Significance of Dermoscopy in Acute Diffuse and Total Alopecia of the Female Scalp: Review of Twenty Cases

Abstract

Background: Acute diffuse and total alopecia of the female scalp (ADTAFS) is a new subtype of alopecia areata that is characterized by rapid progression of diffuse alopecia of the female scalp, marked female predominance and a favorable prognosis. Differential diagnosis of other types of diffuse alopecia such as female pattern hair loss (FPHL) is necessary in some cases. Objective: To describe dermoscopic findings of ADTAFS and to investigate the possibility of utilizing dermoscopy as a diagnostic tool for ADTAFS. Methods: Twenty cases of ADTAFS diagnosed by clinical and/or histological findings were examined by dermoscopy. Results: Cadaverized hairs (black dots), exclamation mark hairs (tapering hairs), broken hairs or yellow dots were seen in 18, 13, 19 and 17 out of 20 cases, respectively. One of these signs was seen in all cases (20/20). On the other hand, none of 12 cases with exclusively FPHL showed the dermoscopic features such as cadaverized hairs, exclamation mark hairs or broken hairs. Only 1 FPHL patient showed a yellow dot in the hair loss area. Conclusion: Dermoscopy is a helpful diagnostic tool for ADTAFS, especially to distinguish it from FPHL.

A importância do exame tricológico no diagnóstico da alopecia areata

“…4,5,9 Exclamation point hairs can also be spindle-like, similar to those found in cases of beaded hair (monilethrix).…”

“…2 Inui et al and Tosti et al were the first to publish papers on AA dermoscopic findings. 4,[7][8][9] Dermoscopy reveals the following in the initial phase of AA:…”

“…4,7,9,10 Hair bendability or 'elbow sign' (Coudability-coudé): typical of apparently normal hair which, due to keratinization changes, has a fragile shaft and folds easily on itself when spread or pushed along its axis toward the scalp. 1 Trichoptilosis: longitudinal splitting of the distal end of the hair (1-3mm).…”

“…The yellow spots also occur in androgenetic alopecia (when hair follicle is empty at the xenogenous stage). 3,4,7 As the lesions progress to more chronic phases of AA the presence of these signs is no longer detected and mild follicular hyperkeratosis may occur, indicating a poor prognosis. 2.10 Finally, numerous telogen hairs can be observed in the trichogram 1,2,4-7 with bulbs or clubshaped tips either of similar size or with dystrophic tips (Figure 2).…”

Dermoscopic evaluation of therapeutic response to intralesional triamcinolone acetonide in the treatment of Alopecia areata

“…Recent studies have shown that dermoscopy can be a useful tool for the clinical diagnosis of AA by the presence of cadaverized hairs (black dots), exclamation mark hairs (tapering hairs), broken hairs, yellow dots and clustered short vellus hairs in the hair loss areas. 10 Black dots as remnants of exclamation mark hairs or broken hairs provide a sensitive marker for disease activity as well as severity of AA. 10 Yellow dots, are considered to be the most sensitive dermoscopic feature of AA.…”