Ann Dermatol.  2014 Apr;26(2):214-220. 10.5021/ad.2014.26.2.214.

Dermoscopic Approach to a Small Round to Oval Hairless Patch on the Scalp

• Shim WH
• Jwa SW
• Song M
• Kim HS
• Ko HC
• Kim BS
• Kim MB

• KMID: 2171658
• DOI: http://doi.org/10.5021/ad.2014.26.2.214

Abstract

BACKGROUND
Various kinds of alopecia can show small round or oval hairless patch. Dermoscopy could be a simple, useful tool for making a correct diagnosis.
OBJECTIVE
The aim of this study is to investigate clinical usefulness of dermoscopy for diseases with small round or oval hairless patch on the scalp.
METHODS
Dermoscopic examination was performed for 148 patients with small round or oval hairless patch using DermLite(R) II pro. The type and its patient number of alopecia investigated in the study were as below: alopecia areata (n=81), trichotillomania (n=24), tinea captis (n=13), traction alopecia (n=12), lichen planopilaris (n=8), discoid lupus erythematosus (n=7), congenital triangular alopecia (n=2) and pseudopelade of Brocq (n=1). The significance of dermoscopic findings for each disease were evaluated.
RESULTS
Characteristic dermoscopic findings of alopecia areata were tapering hairs and yellow dots. Those of trichotillomania and traction alopecia were broken hairs. Dermoscopic findings of tinea capitis included bent hairs, perifollicular white macules and greasy scales. Discoid lupus erythematosus and lichen planopilaris were characterized by dermoscopic findings of lack of follicular ostia. Furthermore, keratin plugs were frequently seen in discoid lupus erythematosus whereas perifollicular hyperkeratosis and erythema were frequently seen in lichen planopilaris.
CONCLUSION
Dermoscopic examination for small round or oval hairless patch showed characteristic findings for each disease. Based on these results, we propose dermoscopic algorithm for small round or oval hairless patch on the scalp.

Keyword

Alopecia; Dermoscopy

MeSH Terms

Alopecia
Alopecia Areata
Dermoscopy
Diagnosis
Erythema
Hair
Humans
Lichens
Lupus Erythematosus, Discoid
Scalp*
Tinea
Tinea Capitis
Traction
Trichotillomania
Weights and Measures

Figure

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  Fig. 1 Dermoscopic features of alopecia areata; yellow dots (A; arrow), clustered vellus hairs (B; dotted circle), black dots (C; triangle), and tapering hairs (D; white arrow).

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  Fig. 2 Dermoscopic features of trichotillomania; broken hairs and characteristic split end (arrow).

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  Fig. 3 Dermoscopic features of traction alopecia; broken hairs (arrow) and black dots (triangle).

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  Fig. 4 Dermoscopic features of tinea capitis; greasy scales (A; arrow), perifollicular white macules (B; triangles) and bent hairs (C; white arrow).

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  Fig. 5 Dermoscopic features of discoid lupus erythematosus; keratin plugs (arrow), lack of follicular ostia (dotted circle) and pigment network (triangle).

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  Fig. 6 Dermoscopic features of lichen planopilaris; perifollicular hyperkeratosis (arrow), perifollicularerythema (triangle) and lack of follicular ostia (dotted circle).

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  Fig. 7 Dermoscopic features of congenial triangular alopecia; clustered short vellus hairs without otherspecific findings (dotted circle).

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  Fig. 8 Dermoscopic features of pseudopelade of Brocq; lack of follicular ostia (dotted circle) without otherspecific finding.

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  Fig. 9 The algorithm for dermoscopy of small round or oval hairless patch on the scalp. AA: alopecia areata, TM: trichotillomania, TA: traction alopecia, TC: tinea capitis, CTA: congenital triangular alopecia, DLE: discoid lupus erythematosus, LPP: lichen planopilaris, PB: pseudopelade of Brocq.

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