Dermoscopy in General Dermatology: A Practical Overview

Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon's plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).

Trichoscopy of Tinea Capitis: A Systematic Review

INTRODUCTION

An increased incidence of tinea capitis has been observed over the last few decades. Trichoscopy is a non-invasive, in-office method helpful in establishing the correct diagnosis in patients with hair loss and inflammatory hair disorders. The objective was to review and analyze current data on the trichoscopy of tinea capitis.

METHODS

A systematic review of the literature was conducted using the PubMed, EBSCO and Scopus databases. The search terms included 'tinea capitis' combined with 'trichoscopy', 'dermatoscopy', 'dermoscopy', 'videodermatoscopy' or 'videodermoscopy'.

RESULTS

Of 326 articles, 37 were considered eligible for the quantitative analysis. The most characteristic (with a high predictive value) trichoscopic findings of tinea capitis included comma hairs (51%), corkscrew hairs (32%), Morse code-like hairs (22%), zigzag hairs (21%), bent hairs (27%), block hairs (10%) and i-hairs (10%). Other common, but not characteristic, trichoscopic features were broken hairs (57%), black dots (34%), perifollicular scaling (59%) and diffuse scaling (89%). Morse code-like hairs, zigzag hairs, bent hairs and diffuse scaling were only observed in Microsporum tinea capitis (8/29, 28%; 6/29, 21%; 4/29, 14% and 4/29, 14%, respectively). In Trichophyton tinea capitis, corkscrew hairs were more commonly detected compared to Microsporum tinea capitis (21/38, 55% vs 3/29, 10%).

CONCLUSION

The presence of characteristic trichoscopic features of tinea capitis is sufficient to establish the initial diagnosis and introduce treatment before culture results are available. Trichoscopy may be useful in distinguishing between Microsporum and Trichophyton tinea capitis.

Scalp dermatoscopic findings in androgenetic alopecia and their relations with disease severity

Background

Clinicians are searching for new methods to diagnose and predict the course of androgenetic alopecia noninvasively.

Objective

Our aim is to evaluate trichoscopic findings and their relations with disease severity in androgenetic alopecia.

Methods

The videodermatoscopic findings of 143 female and 63 male patients with androgenetic alopecia were compared with each other, with those of healthy subjects (n=100), and with those of patients with other nonscarring alopecias (n=208). Mann-Whitney U-test, χ² analyses, and logistic regression analysis were used for statistical analysis.

Results

No statistically significant relation was found between trichoscopic findings and severity in male androgenetic alopecia (MAGA) on the basis of the modified Hamilton Norwood scale (among 7 degrees); however, multihair follicular unit and perifollicular pigmentation were related to low severity whereas white dots, honeycomb pattern pigmentation, and brown dots were related to high severity. On the other hand, according to the Ludwig classification, arborizing red lines were related to low severity and brown dots were related to high severity, whereas there was no difference in stages between the Ebling and Olsen classifications in female androgenetic alopecia (FAGA). In the characteristic trichoscopic findings in this study, perifollicular pigmentation was found as a normal feature of the scalp, whereas multihair follicular unit and honeycomb pigment pattern, which were previously considered as normal features, were observed to be related to androgenetic alopecia.

Conclusion

No relation was found between MAGA severity and trichoscopic findings, as well as between FAGA severity according to different disease severity classifications and trichoscopic findings.

Syphilitic Alopecia: Case Reports and Trichoscopic Findings

There has been a resurgence of syphilis in the last decade. Although alopecia is not a common manifestation of the disease, the "moth-eaten" pattern is considered patognomonic. However, diffuse hair loss, termed essential alopecia, sometimes can be the only sign of syphilis infection and mimic other conditions, such as alopecia areata and telogen effluvium. We describe three patients with syphilis in whom the pattern of alopecia was not typical. Although clinical, histopathological, and trichoscopic examinations may share some similar findings with other hair diseases, the inclusion of syphilis in the differential diagnosis of hair loss causes is fundamental to a correct screening and diagnosis.

