Differentiation of frontal fibrosing alopecia and Lichen planopilaris on trichoscopy: A comprehensive review

Rajan, A.; Rudnicka, Lidia; Szepietowski, Jacek; Lallas, Aimilios; Rokni, Ghasem Rahmatpour; Grabbe, Stephan; Goldust, Mohamad

doi:10.1111/jocd.14457

Cited by 13 publications

(9 citation statements)

References 35 publications

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“…Rajan et al concluded that the sensitive markers for alopecia areata are short vellus hair and yellow dots, and the specific markers are exclamatory hair, broken hairs, black dots, and tapering hair (12). The disappearance of black dots, broken hairs, and exclamation mark hairs indicates a good response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Utility of Trichoscopy in Various Types of Alopecia - A Cross-Sectional Study

et al. 2023

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Background: Alopecia is one of the most common reasons for consulting dermatologists, and the clinical diagnosis can become confusing. In light of the inclination of patients and doctors toward non-invasive diagnosis, along with the vogue of non-invasive diagnostic modalities, trichoscopy has become a promising tool. Objectives: To study various dermoscopic patterns of alopecia. Methods: After obtaining informed consent, this cross-sectional study was conducted among 100 patients with alopecia attending a tertiary health care center. A detailed history and clinical photographs were taken. Relevant investigations were done whenever indicated. Dermoscopy was done using illuco IDS- 1100 with 10x magnification. Statistical analysis used: Data was analyzed using SPSS 22 version software. The chi-square test, Kolmogorov-Smirnov test, and Shapiro-Wilk test was used for assessment with a significant P-value of < 0.05. Kappa statistics were used to assess agreement between the two modalities. Results: Overall, vellus hair (65%) and yellow dots (65%) were the most common findings among all types of alopecia. The most common findings on trichoscopy in androgenetic alopecia were vellus hair (90.48%); in alopecia areata, vellus hair, and exclamation mark hair (86.67% each); in tinea capitis, corkscrew hair, and black dots; and in trichotillomania, splaying of hair. Discoid Lupus erythematosus had absent follicular opening, scaling, and perifollicular pigmentation. Clinical and dermoscopic diagnoses were significantly associated with a kappa agreement of 0.776 (i.e., substantial agreement). Out of 15 cases of difficult-to-diagnose alopecia, further investigations showed that dermoscopic diagnosis was accurate in 7 cases (46.67%). Conclusions: Trichoscopy is a reliable, non-invasive, and faster method of diagnosis in ambiguous cases of alopecia.

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Section: Discussionmentioning

confidence: 99%

Utility of Trichoscopy in Various Types of Alopecia - A Cross-Sectional Study

et al. 2023

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“…Scalp biopsy is the gold standard for diagnosis but is not readily accepted in the pediatric population. RCM and dermoscopy can be considered an intermediate step between clinical and histological analysis in the evaluation of alopecia diseases and can provide clues for diagnosis 7,8 …”

Section: Discussionmentioning

confidence: 99%

“…RCM and dermoscopy can be considered an intermediate step between clinical and histological analysis in the evaluation of alopecia diseases and can provide clues for diagnosis. 7,8 RCM visualizes horizontal planes from the epidermis to the upper dermis at a cellular resolution, which can reveal the skin and skin appendage structures, including hair follicles and perifollicular epidermis, whereas dermoscopy amplifies the optical observation of skin lesions. 9 AA, TM, NS, and LSCS all showed normal honeycomb patterns in the epidermis, and the key feature for differential diagnosis was the dermal.…”

Section: Discussionmentioning

confidence: 99%

Linear alopecia in pediatrics: RCM and dermoscopy reveal diagnostic cues

Wang,

Chen,

Qin

et al. 2023

Skin Research and Technology

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BackgroundAlopecia 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.MethodsA 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.ResultsThe 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 patientsConclusionRCM combined with dermoscopy can provide additional information on disease states and differentiate between AA, TM, NS, and LSCS.

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“…Single stems of terminal hair in the place of the previous hairline are also characteristic, described as the so-called lonely hair sign [15]. Perifollicular erythema is characteristic of the early stages of the disease and may precede hairline regression [16]. The eyebrow trichoscopic image is characterized by hair growing in different directions (the so-called road sign image) [17].…”

Section: Wprowadzeniementioning

confidence: 99%

“…objaw samotnych włosów (lonely hair sign) [15]. Rumień przymieszkowy jest charakterystyczny dla wczesnych faz choroby, może poprzedzać regresję linii włosowej [16]. Dla obrazu trichoskopowego brwi specyficzne są włosy rosnące w różnych kierunkach (tzw.…”

Section: Wprowadzenieunclassified

Potential etiological factors in frontal fibrosing alopecia

Maciejewska¹,

Czuwara²,

Dąbrowska³

et al. 2022

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Frontal fibrosing alopecia is a variant of lichen planus, leading to permanent hair loss from the frontal hairline. It occurs mainly in postmenopausal women, however, the role of hormonal factors in the pathogenesis of this type of alopecia has not been determined. The coexistence of frontal fibrosing alopecia and autoimmune diseases is observed, e.g., hypothyroidism, rheumatoid arthritis, vitiligo, polymyositis, systemic lupus erythematosus and discoid lupus erythematosus. Considering the possible role of genetic factors, research is underway to identify human leukocyte antigen (HLA) polymorphisms. One of the most studied factors is sunscreen, widely used in cosmetic products. The data available so far in this regard are controversial. Factors raising significant doubts include: the retrospective nature of the research, basing the collected data on the self-assessment of respondents and the lack of specification of the ingredients of these products. In the light of current data, sunscreen components cannot be considered as a factor playing a role in the pathogenesis of frontal fibrosing alopecia. Overestimation of the role of sunscreens in hair loss could lead to unjustified avoidance of their use and contribute to increased incidence of skin cancer.

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Differentiation of frontal fibrosing alopecia and Lichen planopilaris on trichoscopy: A comprehensive review

Cited by 13 publications

References 35 publications

Utility of Trichoscopy in Various Types of Alopecia - A Cross-Sectional Study

Utility of Trichoscopy in Various Types of Alopecia - A Cross-Sectional Study

Linear alopecia in pediatrics: RCM and dermoscopy reveal diagnostic cues

Potential etiological factors in frontal fibrosing alopecia

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