Trichoscopy update 2011

Abstract

Trichoscopy performed with a handheld dermoscope or a videodermoscope became an indispensable tool in differential diagnosis of hair and scalp diseases. Current research is focusing on trichoscopy of: 1) non-cicatricial alopecia, 2) cicatricial alopecia, 3) hair shaft disorders, and 4) inflammatory scalp diseases. This review summarizes current knowledge in these four fields of research. In all non-cicatricial alopecias presence of empty follicular openings is a common trichoscopy finding. In alopecia areata black dots and micro-exclamation mark hairs and tapered hairs correlate with disease activity, whereas yellow dots and vellus hairs correlate with disease severity. In androgenic alopecia trichoscopy shows hair shaft thickness heterogeneity, multiple thin and vellus hairs, yellow dots, perifollicular discoloration, and predominance of follicular units with only one hair. These features predominate in the frontal area. In all forms of cicatricial alopecia, trichoscopy shows milky-red or ivory-white areas lacking follicular openings. In classic lichen planopilaris trichoscopy shows perifollicular inflammation, tubular perifollicular scaling, elongated, concentric blood vessels and "classic white dots", which merge to form white areas. Frontal fibrosing alopecia shows mild perifollicular scaling. Folliculitis decalvans is characterized by tufted hairs, large follicular pustules with emerging hair shafts and perifollicular starburst pattern hyperplasia. In dissecting cellulitis characteristic findings are "3D" yellow dots imposed over dystrophic hairs, large, yellow amorphous areas and pinpoint white dots with a whitish halo. Trichoscopy is particularly useful to diagnose hair shaft abnormalities in trichorrhexis nodosa, trichorrhexis invaginata, monilethrix, pili torti, and pili annulati. The method may be also useful in diagnosing inflammatory scalp diseases. In discoid lupus erythematosus trichoscopy shows large arborizing vessels and large hyperkeratotic folliculilar yellow dots. Trichoscopy of scalp psoriasis shows regularly distributed twisted and lacelike blood vessels, whereas in seborroic dermatitis thin arborizing vessels may be observed. In tinea capitis trichoscopy shows comma, corkscrew and zigzag hairs. Examination tinea capitis may be facilitated by UV-light enhanced trichoscopy (UVET). In conclusion, trichoscopy is a non-invasive method which may be applied in differential diagnosis of most hair and scalp diseases.

Sikatrisyel alopeside dermoskopik bulgular

“…Bazı yazarlar FD'da karakteristik vasküler bulguların olmadığını savunsa da, Ross ve ark. aktif hastalıkta epidermal ve infindubular akantozis ile ilişkili görülen interfoliküler kıvrımlı kapiller düğümlerin, alttaki süpürasyona reaktif bir fenomen olabileceğini vurgulamıştır 9,13,14 . Skatrisyel alopesiye sekonder olarak gelişen tek bir foliküler açıklıktan çıkan çok sayıda kılların varlığı (tufted folikülit) ise son yıllarda FD'ın ayırıcı özelliği olarak değerlendirilmektedir 9,12,14 .…”

“…aktif hastalıkta epidermal ve infindubular akantozis ile ilişkili görülen interfoliküler kıvrımlı kapiller düğümlerin, alttaki süpürasyona reaktif bir fenomen olabileceğini vurgulamıştır 9,13,14 . Skatrisyel alopesiye sekonder olarak gelişen tek bir foliküler açıklıktan çıkan çok sayıda kılların varlığı (tufted folikülit) ise son yıllarda FD'ın ayırıcı özelliği olarak değerlendirilmektedir 9,12,14 . Brocq'un psödopeladında dermoskopik özellikler tipik değildir ve tanı hem klinik hem de dermoskopik olarak diğer nedenlerin dışlanmasıyla koyulur 14 .…”

“…Skatrisyel alopesiye sekonder olarak gelişen tek bir foliküler açıklıktan çıkan çok sayıda kılların varlığı (tufted folikülit) ise son yıllarda FD'ın ayırıcı özelliği olarak değerlendirilmektedir 9,12,14 . Brocq'un psödopeladında dermoskopik özellikler tipik değildir ve tanı hem klinik hem de dermoskopik olarak diğer nedenlerin dışlanmasıyla koyulur 14 . Çalışmamızda foliküler açıklıkların görülmediği beyaz alanlar dışında bal peteği pigment paterni bu hastalıkta en sık görülen bulguydu.…”

Dermoscopic findings in psoriasis and seborrheic dermatitis on the scalp and correlation with disease severity

“…In addition, scalp and hair diseases can be diagnosed by dermoscopy. The term "trichoscopy" is also used to describe this method [4][5][6][7][8]. Zalaudek et al [9] even described dermoscopy as "the dermatologist's stethoscope" because of its increasing importance and daily use.…”

Trichoscopy of Hair Shaft: White Nodules

“…Trichoscopy, that corresponds to scalp and hair dermoscopy, is a tool each time more used in the diagnosis of capillary abnormalities and even considered by some authors as an indispensable tool in the differential diagnosis of hair and scalp diseases [1]. It represents a valuable noninvasive and low-cost method, still underutilized, which uses video dermoscopy of hair and scalp at higher magnifications (20-160) [2], and that has been increasingly used as an aid in the diagnosis, follow-up and prognosis of hair disorders [3].…”