Clinical evaluation of alopecias using a handheld dermatoscope
ABSTRACT There are numerous reports of the value of videodermatoscopy in the clinical evaluation of alopecia. Studies performed with a handheld dermatoscope are scarce and limited to a few disease entities.
The aim of this study was to evaluate the potential benefit of a handheld dermatoscope in the clinical diagnosis of alopecia.
In all, 144 patients with alopecia and 144 age- and sex-matched control subjects were enrolled in the study. Diagnoses were established clinically, and confirmed by scalp biopsy in doubtful cases. Dermatoscopic examination was performed by a polarized-light handheld dermatoscope with a 10-fold magnification. The images were obtained by a digital camera with a 3-fold optical zoom.
The dermatoscopic patterns of circular hairs, dirty dots, epidermal scale, and pustules showed no statistically significant difference between patients and control subjects. The following features were significantly more common, or observed solely, in particular types of alopecia: hair diameter diversity, peripilar sign, and empty follicles in androgenetic alopecia; yellow dots, black dots, tapering hairs, and broken hairs in alopecia areata; absence of follicular openings, tufted hairs, white dots, follicular hyperkeratosis, pili torti, red dots, honeycomb pigment pattern, pink-white appearance, crusts, and pustules in primary cicatricial alopecias.
Evaluation of all primary cicatricial alopecias in the same cluster.
We suggest that a polarized-light handheld dermatoscope attached to a digital camera provides a practical and useful aid for the clinical diagnosis of alopecias.
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- "In the current study pig tail regrowing hair was reported in 15.0% (3 out of 20 patients) of alopecia areata patients; this finding was detected in other studies . We observed that pig tail growing hair is not common, but if present it is a diagnostic trichoscopic finding and is a possible sign of spontaneous remission of alopecia areata. "
ABSTRACT: Background. Diagnosis of patchy hair loss in pediatric patients is often a matter of considerable debate among dermatologists. Trichoscopy is a rapid and noninvasive tool to detect more details of patchy hair loss. Like clinical dermatology, trichoscopy works parallel to the skin surface and perpendicular to the histological plane; like the histopathology, it thus allows the viewing of structures not discovered by the naked eye. Objective. Aiming to compare the different trichoscopic features of tinea capitis and alopecia areata in pediatric patients. Patients and Methods. This study included 40 patients, 20 patients with tinea capitis and 20 patients with alopecia areata. They were exposed toclinical examination, laboratory investigations (10% KOH and fungal culture), and trichoscope examination. Results. Our obtained results reported that, in tinea capitis patients, comma shaped hairs, corkscrew hairs, and zigzag shaped hairs are the diagnostic trichoscopic features of tinea capitis. While in alopecia areata patients, the most trichoscopic specific features were yellow dots, exclamation mark, and short vellus hairs. Conclusion. Trichoscopy can be used as a noninvasive tool for rapid diagnosis of tinea capitis and alopecia areata in pediatric patients.Dermatology Research and Practice 06/2014; 2014:848763. DOI:10.1155/2014/848763
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- "Even amongst the white population, the number of yellow dots observed in FPHL cases were 20% higher on ×70 magnification versus ×20 magnification, making it a relatively unreliable finding. Presence of yellow dots is a finding present in alopecia areata, trichotillomania, in addition to AGA; wherein, in a recent study it was found to be significantly higher in alopecia areata. The same study showed that HDD was present in all cases of AGA and was significantly higher than in other forms of hair loss. "
ABSTRACT: Female pattern hair loss (FPHL) presents with visible patterns of hair loss, thus making a bedside diagnosis possible. However, there are cases of FPHL presenting without any visible hair thinning, making it necessary to subject them to a scalp biopsy to make a diagnosis. The aim of the following study is to determine if trichoscopy can be used as a bedside tool to diagnose Early FPHL in women presenting without any visible thinning of hair, using >20% hair diameter diversity - anisotrichosis, as the diagnostic criteria. Trichoscopy was performed on 20 cases of early FPHL (biopsy proven), 63 normal controls and 29 Grade 2 FPHL Controls. In the biopsy proven FPHL cases, 75% showed anisotrichosis on trichoscopy. This finding was significantly higher in FPHL Cases compared to normal controls. As expected, 93% of Grade 2 FPHL controls also showed the same finding. Trichoscopy was found to be 75% sensitive and 61.54% specific in diagnosing early FPHL. Thus, a negative result would be more indicative of absence of disease, however, a positive result would not always indicate the presence of disease.International Journal of Trichology 07/2013; 5(3):121-5. DOI:10.4103/0974-7753.125603
Chapter: Alopecias em Cosmiatria[Show abstract] [Hide abstract]
ABSTRACT: 1. A queixa de queda de cabelo está entre as mais frequentes nos consultórios dermatológicos, especialmente entre jovens e mulheres. 2. Reconhecer as características do couro cabeludo e do ciclo do cabelo normal é fundamental para definir alterações referidas pelo paciente. 3. Anamnese cuidadosa e exame clínico, acompanhados de dermatoscopia, caracterizam a maioria dos diagnósticos. 4. Avaliações complementares, como estudo microscópico dos fios em queda e biópsia de couro cabeludo, podem ser necessárias nos casos desafiadores. 5. Uma biópsia adequada de couro cabeludo, obtida por punch 4 ou 6 mm, avaliada por um dermatopatologista experiente pode fornecer dados valiosos ao diagnóstico. I INTRODUÇÃO Mitos, lendas e superstições cercam as referências his-tóricas do cabelo. Ele é uma das características huma-nas mais variáveis. Cor, comprimento, densidade e pen-teado caracterizam diversas raças, religiões e aspectos políticos e etários. Desde os relatos bíblicos de Sansão e suas longas tranças, o cabelo se relaciona à força. Sua modelagem está relacionada à sedução, especialmente no sexo feminino, e à moda, determinando padrões de beleza. Os estudos de Hipócrates (460 a.C.) incluíram a ob-servação de que crianças e eunucos não desenvolviam calvície. Desde então, muito se desenvolveu no reco-nhecimento e caracterização clínica das diversas formas de alopecia. Os estudos do ciclo do cabelo de Kligman, nos anos 1950, foram a base para determinar os padrões do tricograma. A compreensão e o reconhecimento dos aspectos histológicos do couro cabeludo ganharam for-ça com as observações de Headington, avaliando cortes transversais de amostras de couro cabeludo, na década de 1980. Nos anos seguintes, a utilização da dermatos-copia do couro cabeludo, ou tricoscopia, trouxe novos dados para a prática diária do consultório, responsável por grande número de publicações na área atualmente. A queda de cabelo está dentre as causas mais fre-quentes de visita ao dermatologista, especialmente em mulheres e adultos jovens. A importância psicossocial dos cabelos se reflete na ansiedade e sofrimento, muitas vezes desproporcional, referido pelos pacientes. Neste capítulo, serão discutidos aspectos básicos do couro cabeludo, além de critérios de avaliação clínica, métodos complementares e conduta inicial nos diagnósti-cos mais prevalentes na prática diária do dermatologista.TRATADO DE CIRURGIA DERMATOLÓGICA, COSMIATRIA E LASER, 1a edição edited by ELIANDRE PALERMO et al, 01/2012: chapter COSMIATRIA: pages 207-222; Elsevier., ISBN: 978853526931-4