Trichoscopic findings in cicatricial alopecias and hair shaft disorders and its application in histopathology

Ashwini S. Khadatkar; Nishant B. Ghodake

doi:10.18203/2320-6012.ijrms20175435

Authors

Ashwini S. Khadatkar Department of Pathology, SMBT Medical College, Nashik, Maharashtra, India
Nishant B. Ghodake Department of Dermatology, Skinaccess Clinics, Nashik, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20175435

Keywords:

Dermoscopy, Hair

Abstract

Background: Many studies have been published on dermoscopy of hair and scalp disorders in the past few years, but these have been mainly carried out in western countries. Indian skin is mainly type IV and V and has its own unique set of problems and pathological findings. Hence, we conducted a study at our institute to study the dermoscopic patterns of various cicatricial alopecias.

Methods: This was a descriptive study conducted in the Dermatology outpatient department, Skinaccess clinics, Nashik, between August 2014 to June 2016. The most common and characteristic feature seen in patients with cicatricial alopecia was hair follicle effacement seen in all 24 patients (100%). Hair follicle plugging was seen in 6 (25%) patients with DLE, and one patient with idiopathic scarring. Hyperkeratotic perifollicular scaling was seen in 2 patients with lichen plano pilaris. Perifollicular hyperpigmentation was seen in one patient of discoid lupus erythematosus (DLE) and 2 patients with idiopathic scarring. Hair casts were seen in 2 patients with lichen plano pilaris, and in one patient with idiopathic scarring. Patchy depigmentation was seen in 4 patients with discoid lupus erythematosus, 3 patients with idiopathic scarring, and one patient with lichen plano pilaris.

Results: The most common and characteristic feature seen in patients with cicatricial alopecia was hair follicle effacement seen in all 24 patients (100%). Hair follicle plugging was seen in 6 (25%) patients with DLE, and one patient with idiopathic scarring. Hyperkeratotic perifollicular scaling was seen in 2 patients with lichen plano pilaris. Perifollicular hyperpigmentation was seen in one patient of discoid lupus erythematosus (DLE) and 2 patients with idiopathic scarring. Hair casts were seen in 2 patients with lichen plano pilaris, and in one patient with idiopathic scarring. Patchy depigmentation was seen in 4 patients with discoid lupus erythematosus, 3 patients with idiopathic scarring, and one patient with lichen plano pilaris.

Conclusions: Hair follicle effacement is a characteristic dermoscopic feature of cicatricial alopecia. Hair follicle plugging, patchy depigmentation and red dots are seen in DLE. In lichen plano pilaris the dermoscopic findings of blue dots, white dots and perifollicular scaling were found to be useful for making an accurate diagnosis. Perifollicular scaling and tufting of hair is characteristically seen in patients with folliculitis decalvans. Dermoscopy is very useful in differentiating cicatricial from non-cicatricial alopecias. A biopsy obtained from the peripheral edge of the patch is more likely to show diagnostic features than the central portion. Dermoscopic guided biopsies were shown to yield definitive pathological diagnosis in 95% of the cases. Hair shaft disorders can be easily diagnosed by dermoscopy, without the need for hair.

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