Telogen Effluvium after SARS-CoV-2 Infection: A Series of Cases and Possible Pathogenetic Mechanisms

INTRODUCTION

Physicians have largely studied the cutaneous involvement of coronavirus disease 2019 (COVID-19), but only few reports have focused on telogen effluvium (TE) as a possible sequela of COVID-19. We assessed 14 cases of hair loss occurring after SARS-CoV-2 infection using trichoscopy and trichogram to investigate patterns related to COVID-19. Furthermore, we discussed possible mechanisms involved in COVID-19 TE.

CASE PRESENTATION

Fourteen individuals were referred to our post-COVID-19 dermatology office complaining acute hair loss after SARS-CoV-2 infection. Clinical evaluation included pull test, trichoscopy, and trichogram. CO-VID-19 TE occurred after a median of 2 months (range 1-3 months) following SARS-CoV-2 infection. The median duration of hair loss was 5 months (range 1-6 months). Trichoscopy showed variable but typical TE patterns. Trichogram showed different telogen/anagen ratio depending on the interval between onset of hair loss and trichological visit.

DISCUSSION/CONCLUSION

Our cases showed TE between 1 and 3 months after the onset of SARS-CoV-2 infection, thus earlier than classic TE. Trichoscopic features and trichogram showed no variations from classic TE. Different pathogenetic mechanisms including pro-inflammatory cytokines and direct viral damage on the hair follicle can be hypothesized; further studies on a larger sample are needed to better understand this condition.

Efficacy and Tolerability of a Shampoo Containing Broad-Spectrum Cannabidiol in the Treatment of Scalp Inflammation in Patients with Mild to Moderate Scalp Psoriasis or Seborrheic Dermatitis

Introduction

Scalp inflammation is commonly associated with scalp psoriasis or seborrheic dermatitis. It can aggravate the progression of androgenetic alopecia and cause troublesome itching and burning. Here, we evaluate the efficacy of a shampoo containing 0.075% broad-spectrum cannabidiol in 50 subjects with mild to moderate scalp psoriasis or seborrheic dermatitis.

Methods

Inflammation was assessed by evaluating the density of twisted/glomerular or arborizing vessels by trichoscopy using a 6-point scale at baseline and day 14. Symptoms of itching/burning sensation, clinical evaluation of erythema/scaling, overall tolerability, and subject satisfaction were evaluated using 10-point scales.

Results

There were significant reductions in arborizing vessel/twisted capillary inflammation and scaling by day 14. Severity scores reduced from 2.3 ± 0.1, 2.6 ± 0.1, and 3.6 ± 0.1, respectively, to 0.5 ± 0.05, 0.8 ± 0.05, and 0.6 ± 0.05 (all p < 0.0001). Symptom scores of itching and burning also reduced significantly from 6.9 ± 0.1 to 4.5 ± 0.1 to 1.5 ± 0.05 and 1.0 ± 0.05 (both p < 0.0001). Severity of erythema and scaling was also significantly reduced from 5.5 ± 0.1 and 7.0 ± 0.1, respectively, to 1.3 ± 0.05 and 1.6 ± 0.05 (both p < 0.0001). Tolerability and subject satisfaction were both excellent. There were no significant differences in treatment effect, tolerability, or subject satisfaction between men and women.

Discussion/Conclusion

Replacing current shampooing practices with a broad-spectrum cannabidiol-containing shampoo significantly reduces both severity and symptoms of scalp inflammation within 2 weeks, with excellent tolerability and treatment satisfaction in subjects with mild to moderate scalp psoriasis or seborrheic dermatitis.

Scalp Itch: A Systematic Review

Scalp itch is a frequent complaint in the dermatological setting. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to propose a systematic approach to scalp itch, which classifies scalp pruritus into two types: (1) with or (2) without dermatological lesions, and presence or absence of hair loss. Also, it is important to think first about the most common causes and then rule out other, less common etiologies. The acronym SCALLP and the five steps for scalp evaluation (listen, look, touch, magnify, and sample) are useful tools to keep in mind for an assertive approach in these patients.

Clinical and Dermoscopic Features of the Scalp in 31 Patients with Dermatomyositis

BACKGROUND

Scalp involvement is not directly evaluated in patients with dermatomyositis (DM). Therefore, the exact frequency of scalp dermatomyositis (SDM) and its clinical and trichoscopic characteristics have been poorly described.

