Trichoscopic Signs in Dermatomyositis, Systemic Lupus Erythematosus, and Systemic Sclerosis: A Comparative Study of 150 Patients

Abstract

<b><i>Background:</i></b> Hair and scalp involvement is prevalent in connective tissue diseases (CTDs). Trichoscopic features may provide a diagnostic implementation and enable differentiation among CTDs; however, a direct comparison of these signs among CTD patients is lacking. <b><i>Objectives:</i></b> To compare trichoscopic findings in dermatomyositis (DM), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) as well as determine their distinctive features and associations with disease activity. <b><i>Methods:</i></b> Trichoscopic photographs were taken from DM, SLE, and SSc patients and further evaluated for hair shaft and scalp surface abnormalities. Data regarding patients’ clinical manifestations, laboratory results, and disease activity were analyzed. <b><i>Results:</i></b> One hundred fifty participants, consisting of 30 DM, 60 SLE, and 60 SSc patients, were included. Perifollicular red-brown pigmentation, brown scattered pigmentation, and white patches were exclusive findings in DM, SLE, and SSc, respectively (<i>p</i> < 0.001). A multinomial logistic regression analysis revealed that DM demonstrated higher odds for having microaneurysmal blood vessels than SLE and SSc (odds ratio [OR] = 22.22, 95% confidence interval [CI] = 1.73–285.13, <i>p</i> = 0.017, and OR = 15.34, 95% CI = 1.36–177.59, <i>p</i> = 0.029, respectively). Polymorphic vessels forming a telangiectatic network suggested SSc over SLE (OR = 12.83, 95% CI = 1.35–121.98, <i>p</i> = 0.026), while avascular areas were more pronounced in SSc than DM and SLE (OR = 43.24, 95% CI = 5.17–361.67, <i>p</i> = 0.001, and OR = 0.03, 95% CI = 0.01–0.24, <i>p</i> = 0.001, respectively). In a quantile regression analysis, perifollicular red-brown pigmentation, reduction in hair diameter, and the absence of thin arborizing vessels were linked to higher disease activity in DM, SLE, and SSc, respectively (all <i>p</i> < 0.05). <b><i>Conclusions:</i></b> Trichoscopy is a valuable tool possessing diagnostic and prognostic values for CTDs. Specific trichoscopic features allow adequate distinction between DM, SLE, and SSc and may help identify active disease.

Dermoscopy and Trichoscopy in Dermatomyositis—A Cross-Sectional Study

“…It is worth noting that DM shows some dermoscopic similarities with lupus erythematosus (LE). In a recent study by Chanprapaph et al [17] on trichoscopic findings in CTDs, a decrease in the hair shaft number, presence of white dots, brown honeycomb pattern, white patches, interfollicular scales, dotted vessels, and thin or thick arborizing vessels was observed with comparable frequency in DM and systemic lupus erythematosus (SLE). On the other hand, perifollicular red-brown pigmentation, perifollicular scaling, and tortuous dilated capillaries, referred to by the authors as "microaneurysmal blood vessels", were found to be specific for DM, while hair shaft hypopigmentation was significantly more common in SLE.…”

Trichoscopic, oral, and periungual fold findings as activity and damage markers in dermatomyositis patients and their correlation with myositis antibodies

“…Therefore, this is the one with the highest number of cases. Chanprapaph et al [ 26 ] recently compared trichoscopic findings in DM, systemic lupus, and systemic sclerosis patients. They found that perifollicular reddish-brown pigmentation and the presence of blood vessels with microaneurysms were present exclusively in DM patients.…”

Subacute Cutaneous Lupus Erythematosus-Like Eruption Induced by Durvalumab: A Case Report and Literature Review

“…11,12 Another mechanism is that SCLE may be stimulated by ultraviolet (UV)-B radiation resulting in translocation of Ro (SSA) antigen and increase of cell membrane antigen expression via epitope spreading. [13][14][15] Our patient frequently engaged in outdoor activities with inadequate photoprotection which may have aggravated the symptoms. 16 Lastly, focusing on mechanism of action, anti-PD-1 or PD-L1 may modulate humoral immunity which enhances pre-existing autoantibodies and unmask latent auto-immunity.…”