Trichoscopy of Discoid Lupus Erythematosus in the Black Scalp: A Literature Review.

Discoid lupus erythematosus (DLE) is the most common type of chronic cutaneous lupus erythematosus. It is more frequent in adult women, particularly black race. Scalp DLE has an earlier onset and a more severe clinical course in black patients compared to Caucasians. Nevertheless, studies on this population remain scarce. The aim of this study was to review the literature and summarize the most frequent trichoscopic findings of scalp DLE among patients with a higher phototype. The main trichoscopic findings of DLE on black scalp are interruption of the honeycomb pattern, reduction, or absence of pinpoint white dots, keratotic follicular plugs and peripilar casts, blue-gray dots in a speckled pattern, and large tortuous arboriform vessels. Knowledge of these and other changes enables an early diagnosis of these individuals, preventing cicatricial sequelae and reducing its impact on quality of life.

Hair-to-Hair Trichoscopy: An Objective Method to Assess Effectiveness of Botulinum Toxin in a Clinical Trial for Androgenetic Alopecia.

Introduction: Androgenetic alopecia (AGA) is the most common alopecia affecting both genders leading to a potential decrease in quality of life and self-esteem. A current concern in trichology is how to accurately measure clinical response in both daily medical practice and academic research. Hair-to-hair (H2H)-matching technology™ has recently emerged as a technique to evaluate variations in follicular units, hair shaft number, and thickness. This study aimed to describe the methodology employed in a clinical trial using this technology to test the efficacy of botulinum toxin (BT) for male AGA. Methods: This pilot study is a triple-blind, randomized, split scalp, placebo-controlled clinical trial. Patients enrolled were submitted to injections half of the scalp with 50 IU of BT and the other half with 1 mL of normal saline as a control. The trial involved three visits (weeks 0, 12, and 24) and 8 global clinical photographs followed by H2H-matching trichoscopy were captured before the injections at each visit. Paired t test analysis was employed for matched pairs of the following parameters: total hair count, the total number of terminal hair strands, average shaft thickness, and the number of hairs lost or gained during each visit. Then, the software compared the differences between the two sides (BT vs. placebo) per scalp zone and a long time. Conclusion: The combination of manually corrected image processing, follicular map, and H2H-matching technology™ appears to be the most precise way to evaluate changes in hair count and thickness over time. The design is reproducible and can help other researchers and dermatologists in their clinical practice to obtain reliable results in similar scientific research.

Scalp Seborrheic Dermatitis: What We Know So Far.

Scalp seborrheic dermatitis (SSD) is a prevalent chronic, relapsing inflammatory skin disease. The etiology is related to sebum production, bacterial proliferation - Staphylococcus sp., Streptococcus, and M. restricta - and host immunity factors - NK1+, CD16+ cells, IL-1, and IL-8. Trichoscopy features include mostly arborizing vessels and yellowish scales. New trichoscopic findings were described to guide the diagnosis as dandelion vascular conglomerate, "cherry blossom" vascular pattern, and intrafollicular oily material. Antifungals and corticosteroids constitute the essential therapy, but new treatments have been described. This article aims to review and discuss the etiology, pathophysiology, trichoscopy, histopathologic findings, main differential diagnoses, and therapeutic options of SSD.