OBJECTIVE

The aim of this study was to determine the frequency and clinical and dermoscopic features of SDM in patients diagnosed with DM.

METHODS

We performed a descriptive prospective, cross-sectional observational study that included all patients diagnosed with DM at a Mexican academic institute over the course of a year.

RESULTS

Twenty-four out of 31 patients with DM had scalp involvement at clinical examination, with a prevalence of 77.4%. SDM was clinically characterized by erythema in all cases, scales in 20 (83.3%) patients, nonscarring alopecia in 21 (87.5%) patients, pruritus in 17 (70.8%) patients, and poikiloderma of the scalp in 16 (51.6%) patients. Twenty-eight patients were evaluated by trichoscopy. The most consistent finding was the presence of enlarged capillaries, found in 20 (71.4%) cases, followed by peripilar casts (57.1%) and tufting and interfollicular scales in 14 (50%) cases. Twenty-two patients also had positive nail fold capillaroscopic features similar to those observed by trichoscopy.

LIMITATIONS

The simple size was limited.

CONCLUSIONS

Scalp involvement and alopecia are common in patients with DM, and trichoscopy shows features similar to those found at capillaroscopy. Trichoscopy is a very important tool for diagnosis of scalp involvement in patients with DM.

Trichoscopy of Dark Scalp

Trichoscopy (dermoscopy of the hair and scalp) is a technique that improves diagnostic accuracy and follow-up with hair and scalp disorders. Although several studies of trichoscopy have been made in Caucasian and Asian populations, little has been published regarding trichoscopy findings in skin of color, despite the great prevalence of hair diseases in populations with this kind of skin. The aim of this review was to describe the trichoscopic features of normal scalp and of hair disorders in patients with dark skin phototypes. This will help dermatologists to distinguish between unique trichoscopic features of dark skin, and allow them to provide more accurate diagnoses and treatments for these patients.

Central Centrifugal Cicatricial Alopecia Presenting with Irregular Patchy Alopecia on the Lateral and Posterior Scalp

BACKGROUND

Central centrifugal cicatricial alopecia (CCCA) is the most common cause of scarring alopecia among women of African descent which affects the central scalp and spreads centrifugally but spares the lateral and posterior scalp.

OBJECTIVES

The objective of this study is to report on a new clinical variety of CCCA presenting with patchy alopecia involving the lateral and posterior scalp in addition to the central scalp.

MATERIALS AND METHODS

We reviewed the medical records and the clinical, dermatoscopic and pathologic data of 14 African-American women with CCCA presenting with patchy alopecia.

RESULTS

Two patients had individual well-delineated patches of hair loss, and 12 patients had multiple irregular patches of hair loss. In all cases, the alopecia affected the lateral and posterior scalp in addition to the central scalp. Four patients had a history of traumatic hairstyles, and 10 patients were also affected by marginal traction alopecia. On dermatoscopy, the patches showed peripilar white-gray halos and broken hairs. The pathologic diagnosis of CCCA was based on the following features: follicular dropout, absent or only focally preserved sebaceous glands, premature desquamation of the inner root sheath and perifollicular fibrosis with mild inflammatory infiltrate.

CONCLUSION

CCCA can present with patches of hair loss involving the parietal and posterior scalp in addition to the central scalp. Without dermatoscopy and pathology, this variety can be easily misdiagnosed as traction alopecia.

Hair Loss in Lichen Planopilaris and Frontal Fibrosing Alopecia: Not Always Irreversible

Introduction

We present 2 cases in which typically irreversible lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) showed signs of reversal.

Case Presentation

A 27-year-old Caucasian man presented with hair loss and intense pruritus on the vertex scalp for 4 years with biopsy-proven LPP and having failed multiple pharmacologic modalities. Six months after adding oral tofacitinib and later dapsone, he demonstrated reduced scalp visibility, evidence of crown and vertex hair regrowth, and elimination of itch. A 45-year-old premenopausal Hispanic woman presented with eyebrow loss for 3.75 years and hair loss for 9 months with biopsy-proven FFA. After beginning oral finasteride and hydroxychloroquine, triamcinolone injections, and topical minoxidil, she initially worsened over 11 months but subsequently improved over 6 months, demonstrating hair and eyebrow regrowth, reduction in glabella-hairline distance, and new absence of frontal hair line hyperkeratosis and inflammation.

