Trichoscopy of Cicatricial Alopecia
June 2012 | Volume 11 | Issue 6 | Original Article | 753 | Copyright © June 2012
Trichoscopy is widely used in differential diagnosis of non-cicatricial alopecia.
The aim of this prospective study was to identify possible characteristic trichoscopy patterns of diseases leading to primary
Trichoscopy was performed in a total of 1,884 consecutive patients presenting with hair loss. In this group, 84 patients were diagnosed
with cicatricial alopecia and 1,800 patients with non-cicatricial alopecia. Sixty healthy persons served as healthy controls. Trichoscopy
was performed with the use of Fotofinder II videodermoscopy system. Following unique or characteristic features were identified: scattered
dark-brown discoloration of the skin, large yellow dots and thick arborizing vessels in cutaneous (discoid) lupus erythematosus (n=20), tubular
perifollicular scaling and elongated blood vessels in lichen planopilaris (n=28), minor perifollicular scaling in frontal fibrosing alopecia (n=19), tufted
hairs with starburst pattern perifollicular hyperplasia in folliculitis decalvans (n=9) and large, "3D" yellow dots imposed over dystrophic hairs in
dissecting cellulitis (n=8).
All patients with cicatricial alopecia trichoscopy showed white and milky-red areas lacking follicular openings. These features
were not found in patients with non-cicatricial alopecia or healthy controls.
These results indicate that trichoscopy may be applied as a quick and non-invasive auxiliary method in differential diagnosis
of diverse diseases leading to cicatricial alopecia, such as cutaneous lupus erythematosus, classic lichen planopilaris, frontal fibrosing
alopecia, folliculitis decalvans, and dissecting cellulitis.
J Drugs Dermatol
The term “primary cicatricial alopecia” refers to a diverse
group of disorders having as a common final pathway
the destruction of the hair follicle unit.1 According to the
North American Hair Society working classification of cicatricial
alopecia, primary cicatricial alopecia may be divided into:
lymphocytic [lichen planopilaris (LPP), Graham Little syndrome,
frontal fibrosing alopecia (FFA), pseudopelade Brocq, central
centrifugal cicatricial alopecia, chronic cutaneous lupus erythematosus
(discoid lupus erythematosus, DLE), keratosis follicularis
spinulosa decalvans], and neutrophilic [folliculitis decalvans
(FD), tufted folliculitis] and mixed [dissecting cellulitis (DC), folliculitis
keloidalis] and end-stage nonspecific group.2,3
Trichoscopy (hair and scalp dermoscopy) is a newly developed
method of hair imaging and analysis, based on dermoscopy or
videodermoscopy of hair and scalp.4,5 The method allows visualization
of hair shafts at high magnification without the need of
removing hair for diagnostic purposes and in vivo analysis of the
epidermal portion of hair follicles and perifollicular epidermis.5
Several reports raise the issue of potential usefulness of this technique
in diagnosing hair and scalp disorders, such as androgenic
alopecia,6-8 alopecia areata,9-12 tinea capitis,13-15 inherited hair shaft
abnormalities,16-22 and other hair and scalp diseases.23-25
The aim of the study was to establish usefulness of trichoscopy in
diagnosing primary scarring alopecia and to analyze trichoscopy
features of different diseases leading to primary cicatricial alopecia.
MATERIALS AND METHODS
Trichoscopy (hair and scalp dermoscopy) was performed in 1,884
consecutive adult patients who visited the Hair Clinic at Department
of Dermatology, CSK MSWiA in Warsaw, Poland. All patients
were Caucasian. In this group, 4.4% (84 of 1,884) of patients were
diagnosed with primary cicatricial alopecia (20—DLE, 28—LPP,
19—FFA 8—DC and 9—FD). A proportion of 18 out of 20 (90%), 22
of 28 (78%), 19 of 19 (100%), 0 of 8 (0%) and 0 of 9 (0%) of patients,
respectively, were females. In all cases, the diagnosis was based
on anamnesis, clinical presentation, and histopathological examination
of biopsies taken from the edge of the lesion. In all patients
with DLE, direct immunofluorescence of lesional skin was positive.
The control group consisted of 1,800 patients with various
forms of non-cicatricial alopecia, including androgenic alopecia,
telogen effluvium, and alopecia areata. Sixty healthy subjects
served as an additional control group.
In patients with DLE, 15 active lesions and 17 inactive lesions
were examined by trichoscopy and evaluated separately. Active
lesions were defined as lesions that developed or enlarged within
3 months preceding trichoscopy examination.
Trichoscopy was performed with Fotofinder II videodermoscope.
Images of the scalp were taken at a 20-fold magnification, which
allows high quality enlargement of 1 cm2 of scalp area to the size of
a computer screen and at a 70-fold magnification, which magnifies
in a similar manner an area of 9 mm.2 In each case the examination
was performed with immersion fluid (70% ethanol) and without