Introduction:Trichotillomania (TTM) is characterized by patchy alopecia of hair bearing areas. This is because of compulsive urge to pull the hair. Scalp is the most common site for pulling hair. Usually, patients may have only small areas of baldness, in severe forms, tonsure pattern of baldness is observed. Diagnosis is by history and clinical examination. However, it is difficult to differentiate from other causes of noncicatricial alopecia. Here, authors observed trichoscopic patterns and evaluated their importance in the diagnosis of TTM.Materials and Methods:This study was conducted in S. Nijalingappa Medical College, Bagalkot, from January 2014 to July 2014. Ten patients with clinically suspected TTM were included in the study. Informed consent was taken and ethical clearance was obtained. Dermlite3 dermoscope was used with Sony camera attachment to save the images. Histopathological examination was conducted in all the patients to confirm the diagnosis.Results:Ten patients were included in the study. Mean age of the patients was 34 years. Most common symptom was patchy loss of hair in the frontal area (100%). Common trichoscopic feature was decreased hair density and broken hairs. Trichoptilosis (split ends) and irregular coiled hairs were seen in 80% patients. Novel diagnostic signs like black dots, flame hair, v-sign, follicular hemorrhages, were seen in 30% each. Tulip hair and hair powder were observed in 10% of patients. All patients had the noninflammatory alopecia with distorted and collapsed inner root sheath in histopathology.Conclusion:Trichotillomania is often chronic and difficult to treat. Hence, early diagnosis and treatment is necessary. Authors believe that the trichoscopy plays a vital role in the diagnosis of this condition by demonstrating specific trichoscopic patterns.

Trichoscopy enables visualization of subsurface structures and color patterns of scalp and hair. Recently, its applications expanded to diagnose inflammatory conditions such as lichen planopilaris (LPP), scalp psoriasis, and discoid lupus erythematosus (DLE). Clinically, both LPP and DLE appear similar as cicatricial alopecia on the scalp making the diagnosis difficult. Here, we report the utility of trichoscopy in the clinical diagnosis of LPP and DLE. Clinically, suspected lesions of DLE and LPP on the scalp of each patient were observed under trichoscopy. Histopathology of lesions confirmed the clinical diagnosis. Authors observed characteristic trichoscopic features in LPP as well as in DLE proving the clinical diagnosis. Hence, trichoscopy can be used to diagnose LPP and DLE clinically avoiding skin biopsy.

Background:Hypertrophic lichen planus (HLP) classically involves shin and ankles and is characterized by hyperkeratotic plaques and nodules. Prurigo nodularis (PN) is a chronic neurodermatitis that presents with intensely pruritic nodules. Histopathology of HLP and PN demonstrate epidermal hyperplasia, hypergranulosis, and compact hyperkeratosis. The dermis shows vertically arranged collagen fibers and an increased number of fibroblasts and capillaries in both conditions. Moreover, basal cell degeneration is confined to the tips of rete ridges, and band-like infiltration is conspicuously absent in HLP. Therefore, both conditions mimic each other clinically, which makes diagnosis difficult. Hence, there is a need for a diagnostic technique to differentiate both conditions.Objective:To evaluate dermoscopic patterns in HLP and PN and to study these patterns histopathologically.Materials and methods:The study was conducted at S. Nijalingappa Medical College in Bagalkot. It was an observational case series study. Ethical clearance and informed consent was obtained. A Dermlite 3 dermoscope (3Gen, San Juan Capistrano, CA, USA) attached to a Sony Cyber Shot camera DSC-W800 (Sony Electronics Inc., San Diego, California, USA) was employed. Histopathology was done to confirm the diagnosis.Results:There were 10 patients each with HLP and PN. HLP was seen in 8 males and 2 females. PN was observed in 7 females and 3 males. Dermoscopy of HLP demonstrated pearly white areas and peripheral striations (100%), gray-blue globules (60%), comedo-like openings (30%), red dots (40%), red globules (10%), brownish-black globules (30%), and yellowish structures (90%). In PN, red dots (70%), red globules (60%), and pearly white areas with peripheral striations (100%) were observed under dermoscopy.Conclusion:Both HLP and PN demonstrated specific dermoscopic patterns which can be demonstrated on histopathologic findings. The authors propose that these patterns are hallmarks of each condition. Thus, dermoscopy is a good diagnostic tool in the differentiation of HLP and PN.

Background:Depigmented skin lesions are of great concern in the society, especially in the Indian subcontinent. These comprise many infective and inflammatory conditions that cause apprehension and anxiety among patients due to the social stigma attached to these conditions. Idiopathic guttate hypomelanosis (IGH) appears similar to many depigmented lesions and differentiation of IGH from these conditions is difficult clinically as well as histopathologically.Methods:Clinically suspected IGH were included in the study. All IGH lesions were confirmed by histopathology. Clinical data and dermoscopic patterns were analyzed and presented in proportions and percentages.Results:Thirty patients were included in the study with 16 females and 14 males. Dermoscopy showed amoeboid, feathery, petaloid and nebuloid patterns in 12, 7, 6 and 1 patients respectively. Four patients had combination of these patterns.Conclusion:Dermoscopy of IGH revealed consistent patterns. Hence, we propose these patterns were specific to IGH and help clinician to differentiate many depigmented skin lesions from IGH in clinical practice. However, histopathology must be done for confirmation of diagnosis. Further studies on dermoscopy of IGH with histopathology correlation are proposed.

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