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

Trichoscopy is a diagnostic tool for hair and scalp diseases. It was recently shown that it also allows the identification of features associated with disorders that typically don't affect the scalp. The aim of this article was to analyze and outline the usefulness of trichoscopy in suspecting such diseases. Connective tissue diseases were the most investigated systemic diseases in regard to trichoscopy. The most common features of systemic lupus erythematosus, systemic sclerosis, and dermatomyositis are thick arborizing and tortuous vessels. Avascular areas are present in systemic sclerosis. Spermatozoa-like vessels may be observed in cutaneous T-cell lymphomas, while salmon-colored areas with arborizing and linear vessels can be seen in patients with cutaneous B-cell lymphomas. In patients with advanced multiple myeloma, follicular spicules may be observed. Trichoscopic features of angiosarcomas include pink areas, red polymorphic areas, and dark red to purple areas. Polymorphous vessels and yellowish areas on a pink background are the predominating trichoscopy features of metastases of malignant tumors to the scalp. Cutaneous sarcoidosis is characterized by orange-colored areas and telangiectasias. Systemic amyloidosis may manifest with salmon-colored perifollicular halos, while the most common trichoscopic features of syphilitic alopecia are: a decreased number of hairs per follicular unit, vellus hairs, background erythema, focal atrichia and yellow dots. In conclusion, dermatologists may suspect some systemic diseases on the basis of trichoscopy findings.

The value of dermoscopy in diagnosing eyebrow loss in patients with alopecia areata and frontal fibrosing alopecia

INTRODUCTION

Alopecia areata and frontal fibrosing alopecia are common causes of eyebrow loss (madarosis).

OBJECTIVE

Assessment of trichoscopic markers of eyebrow loss in alopecia areata and frontal fibrosing alopecia.

MATERIALS AND METHODS

The analysis included 50 patients with scalp alopecia areata with madarosis, 50 patients with scalp frontal fibrosing alopecia with madarosis and 50 healthy controls. In every case, trichoscopy of the eyebrow area was performed.

RESULTS

Empty follicular and eccrine duct openings were observed in all patients and presented predominantly as yellow dots. Exclamation mark hairs were only detected in patients with alopecia areata (30%). Tapered hairs, broken hair, black dots and Pohl-Pinkus constrictions were observed in 14%, 36%, 26% and 4% of patients with alopecia areata, respectively, 4%, 16%, 2% and 0% of patients with frontal fibrosing alopecia, respectively, and they were not present in healthy controls. Dystrophic hairs and whitish areas were observed only in patients with frontal fibrosing alopecia (28% and 32%, respectively). Eyebrow regrowth in distinct directions was present in 32% of patients with frontal fibrosing alopecia, 8% of patients with alopecia areata and 4% of healthy controls. Diffuse erythema was detected in 60% of patients with alopecia areata and frontal fibrosing alopecia and 56% of healthy controls. Vellus hairs and upright regrowing hairs were observed in patients with alopecia areata (62% and 58%, respectively), frontal fibrosing alopecia (60% and 84%, respectively) and healthy controls (100% and 100%, respectively).

CONCLUSION

Trichoscopy of the eyebrow area is useful in diagnosing patients with isolated eyebrow loss. The most characteristic trichoscopic features of eyebrow loss in alopecia areata include exclamation mark hairs, tapered hairs, broken hairs and black dots. Frontal fibrosing alopecia of the eyebrows is characterized by the presence of dystrophic hairs, white areas and eyebrow regrowth in distinct directions.