Trichoscopic findings in children and adults with alopecia areata: A comparative study.

BACKGROUND: Alopecia areata is a chronic and relapsing condition that affects individuals of all age groups. Dermoscopy is a popular and non-invasive method for diagnosing alopecia areata. This study aimed to analyze dermoscopic findings and their relationship with age, gender, appearance, and clinical signs in children and adults. METHODS: This retrospective cross-sectional study was conducted on 124 children and adults diagnosed with alopecia areata who were referred to a Hospital in Iran between 2021 and 2022. After reaching the calculated sample size, trichoscopic findings were examined and the results were recorded. Data analysis was performed by a statistician and presented in relevant tables. RESULTS: The participants in the study comprised 53.2% female children, 46.8% male children, 27.42% adult males, and 72.58% adult females. The median age in the pediatric group was 10 years, while it was 27 years in the adult group. Yellow dots were significantly less observed in children than in adults (29% vs. 48.4%), while exclamation mark hairs were significantly more common in children than adults (38.7% vs. 21%). No significant differences were found in the frequency of other trichoscopic features between children and adults. Specifically, black dots, broken hairs, short vellus hairs, pigtail hairs, and empty follicular openings were observed in 38.7%, 40.3%, 32.3%, 11.3%, and 75.8% of children, respectively, and in 35.5%, 32.3%, 21%, 46.8%, and 12.9% of adults, respectively. CONCLUSION: The most common trichoscopic findings in alopecia areata in children are empty follicular openings and broken hairs, while exclamation mark hairs are more common in children than adults. In contrast, yellow dots are less frequently observed in children compared to adults. This distinct difference between children's and adults' dermoscopic findings highlights the critical need for age-specific considerations in AA evaluations.

Linear alopecia in pediatrics: RCM and dermoscopy reveal diagnostic cues.

BACKGROUND: Alopecia areata (AA), trichotillomania (TM), nevus sebaceous (NS), and linear scleroderma en coup de sabre (LSCS) can all present with a patch of linear alopecia, making diagnosis challenging. The purpose of this study was to combine reflectance confocal microscopy (RCM) and dermoscopy in the diagnosis of these lesions in children. METHODS: A total of 36 patients with linear alopecia were enrolled, of whom 14 had AA, seven had TM, nine had NS, and six had LSCS. We evaluated the characteristics and distinguishing features of the four conditions using RCM and dermoscopy. RESULTS: The key to differential diagnosis was the dermal Hair follicle density in the dermis was decreased in AA, and the size and density of the follicular openings were normal in TM. In NS, the major features were petal-like and frogspawn-like structures. In LSCS, dermal papillary rings, sebaceous glands, and follicles were partially or completely missing, and abundant fibrous material was distributed in the dermis. Dermoscopy revealed alopecia, and all four conditions resulted in decreased hair density. AA patients exhibited yellow dots, black dots, and exclamation mark hairs. TM patients presented with irregularly broken hairs and blood spots. Both NS and LSCS patients exhibited an absence of follicular openings; NS patients demonstrated whitish and yellowish round structures, while an atrophic area with white patches, linear vessels, and no yellow or black dots was observed in LSCS patients CONCLUSION: RCM combined with dermoscopy can provide additional information on disease states and differentiate between AA, TM, NS, and LSCS.

Diagnosis and differential diagnosis of tertiary androgenetic alopecia with severe alopecia areata based on high-resolution MRI.

BACKGROUND AND AIM: No previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using high-resolution magnetic resonance imaging (HR-MRI). This study aimed to explore the value of HR-MRI in assessing alopecia. MATERIALS AND METHODS: Forty-eight people were included in this study. The imaging indicators of the vertex and occipital scalp were recorded and compared. The logistic regression model was developed for the indicators that differed between tertiary androgenetic alopecia and severe alopecia areata. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic efficacy of the model for tertiary androgenetic alopecia and severe alopecia areata. RESULTS: At the vertex, the thickness of the subcutaneous tissue layer, follicle depth, relative follicle depth, total number of follicles within a 2-cm distance, and number of strands reaching the middle and upper third of the subcutaneous fat layer within a 2-cm distance were statistically different between patients with tertiary androgenetic alopecia, those with severe alopecia areata, and healthy volunteers (p < 0.05). The logistic regression model suggested that the subcutaneous tissue layer thickness was important in discriminating tertiary androgenetic alopecia from severe alopecia areata. The ROC curve showed that the area under the curve, sensitivity, specificity, and best cutoff values of the subcutaneous tissue layer were 0.886, 94.4%, 70%, and 4.31 mm, respectively. CONCLUSIONS: HR-MRI can observe the changes in anatomical structures of the scalp and hair follicles in patients with alopecia. HR-MRI can be applied to the differential diagnosis of tertiary androgenetic alopecia and severe alopecia areata.

