Trichoscopy pattern in alopecia areata: A systematic review and meta‐analysis

Abstract

Background:The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful tool in determining the correct diagnosis of hair loss presentations.Objective: Through mapping the researches that have been done to represent the spectrum of trichoscopic findings in AA and to identify the most characteristic patterns. Methods:Thirty-nine studies were eligible for the quantitative analysis. Meta-analysis and subgroup analysis were performed. Results:Thirty-nine studies (29 cross-sectional, five retrospective, two descriptive, one case series, one observational, and one cohort) with a total of 3204 patients were included. About 66.7% of the studies were from Asia, 25.6% from Europe, and 7.7% from Africa. The most characteristic trichoscopic findings of AA were as follows; yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Conclusion:There is no single pathognomonic diagnostic trichoscopic finding in AA rather than a constellation of characteristic findings. The five most characteristic trichoscopic findings in AA are: yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Yellow dots and short vellus hairs considered the most sensitive clues for AA, while black dots and tapering hairs are the most specific ones. Furthermore, trichoscopy is a useful tool that allows monitoring of response during the treatment of AA. Treatment responded cases will show an increase in short vellus hairs, but loss of tapering hairs, broken hairs, and black dots, while yellow dots are the least responsive to the treatment.

Combination of baricitinib and conventional immunomodulating therapy for alopecia totalis

“…5 Additionally, black dots, broken hairs, short vellus hairs, and taper- the results of Al-Dhubaibi et al's meta-analysis, suggesting that incorporating trichoscopy as an active tool in AA treatment could be advantageous for monitoring progress. 6 In conclusion, the combination of baricitinib with appropriate use of conventional immunomodulating therapy may be effective and safe for treating AA, including AT.…”

European expert consensus statement on the systemic treatment of alopecia areata

“…5 A trichoscopy-guided biopsy should include areas indicative of high disease activity (exclamation mark hairs, tapering hairs, black dots). 12 If not present, then the hair-bearing margin of the patch is a preferable biopsy area. Investigation for comorbidities is based on medical history and clinical findings.…”

C‐reactive protein as a novel biomarker for vitamin D deficiency in alopecia areata

“…According to the extent of hair loss, AA can be divided into three categories: patchy alopecia, which causes partial scalp hair loss; alopecia totalis, which causes whole scalp hair loss; and alopecia universalis, which causes complete scalp and body hair loss. Different clinical types of scalp hair loss may be seen clinically, including patchy (localized or multiple), ophiasis, sisaipho, reticulate, and diffuse 3 …”