients, followed by short vellus hair (50%), peripilar sign (20%), broken hair (10%), coiled hair (10%) and white dots (10%). Conclusions: Alopecic skin lesions induced by radiation exposure during angioembolization share characteristic dermoscopy findings with alopecia areata. They may be misdiagnosed if a precise history is not obtained.

Flame Hair

“…The flame hairs were very numerous in alopecias due to anagen effluvium, including chemotherapy- and radiotherapy-induced alopecia (100%) and acute alopecia areata (21%). These conditions are characterized clinically by the abrupt onset of focal or extensive non-scarring alopecia, including alopecia totalis, and with various types of broken hairs on trichoscopy [3,4,5,6,7]. The hair breakage results from acute damage to the matrix and keratogenous zone of terminal anagen follicles causing hair anagen arrest.…”

Three cases of radiation-induced temporary alopecia with hair microscopic examination: “coudability hair” might not be specific for alopecia areata

“…[ 13 ] concluded that the most common position of the head during coil embolization of an AVM is posteroanterior, which may explain why the most frequent location of radiation-induced temporary alopecia is the occipitoparietal scalp. [ 1 12 ] All three patients in our report had patches of hair loss on the occipitoparietal scalp region.…”

“…[ 8 9 10 11 ] This peculiar configuration is assumed to be the result of three-dimensional radiation exposure and the prolonged fixed position of the patient during the procedure. [ 12 ] Mooney et al . [ 13 ] concluded that the most common position of the head during coil embolization of an AVM is posteroanterior, which may explain why the most frequent location of radiation-induced temporary alopecia is the occipitoparietal scalp.…”

Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy

“…Cho et al reported 10 patients developing alopecia after angioembolization with mean duration of 3.4 weeks, ranging from 1 to 8 weeks, after procedure. All patients had a rectangular-shaped, alopecic patch on the occipital and temporal area, and 9 of 10 patients had complete hair regrowth within 3-4 months [15]. Our patient also presented with rectangular alopecia on the occipital scalp at 4 weeks after radiation exposure and achieved complete hair regrowth within 4 months aided with the use of twice-daily 5% minoxidil application.…”

“…All dystrophic anagen hairs shed off in the first few weeks after radiation exposure. A study of 10 patients with postangioembolization alopecia by Cho et al reported that dermoscopic findings demonstrated both yellow dots and black dots (60%), short vellus hair (50%), peripilar sign (20%), broken hair (10%), coiled hair (10%), and white dots (10%), whereas histopathology showed increased numbers of catagen and telogen hairs without peribulbar inflammatory cell infiltrate, unlike alopecia areata, which usually shows peribulbar inflammation [15]. Although the dermoscopic findings of radiation-induced alopecia are nonspecific and share some common features with alopecia areata, the presence of peribulbar inflammation in histopathologic examination, which is commonly observed in alopecia areata, can help distinguish between these two conditions.…”