Dermoscopic findings in female androgenetic alopecia

Abstract

BACKGROUND: Androgenetic alopecia is the most common form of hair loss. It is a clinical entity of relevant interest and presents a significant psychosocial impact as it undermines self-esteem and quality of life in female patients due to the importance of the hair for people's facial balance. OBJECTIVE: The purpose of the present study is to evaluate dermoscopic signs in women clinically diagnosed with androgenetic alopecia. METHOD: Observational study with 34 women between 17 and 68 years old who were diagnosed with androgenetic alopecia. All of them underwent photographic sessions with a 10x magnification dermoscope and a digital camera zoom set to 20x magnification and 40x magnification on the scalp frontal midline. RESULTS: All patients showed miniaturization. A peripilar brown halo was found in 22 patients, honeycomb-like scalp pigmentation was found in 14 and yellow dots in only 1 patient. Recent studies show dermoscopy as the new tool for diagnosis assistance and treatment follow up in scalp disorders. Our study used an ordinary dermoscope and we evaluated several findings reported in the literature with significant clarity and easiness. CONCLUSION: The dermoscope, which is used by dermatologists on a daily basis, is an excellent tool to assist in early diagnosis and assessment of therapeutic response in androgenetic alopecia. Keywords: Alopecia; Dermoscopy; Miniaturization Resumo: FUNDAMENTOS: Alopecia androgenética é forma mais comum de queda de cabelo. Constitui entidade clí-nica de interesse relevante e acarreta grande impacto psicossocial por comprometer a auto-estima e a qualidade de vida das pacientes. OBJETIVO: Procurar os sinais dermatoscópicos comuns em mulheres com diagnóstico clínico de alopecia androgenética, visando diagnóstico precoce e melhor resposta terapêutica. MÉTODOS: Estudo observacional em 34 mulheres com idades entre 17 e 68 anos, com diagnóstico clínico de alopecia androgenética. Todas pacientes foram avaliadas e submetidas a registros fotográficos com o dermatoscópio no aumento de 10x e câmera digital no aumento de 20x e 40x na linha média frontal do couro cabeludo. RESULTADOS: Todas as pacientes apresentaram miniaturização dos fios na área examinada. Halo castanho peripilar foi encontrado em 22 pacientes, pigmentação em favo de mel em 14 e pontos amarelos em apenas 1 paciente. Estudos recentes mostram a dermatoscopia como uma nova ferramenta no auxílio diagnóstico e acompanhamento do tratamento das desordens do couro cabeludo. Em nosso estudo utilizamos um dermatoscópio comum e avaliamos vários achados relatados na literatura com facilidade e clareza significativas. CONCLUSÃO: O dermatoscópio, instrumento de uso diário dos dermatologistas, é excelente ferramenta para auxí-lio no diagnóstico precoce e avaliação da resposta terapêutica na alopecia androgenética e é capaz de mostrar de forma simples sinais precoces de miniaturização capilar.

White and yellow dots as new trichoscopic signs of severe female androgenetic alopecia in dark skin phototypes

“…The character of yellow dots in FAGA is predominantly oily (sebaceous) . Its presence appears to be highly variable between different studies, ranging from 1.67% to 66% . Yellow dots were found only in 15.2% (12/79) of the currently studied patients, which was more consistent with the study of Ross et al ., who reported a percentage of 7% (5/64) .…”

“…This percentage was close to that observed in the present study, where this sign was found in 17.7% (14/79) of patients. In contrast, Ramos et al, Zhang et al, and Karadag Kose and Gulec reported lower percentages in their patients . The patients in the current study were veiled, suggesting an etiology other than the exposure of the scalp through thinned hair to ultraviolet rays, which has been speculated as a cause for this sign.…”

“…His study concluded that this clinical feature, by itself, constitutes a new tool of substantial utility in the diagnosis and management of androgenic alopecia . This was confirmed in later studies by Inui et al ., Ramos et al ., Karadag Kose and Gulec, and Mubki et al ., and they also observed that all trichoscopic abnormalities are more prominent in the frontal area compared with the occipital area . Similarly, the present study found that all patients displayed anisotrichosis or hair shaft diameter diversity with increased percentage of miniaturized vellus hairs not only in the frontal area but also in the temporal areas, especially when compared with the occiput.…”

“…The peripilar sign was observed in the range of 20–60% in previous studies as reported by Rakowska et al ., Inui et al ., Karadag Kose and Gulec, and Ramos et al . Zhang et al .…”

“…It is a noninvasive tool that is increasingly used in dermatological daily practice. The main trichoscopic findings in both FAGA and male androgenetic alopecia are: hair shaft diameter diversity with increased number of miniaturized thin vellus hairs, especially in the frontoparietal region, predominance of single hair pilosebaceous units, the peripilar sign, the honeycomb pigmented network, and the yellow dots . These signs are more pronounced in the frontal area when compared to the occipital area and, when evaluated together, allow the early diagnosis of FAGA and hence early intervention, before the occurrence of significant reduction in hair volume .…”