Trichoscopy of Primary Cicatricial Alopecia

Abstract

Background: Cicatricial alopecias are classified into primary and secondary types according to the initial site of inflammation. In primary cicatricial alopecias (PCA), the hair follicle is the main target of destruction; the term secondary cicatricial alopecia implies that follicular destruction is not the primary pathologic event. Cicatricial alopecia is a trichologic emergency state which requires a fast and confident confirmation of diagnosis, as well as aggressive treatment in the active stage of the disease to guard against permanent destruction of hair follicles therefore trichoscopy may be applied as a quick and non-invasive method that helps in the differential diagnosis of diverse diseases leading to cicatricial alopecia. Objective: To evaluate the potential benefit of trichoscopy in the clinical diagnosis of primary cicatricial alopecia. Methods: Trichoscopic examination for 24 patients suffering from PCA using the DermLite II Pro and 3X optical zoom by Samsung S4 Zoom camera and their dermoscopic findings were reported. Results: Our results revealed that among these 24 patients, who presented with PCA, 7 had lichen planopilaris (LPP), 5 had discoid lupus erythematosus (DLE), 5 had folliculitis decalvans (FD), 4 had central centrifugal cicatricial alopecia (CCCA), 2 had dissecting cellulitis (DC) and 1 had keratosis follicularis spinulosa decalvans (KFSD). The most characteristic dermoscopic findings in each disease were as follows: perifollicular scales and peritubular casts in LPP, follicular plugging in DLE, Hair tufting and pustules in FD, hypotrichosis and white structureless areas in CCCA, diffuse white area and 3D yellow dots in DC and follicular keratosis in KFSD. Conclusion: Trichoscopy is a noninvasive tool that significantly improves the accuracy of the diagnosis of PCA.