Discussion/Conclusion

Cicatricial alopecia involves inflammation with JAK-STAT upregulation. We report a positive clinical response in LPP to tofacitinib, a JAK1/3 inhibitor, and dapsone, an anti-neutrophilic agent. FFA is believed to involve autoimmune and/or hormonal processes. Here we report a positive clinical response to androgenic and immune modulators.

Flame Hair

BACKGROUND

'Flame hairs' is a trichoscopic feature described as hair residue from pulling anagen hairs in trichotillomania.

OBJECTIVE

To detect whether flame hairs are present in other hair loss disorders.

METHODS

We retrospectively, independently and blindly reviewed the trichoscopic images of 454 consecutive patients with alopecia areata (99 cases), trichotillomania (n = 20), acute chemotherapy-induced alopecia (n = 6), acute radiotherapy-induced alopecia (n = 2), tinea capitis (n = 13), lichen planopilaris (n = 33), frontal fibrosing alopecia (n = 60), discoid lupus erythematosus (n = 30), dissecting cellulitis (n = 11), central centrifugal cicatricial alopecia (n = 94) and traction alopecia (n = 86) for the presence of flame hairs. We prospectively obtained trichoscopy-guided scalp biopsies from flame hairs in trichotillomania, alopecia areata, traction alopecia and central centrifugal cicatricial alopecia (1 case each).

RESULTS

Flame hairs were detected in 100% of the acute chemotherapy- and radiotherapy-induced alopecias, where they were the predominant hair abnormality. They were also found in trichotillomania (55%), alopecia areata (21%), traction alopecia (4%) and central centrifugal cicatricial alopecia (3%). On pathology, they corresponded to distorted hair shafts.

CONCLUSION

The flame hair is a type of broken hair which can be seen in various hair loss disorders. It results from traumatic pulling of anagen hairs or from anagen arrest due to inflammation or drugs. © 2015 S. Karger AG, Basel.

Trichoscopic Findings of Erosive Pustular Dermatosis of the Scalp Associated with Gefitinib

Alopecia associated with epidermal growth factor receptor (EGFR) inhibitor therapy is a rare cutaneous side effect with the potential to progress to scarring alopecia. Thus, dermatologists should make an early diagnosis. We present the case of a 57-year-old Japanese female with scarring alopecia associated with gefitinib, which is an EGFR inhibitor, including trichoscopic findings. The patient treated with gefitinib for non-small cell lung cancer experienced skin rash and hair loss of the scalp. The scalp lesions appeared similar to erosive pustular dermatosis of the scalp. Trichoscopic examination showed follicular keratotic plugging, milky red areas, white patches, hair shaft disorder, tapering hair, and absence of follicular opening. Histological examination showed ruptured hair follicles with a perifollicular infiltration of plasma cells, lymphocytes, and histiocytes. Oral minocycline and topical steroid treatment produced no improvement. With a reduction in the gefitinib dosage, alopecia gradually improved, although scarring remained. We consider these trichoscopic findings and suspect that follicular keratotic plugging might be a finding associated with scarring alopecia due to EGFR inhibitor therapy.

Blue-White Veil as Novel Dermatoscopic Feature in Discoid Lupus Erythematosus in 2 African-American Patients

Dermoscopic features of discoid lupus erythematosus (DLE) depend on the stage of the lesions: active lesions include yellow-brown dots and red dots, whereas longstanding inactive lesions show absence of follicular openings, cicatricial milky red or white patches, structureless white and brown areas, and thick arborizing vessels. Loss of pinpoint white dots, blue-gray dots in a speckled pattern, and a peripheral pigmented network have been described on dermoscopy of DLE in dark skin. We report a blue-white veil as a novel dermoscopic feature in 2 cases of biopsy-proven DLE in African-American patients. Dry trichoscopy revealed a central white area surrounded by irregular patchy areas of confluent blue and brown pigment and an overlying white "ground-glass" hue. This corresponds on pathology to the hyperkeratosis overlying interface changes at the dermal-epidermal junction, with pigment incontinence and melanophages in the papillary dermis.