Actualización en tricoscopia / Trichoscopy: An Update

La tricoscopia es una técnica sencilla y no invasiva que se puede realizar durante la consulta con un dermatoscopio manual o digital. Esta herramienta ha ganado popularidad en los últimos años, ya que la visualización e identificación de estructuras y signos característicos puede ser la clave en el diagnóstico de alopecias y enfermedades del cuero cabelludo. El enfoque de esta revisión es el estudio y actualización de los hallazgos tricoscópicos en las alopecias más frecuentes en la práctica clínica habitual. Así pues, existen algunas alopecias como la alopecia areata, la tricotilomanía o la alopecia frontal fibrosante en las que los hallazgos con la tricoscopia resultan clave para su diagnóstico y seguimiento. El reconocimiento de estas estructuras distintivas puede ser de gran ayuda y, por ello, como dermatólogos debemos estar familiarizados con las mismas (AU)

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia (AU)

[Translated article] Trichoscopy: An Update / Actualización en tricoscopia

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia (AU)

La tricoscopia es una técnica sencilla y no invasiva que se puede realizar durante la consulta con un dermatoscopio manual o digital. Esta herramienta ha ganado popularidad en los últimos años, ya que la visualización y la identificación de estructuras y de signos característicos puede ser la clave en el diagnóstico de alopecias y enfermedades del cuero cabelludo. El enfoque de esta revisión es el estudio y la actualización de los hallazgos tricoscópicos en las alopecias más frecuentes en la práctica clínica habitual. Así pues, existen algunas alopecias, como la alopecia areata, la tricotilomanía o la alopecia frontal fibrosante, en las que los hallazgos con la tricoscopia resultan clave para su diagnóstico y su seguimiento. El reconocimiento de estas estructuras distintivas puede ser de gran ayuda y, por ello, como dermatólogos debemos estar familiarizados con ellas (AU)

Trichoscopy pattern and evaluation of serum vitamin D status in alopecia areata.

BACKGROUND: Vitamin D (VD) insufficiency has been linked to a number of autoimmune illnesses including, alopecia areata (AA). To distinguish between clinically common hair problems, trichoscopy is a beneficial non-invasive, rapid, and affordable procedure that is yet neglected. OBJECTIVE: to evaluate trichoscopic patterns and severity in various clinical categories of AA considering vitamin D level (VDL). Also, focusing on specific patterns of trichoscopy in AA related to VDL. SUBJECT AND METHODS: Severity of Alopecia Tool (SALT) was used to clinically assess patients with AA scores. Trichoscopic patterns were analyzed concerning VDL and disease severity. The VDL was estimated for 59 patients and 60 healthy controls. RESULTS: VDL was higher in healthy controls than in AA patients. The most common trichoscopic findings seen in our study were yellow dots (77.97%), followed by black dots (67.8%), and broken hairs (59.32%). Short vellus hairs and yellow dots were the most common in remitting AA. In progressive AA, the most common findings were broken hairs, yellow dots, and tapering hairs. VDL was significantly higher in both mild and moderate AA. CONCLUSIONS: VDL was significantly lower in severe AA and active progressive disease. Trichoscopic features could predict disease activity and VDL in patients with AA. Broken and tapering hairs will be more represented in patients with progressive disease. Short vellus hairs were seen more in stable or remitting disease. Furthermore, black dots and broken hairs were more prevalent in AA with deficient VDL.

Tricoscopia en la alopecia areata / Trichoscopy in Alopecia Areata

La alopecia areata es una enfermedad autoinmune, que afecta al folículo piloso. Se presenta en forma de placas alopécicas e incluso pérdida de pelo corporal. El diagnóstico es clínico. Sin embargo, la tricoscopia, una técnica valiosa no invasiva, simple y rápida, mejora el diagnóstico, la monitorización del tratamiento y reduce la necesidad de procedimientos invasivos. Realizaremos una descripción de la utilidad de la tricoscopia en la alopecia areata. Los hallazgos tricoscópicos más frecuentes de la alopecia areata son los puntos amarillos, los puntos negros, pelos en signos de exclamación, pelos vellosos cortos, pelos acodados. Sin embargo, existen otros hallazgos menos frecuentes, pero útiles para realizar el diagnóstico. La buena respuesta al tratamiento implica la desaparición de los puntos negros, pelos rotos y pelos con signo de exclamación, pero la presencia de los puntos amarillos indica enfermedad crónica y mala respuesta (AU)

Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment (AU)

[Translated article] Trichoscopy in Alopecia Areata / Tricoscopia en la alopecia areata

Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment (AU)

La alopecia areata es una enfermedad autoinmune, que afecta al folículo piloso. Se presenta en forma de placas alopécicas e incluso pérdida de pelo corporal. El diagnóstico es clínico. Sin embargo, la tricoscopia, una técnica valiosa no invasiva, simple y rápida, mejora el diagnóstico, la monitorización del tratamiento y reduce la necesidad de procedimientos invasivos. Realizaremos una descripción de la utilidad de la tricoscopia en la alopecia areata. Los hallazgos tricoscópicos más frecuentes de la alopecia areata son los puntos amarillos, los puntos negros, pelos en signos de exclamación, pelos vellosos cortos, pelos acodados. Sin embargo, existen otros hallazgos menos frecuentes, pero útiles para realizar el diagnóstico. La buena respuesta al tratamiento implica la desaparición de los puntos negros, pelos rotos y pelos con signo de exclamación, pero la presencia de los puntos amarillos indica enfermedad crónica y mala respuesta (AU)

Trichoscopy in Alopecia Areata. / Tricoscopia en la alopecia areata.

Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment.

Trichoscopy: An Update. / Actualización en tricoscopia.

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia.

Fractional CO2 laser versus microneedling as a transepidermal drug delivery system for the treatment of alopecia areata: A clinical dermoscopic evaluation.

New treatment modalities are rising for better clinical improvement in alopecia areata. This work aims to evaluate the efficacy of fractional CO2 laser and microneedling as a transepidermal drug delivery in cases with alopecia areata. The study included 30 patients with alopecia areata. All lesions in each patient have received randomly two different treatment modalities, fractional CO2 laser or microneedling followed by triamcinolone acetonide (TA) application according to group assignment. Sessions were done every month for a maximum of six sessions or complete resolution. Response to treatment was assessed on SALT score and dermoscopic imaging. Both treatment modalities showed a significant clinical improvement of alopecia areata, with a statistically significant reduction of SALT score for fractional CO2 laser group and microneedling group (p value <0.001). Moreover, there is a significant difference in the SALT score between both modalities (p = 0.013), whereas the reduction of the SALT score was more evident in microneedling group. On comparing the dermoscopy findings in fractional CO2 laser and microneedling treated areas before and after treatment, a significant reduction was found regarding all dermoscopic findings of alopecia areata. Fractional CO2 laser and microneedling as a transepidermal drug delivery could be a novel and effective treatment modality in alopecia areata. Dermoscopy is very useful to identify disease activity and early signs of clinical improvement during treatment.

Choroidal thickness in patients with alopecia areata: Is it a sign for poor prognosis?

INTRODUCTION: Alopecia areata (AA) is an autoimmune disease which causes non-scarring type hair loss considered to target the pigmentary system. The hair follicle may not be the only site for involvement of the disease. Iris, the ciliary body, choroid and epithelium of the retinal pigment may also be affected. The aim of the present study was to compare retinal pigment epithelium (RPE) and choroidal thicknesses between patients with AA and healthy controls. METHODS: The study included 44 patients with alopecia areata, and 44 healthy individuals with similar age and gender distribution. RPE and choroidal thickness measurements were performed through Spectral-domain optical coherence tomography (SD-OCT) (Heidelberg Spectralis® OCT). RESULTS: There was not any significant difference between patients with AA and healthy individuals for RPE and choroidal thickness (p = 0.751, p = 0.725, respectively). However, the choroidal thickness (422 ± 79 µm) was significantly thinner in patients with poor prognostic criteria than other patients (371 ± 75 µm; p = 0.039). CONCLUSION: Monitoring of choroidal thicknesses through optic coherence tomography (OCT) may provide an insight for the disease prognosis in patients with AA.

Evaluation of dermatoscopic findings of alopecia areata and tinea capitis in pediatric patients.

