How to Optimize Trichoscopy for Evaluation of Scalp Vessels

Abstract

Introduction: Trichoscopy greatly facilitates clinical diagnosis in patients with hair loss and may decrease the necessity for histopathological examination. Structures which may be revealed by trichoscopy include hair shafts, hair follicle openings, the perifollicular epidermis, and cutaneous microvessels. Cutaneous microvessels revealed in trichoscopy may vary in type and number depending on the scalp area, type of the disease, and its activity. Firm direct pressure (diascopy) might result in their blanching, but as of yet, there are no studies on the types of vessels that do or do not blanch on applying pressure. Methods: We studied interfollicular twisted loops in 16 cases of biopsy-confirmed scalp psoriasis and 37 cases of arborizing vessels in normal subjects and seborrheic dermatitis patients. Results: We observed that all arborizing red line vessels blanched on applying pressure. Instead, the vast majority of twisted and simple loops, despite their vascular nature, did not blanch on performing diascopy. Conclusion: In the light of these findings, diascopy of vascular changes in hair loss patients might provide additional clues for a proper diagnosis, especially in differentiating scalp psoriasis, seborrheic dermatitis, and discoid lupus erythematosus.

Dermoscopic findings and comparison of usefulness of longitudinal versus transversal sections in the histological diagnosis of alopecia X

“…24 In order to visualise distinctive morphological features of the cutaneous vasculature, it is important to perform dermoscopic examination without inducing a firm direct pressure (diascopy) that might result in their blanching although in the pigmented skin, the heavy pigment also obfuscates the vascular patterns. 25 In this study, the type of HF findings observed dermoscopically were supposedly related to the hair cycle arrest and/or, at least for some of them, to the singular shape of flame/dysmorphic HFs. However, it cannot be excluded that this finding could be detected also in other hair cycle arrest disorders, and in the future, we expect to isolate all those features that are significantly associated with a particular diagnosis from other alopecic conditions also.…”

“…In order to visualise distinctive morphological features of the cutaneous vasculature, it is important to perform dermoscopic examination without inducing a firm direct pressure (diascopy) that might result in their blanching although in the pigmented skin, the heavy pigment also obfuscates the vascular patterns 25 …”

The role of trichoscopy beyond hair and scalp diseases: A review

“…It may serve as a helpful diagnostic tool in inflammatory scalp diseases (e.g. psoriasis 11 and seborrheic dermatitis 12,13 ). It has been recently shown that trichoscopy may be useful in identifying features associated with systemic diseases and cutaneous disorders that typically do not affect the scalp.…”

“…It may serve as a helpful diagnostic tool in inflammatory scalp diseases (e.g. psoriasis 11 and seborrheic dermatitis 12,13 ). It has been recently shown that trichoscopy may be useful in identifying features associated with systemic diseases and cutaneous disorders that typically do not affect the scalp.The aim of the review was to analyse available data on the trichoscopic features of systemic conditions including connective tissue, lymphoproliferative, inflammatory, and infectious disorders.…”