A prospective study of tinea capitis in children: making the diagnosis easier with a dermoscope

INTRODUCTION

Tinea capitis is a scalp infection caused by different fungi. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. The association of clinical and dermatoscopic findings in suspected cases of tinea capitis may help the identification of the etiological agent, facilitating precocious, specific treatment.

MATERIALS AND METHOD

We report a prospective descriptive analytical study of 34 children with tinea capitis. We performed a trichoscopic examination of all patients; only six children were able to have the mycological culture.

RESULTS

Trichoscopy was abnormal in all 34 patients; it showed hair shaft abnormalities and, in some cases, scalp disorders too. We found that the comma and corkscrew appearance was found in microsporic tinea capitis, V-shaped hair was mainly seen in inflammatory tinea capitis, scales and follicular keratosis in non-inflammatory tinea capitis, and crusts and follicular pustules in inflammatory tinea capitis. Finally, erythema was seen in trichophytic and inflammatory tinea capitis.

CONCLUSION

We propose a classification of trichoscopic signs of tinea capitis. This classification will enable rapid diagnosis and prediction of the type of fungus before mycological culture, thus a faster and more adapted management. Our study shows the importance of trichoscopy in the diagnosis and monitoring of tinea capitis. We suggest further prospective studies with a larger number of patients with tinea capitis, having performed mycological culture, to confirm this classification.

Pressure-Induced Alopecia: Presence of Thin Hairs as a Trichoscopic Clue for the Diagnosis

Pressure-induced alopecia (PA) is an unusual pattern of circumscribed hair loss that occurs after ischemic changes on the scalp. Trichoscopic findings described in the literature are scarce, nonspecific, and include black dots, broken hairs, circle hairs, and erythema. However, we report 3 cases of PA in which trichoscopy also showed many vellus and thin hairs. Possibly, the maintenance of these hair shafts may be explained by the more superficial insertion of their bulbs on the skin and/or their lower metabolic rates, making them suffer less from local hypoxia. Therefore, the authors suggest that these relevant signs should be added as a clue for the diagnosis of PA in doubtful cases.

Hair Breakage in Patients of African Descent: Role of Dermoscopy

Dermoscopy represents a useful technique for the diagnosis and follow-up of hair and scalp disorders. To date, little has been published regarding dermoscopy findings of hair disorders in patients of African descent. This article illustrates how dermoscopy allows fast diagnosis of hair breakage due to intrinsic factors and chemical damage in African descent patients.

Use of Low-Cost Videomicroscopy versus Standard Videodermatoscopy in Trichoscopy: A Controlled, Blinded Noninferiority Trial

Affordable (USD ∼30) handheld USB digital microscopes, or videomicroscopes (VMs), that provide ×10-200 magnification are available on the web for nonmedical uses such as in botany, entomology, microelectronics or, recently, for hair/scalp evaluation. The aim of this study was to compare the reliability of low-cost VMs versus standard, medically marketed videodermatoscopes (VDs) in trichoscopy. Twenty-five patients affected by different types of hair loss were enrolled in a controlled, blinded noninferiority trial. All patients underwent examination by two low-cost VMs as well as by standard VD in order to evaluate any variability in the detection of common trichoscopic features. At the end of the study, the two low-cost VMs enabled a correct identification of all hair shaft alterations; as regards follicular and/or perifollicular examination, black dots were easily recognized by both equipments, but other follicular features, such as yellow dots, white dots and perifollicular scales, were not always adequately visualized because of low color quality and/or reduced brightness and/or resolution. In conclusion, our study suggests that the potential accuracy of low-cost VMs in the evaluation of hair loss may have some pitfalls. Therefore, a low-cost VM should not be routinely used for reliable scalp trichoscopy, unless supported by individual controlled noninferiority trials.

Trichoscopy of Steroid-Induced Atrophy

Intralesional corticosteroid (IL-CS) injections have been used to treat a variety of dermatological and nondermatological diseases. Although an important therapeutic tool in dermatology, a number of local side effects, including skin atrophy, have been reported following IL-CS injections. We recently noticed that a subset of patients with steroid-induced atrophy presented with ivory-colored areas under trichoscopy. We performed a retrospective analysis of trichoscopic images and medical records from patients presenting ivory-colored areas associated with atrophic scalp lesions. In this paper, we associate this feature with the presence of steroid deposits in the dermis and report additional trichoscopic features of steroid-induced atrophy on the scalp, such as prominent blood vessels and visualization of hair bulbs.