OBJECTIVE: Pediatric patients often reveal localized alopecic foci on the scalp. The essential point upon approaching a child with localized alopecia is distinguishing the two most common causes, alopecia areata and tinea capitis, as their treatments are entirely different. Although potassium hydroxide examination is the preferred method for their clear distinction, dermatoscopy is also emerging as a rapid diagnostic tool. This study aimed to assess and compare the dermatoscopic findings of alopecia areata and tinea capitis. MATERIALS AND METHODS: Enrolled in this study were 34 children with tinea capitis and 21 children with alopecia areata admitted to a single-center outpatient clinic between 2017 and 2021. The authors confirmed all children's diagnoses by an integrative evaluation of clinical features, potassium hydroxide examination results, and treatment response patterns. Clinical features and the variables of interest (dermatoscopic findings) were investigated through the medical records and the baseline dermatoscopic images. RESULTS: The most common dermatoscopic finding within the tinea capitis cohort was comma hairs, detected in 33 (97.1%) of the patients. Other findings of the tinea capitis group included squamation (n = 31, 91.2%), broken and dystrophic hairs (n = 30, 88.2%), corkscrew hairs (n = 24, 70.6%), zigzag hairs (n = 18, 52.9%), and pigtail hairs (n = 9, 26.5%). The most common dermatoscopic finding within the alopecia areata cohort was exclamation mark hairs (n = 13, 61.9%), that was followed by black dots (n = 9, 42.9%), yellow dots (n = 8, 38.1%), vellus hairs (n = 6, 28.6%), and broken and dystrophic hairs (n = 5, 23.8%). CONCLUSION: Among the detailed evaluation of dermatoscopic findings of tinea capitis and alopecia areata patients, the only overlapping feature was dystrophic and broken hairs that could be present in both diseases; but were more common within the TC group than within the AA group (88.2% vs. 23.8%).

Classification Framework for Healthy Hairs and Alopecia Areata: A Machine Learning (ML) Approach.

Alopecia areata is defined as an autoimmune disorder that results in hair loss. The latest worldwide statistics have exhibited that alopecia areata has a prevalence of 1 in 1000 and has an incidence of 2%. Machine learning techniques have demonstrated potential in different areas of dermatology and may play a significant role in classifying alopecia areata for better prediction and diagnosis. We propose a framework pertaining to the classification of healthy hairs and alopecia areata. We used 200 images of healthy hairs from the Figaro1k dataset and 68 hair images of alopecia areata from the Dermnet dataset to undergo image preprocessing including enhancement and segmentation. This was followed by feature extraction including texture, shape, and color. Two classification techniques, i.e., support vector machine (SVM) and k-nearest neighbor (KNN), are then applied to train a machine learning model with 70% of the images. The remaining image set was used for the testing phase. With a 10-fold cross-validation, the reported accuracies of SVM and KNN are 91.4% and 88.9%, respectively. Paired sample T-test showed significant differences between the two accuracies with a p < 0.001. SVM generated higher accuracy (91.4%) as compared to KNN (88.9%). The findings of our study demonstrate potential for better prediction in the field of dermatology.

Clinical and trichoscopic evaluation of trichloroacetic acid 35% vs phenol 88% peels in treatment of alopecia areata.

BACKGROUND: Among alopecia areata (AA) treatments, contact irritants (anthralin) and topical immunotherapies (diphenylcyclopropenone) have been successfully used. Chemoexfoliation can potentially be utilized, acting as irritants and consecutively immunomodulators. Peels via therapeutic wounding provoke growth factors and cytokines that may induce hair regrowth. AIM: To evaluate and compare trichloroacetic acid (TCA) 35% and phenol 88% peels effectiveness and tolerability in patchy AA. PATIENTS/METHODS: This comparative, randomized, double-blind study included 20 patients with multifocal patchy AA. In each patient, 2 patches were selected and randomized into group I (20 patches: TCA 35%) and group II (20 patches: phenol 88%). A session was performed every 3 weeks for 9 weeks. Response was assessed by two blinded observers as regards percentage of clinical improvement, severity of alopecia tool (SALT), and trichoscopic scaled scores for dystrophic and terminal hairs, respectively. Patients were scheduled for follow-up visits over 6 months past treatment cessation. RESULTS: A total of 19 patients completed the study and showed significant reduction in SALT score. TCA- and phenol-treated patches demonstrated significant improvement in the percentage of clinical improvement, trichoscopic scale of dystrophic and terminal hairs. However, TCA was superior to phenol as it showed significant more reduction in trichoscopic score of dystrophic hairs and significant higher increase in terminal hairs. Phenol yielded significant higher discomfort than TCA. No relapse was detected. CONCLUSIONS: Trichloroacetic acid 35% and phenol 88% peels can be considered effective therapeutic modalities for patchy AA. TCA 35% represents a treatment of choice in terms of the efficacy and tolerability.