engleski

Fundamental trichoscopy

Trichoscopy is hair and scalp dermoscopy using a handheld dermoscope (x10 magnification) or polarized light video microscope (x20 to x160 magnifications, also equipped with software) Trichoscopy is based on analysis of structures that may be visualized with a dermoscope. These basic structures may be divided into 4 groups: (1) hair shaft (2) hair follicle openings (dots), (3) perifollicular epidermis, and (4) blood vessels. Hair shaft abnormalities can be divided into six groups: (1) hair shaft with fractures, (2) hair narrowings, (3) hairs with node-like structures, (4) curls and twists, (5) bands, and (6) short hairs. Dots is a common term for hair follicle openings seen by trichoscopy. Black dots (formerly called cadaverized hairs) represent pigmented hairs broken or destroyed at scalp level. They are seen in alopecia areata. Yellow dots are hair follicle openings that contain keratosebaceous material. They are observed in alopecia areata, discoid lupus erythematosus and female androgenetic alopecia. The classic white dots- are big, irregular white dots, which represent areas of perifolliculare fibrosis, and are seen in lichen planopilaris. Red dots are described in discoid lupus erythematosus. Gray or brown-gray dots are regulary distributed in the eyebrow area of patients with frontal fibrosing alopecia. Features that are analysed in the perifollicular area are – (1) scaling, (2) changes in color, (3) abnormalities in skin surface, (4) and presence of discharge. In lichen planopillaris we can see very typical tubular white scale, while in folliculitis decalvans the tubular scale are yellow and with a collar formation. In folliculitis decalvans we can see surface structure abnormalities – hyperplasia with starburst pattern. Appearance of cutaneous microvessels in trchoscopy may vary in type, arrangement, and number, depending on the disease. Analysis of blood vessels arrangement is of special importance in differential diagnosis of inflammatory scalp diseases, such as scalp psoriasis, seborrheic dermatitis, or discoid lupus erythematosus Trichoscopy represents a valuable noninvasive and low-cost technique, still underutilized, to rapidly differentiate clinically frequent hair disorders, but also in monitoring treatment response or giving an insight of prognosis.

trichoscopy; alopecia; hair

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