Distinct Trichoscopic Features of the Sideburns in Frontal Fibrosing Alopecia Compared to the Frontotemporal Scalp

The trichoscopic features of frontal fibrosing alopecia (FFA) have been described in the frontotemporal area, yet there is no data detailing the trichoscopic features of the sideburns, which can be the initial or exclusive area of involvement. In this retrospective cohort study, 236 trichoscopic images of the frontotemporal and sideburn area obtained via dry trichoscopy from patients with biopsy-proven FFA were examined by two independent researchers to determine the trichoscopic features of FFA in the sideburns. The images of the sideburns were compared to 44 trichoscopic images of 11 healthy volunteers with intact sideburns. Transparent proximal hair emergence surrounded by patches of paler smooth skin was the most prominent finding in the sideburns. Peripilar casts and peripilar erythema were rare in the sideburns compared to the frontotemporal area. Although less common, transparent proximal hair emergence was also seen in the sideburns of healthy controls, yet it was shorter and restricted to individual hairs. Early FFA presenting exclusively or mostly with sideburn involvement should not be missed due to absence of peripilar casts and peripilar erythema. Dermoscopy-guided biopsy obtained from hair shafts with transparent proximal hair emergence should be considered to make the diagnosis in this location.

Evaluation of Hair Density in Different Ethnicities in a Healthy American Population Using Quantitative Trichoscopic Analysis

Background

There is limited research into normative hair density values in individuals of Hispanic descent.

Methods

In order to help establish baseline density values in these individuals, we evaluated the hair density in 99 Americans of Hispanic descent and compared them with the values in 44 individuals of African descent and 23 Caucasians. Participants were recruited from a New York City medical center and self-identified their ethnicity. Biracial individuals were excluded from the study.

Results

The hair density means ± SD ranged from 169 ± 31 to 178 ± 33/cm² in Americans of Hispanic descent, from 148 ± 25 to 160 ± 27/cm² in individuals of African descent, and from 214 ± 28 to 230 ± 33/cm² in Caucasian individuals. All differences in hair densities between the ethnicities were statistically significant (p values ranging from 3.03 × 10^-14 to 0.0249).

Conclusion

While trichoscopy is not as accurate as invasive histological assessment of hair density or phototrichogram, it is still a reliable and fast method for assessing hair density. Increased awareness of ethnic variances in hair density can help clinicians and researchers diagnose hair disorders, monitor response to therapy, and conduct hair-related research in these patients.

Comparison between single- versus double-spin prepared platelet-rich plasma injection in treatment of female pattern hair loss: clinical effect and relation to vascular endothelial growth factor

Platelet-rich plasma (PRP) provides a treatment option for female pattern hair loss (FPHL). However, the most suitable preparation method is not yet clear. The primary aim is to compare between the efficacy of single- versus double-spin PRP preparation injection in the treatment of FPHL, while the secondary aim is to assess the relationship between vascular endothelial growth factor (VEGF) concentrations in different prepared PRP preparations (pre- and post-activation) and the obtained treatment results. 15 female patients with FPHL were subjected to intradermal injection of double-spin prepared PRP into the right (Rt) half of the scalp and single-spin prepared PRP into the left (Lt) half of the scalp, three sessions, 3 weeks apart. Evaluation of treatment response was done through comparing patients' photographs, patients' satisfaction and trichoscopic assessment (measurement of terminal hair density) before and after treatment. In addition, VEGF concentration was measured in different PRP samples before and after activation with calcium gluconate. Results showed clinical improvement in both sides of scalp 6 weeks after last PRP session. Meanwhile, Rt median terminal hair density measured by trichoscan following treatment was significantly higher compared to Lt median terminal hair density. Furthermore, VEGF concentration did not differ significantly in single- versus double-spin prepared PRP, or upon calcium activation. PRP is effective in treatment of FPHL. Double-spin method could yield better results than single-spin method. Adding calcium gluconate prior to PRP injection is of no value.

Comparison of 5% minoxidil lotion monotherapy versus its combination with autologous platelet rich plasma in androgenetic alopecia in hundred males

Background

Androgenetic alopecia (AGA) is the most common form of alopecia in men, affecting 70% by the age of 20 years. The present study was conducted with the objective of comparing the efficacy of monotherapy with topical 5% minoxidil and its combination with intradermal platelet rich plasma (PRP), in male AGA.

Methods

This observational study was conducted at the dermatology department of a tertiary care hospital over a duration of 2 years. 100 patients with AGA were selected and divided randomly into 2 treatment arms: Group A (MM): received topical 5% Minoxidil monotherapy for 12 months and; Group B (M + PRP): received combination therapy of PRP and topical 5% Minoxidil for 12 months. The following parameters were subsequently analyzed on follow up: Physician-assessed global photography by a 4-point improvement scale and trichoscopic improvement of mean hair diameter.

Results

The combination was statistically superior to the monotherapy group in promoting hair growth in men with AGA for both measures of hair growth - photographic assessment and trichoscopic mean diameter.

Conclusion

We hereby conclude that intradermal PRP injections should be offered to all patients with AGA along with the existing therapeutic modalities, for faster hair regrowth and improved compliance.

Noncorticosteroid Combination Shampoo versus 1% Ketoconazole Shampoo for the Management of Mild-to-Moderate Seborrheic Dermatitis of the Scalp: Results from a Randomized, Investigator-Single-Blind Trial Using Clinical and Trichoscopic Evaluation

PURPOSE

The aim of this study was to assess the efficacy and tolerability of a combination noncorticosteroid, antiinflammatory/antifungal shampoo versus 1% ketoconazole shampoo in the treatment of mild-to-moderate scalp seborrheic dermatitis (SD).

PROCEDURES

Twenty patients were randomized to using the combination shampoo (group A, 10 patients) or the 1% ketoconazole shampoo (group B, 10 patients) 3 times a week every other day for 8 weeks. Efficacy was evaluated by measuring the degree of scaling and pruritus by clinical and trichoscopic examination using a 4-point scale. Additionally, a physician global assessment (PGA) was assessed at the end of the study.

RESULTS

At 4 weeks, there was a significant reduction of scaling from baseline for both groups, while pruritus showed a significant reduction only for group A. After 8 weeks, there was a significant reduction of scaling and pruritus for both groups. PGA showed a complete response in 90% of the cases in both groups.

CONCLUSIONS

The results of our study demonstrate that the combination noncorticosteroid, antiinflammatory/antifungal shampoo represents an alternative approach to standard topical treatment for scalp SD. A noncorticosteroid shampoo may be equally safe and effective as ketoconazole shampoo for scalp SD, and trichoscopy provides accurate and reliable quantifiable data to assist in therapeutic monitoring.

Diagnostic Accuracy of Trichoscopy in Inflammatory Scalp Diseases: A Systematic Review

BACKGROUND

The common inflammatory scalp diseases, such as psoriasis, seborrheic dermatitis, lichen planopilaris, discoid lupus erythematosus, contact dermatitis, or pemphigus may share similar clinical features.

OBJECTIVE

To identify and systematically review the available evidence on the accuracy of trichoscopy in inflammatory scalp disorders.

METHODS

A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 58 articles were included in the analysis.

RESULTS

The following trichoscopy features were found to show the highest specificity for the respective diseases: in psoriasis: diffuse scaling, simple and twisted red loops, red dots and globules, and glomerular vessels; in seborrheic dermatitis: atypical vessels, thin arborizing vessels, and structureless red areas; in discoid lupus erythematosus: follicular plugs and erythema encircling follicles; in lichen planopilaris: milky red areas or fibrotic patches; in contact dermatitis: twisted red loops; in pemphigus foliaceus: white polygonal structures and serpentine vessels; in pemphigus vulgaris: red dots with whitish halo and lace-like vessels; and in dermatomyositis: lake-like vascular structures.

LIMITATIONS

Different nomenclature and variability in parameters, which were analyzed in different studies.

CONCLUSION

This systemic analysis indicates that trichoscopy may be used with high accuracy in the differential diagnosis of inflammatory scalp diseases.