斑秃皮损的皮肤镜影像及其与临床病理的关系

目的 探讨皮肤镜下斑秃皮损的微细改变及其与临床、病理相关性。方法 使用皮肤镜观察62例斑秃患者和44例其他类型脱发患者的皮损,收集患者临床及实验室资料,并对其中15例斑秃患者进行皮损部位组织病理活检,以了解皮肤镜的组织形态学基础。结果 皮肤镜下斑秃影像为黄点征、黑点征、断发、毳毛、新生短发和感叹号样毛发。黄点征发生率最高（83.9%）,而诊断斑秃的特异性指标为感叹号样毛发、黑点和断发,且后三者发生率与斑秃的活动性及轻拉发试验阳性率呈显著正相关关系。甲状腺过氧化物酶抗体升高发生率与轻拉发实验阳性率及断发发生率呈显著正相关。黄点征发生率和病理下毛囊口角栓阳性率之间呈显著正相关关系,新生短发发生率和毛囊周围肥大细胞浸润发生率以及黑点发生率则与生长期与退行期毛囊之间比例减少均呈显著负相关关系。结论 可以用黄点征作为斑秃诊断的初筛指标,而感叹号样毛发、黑点和断发对于确诊斑秃的特异性较高,且提示患者病情仍处于活动期。斑秃患者皮肤镜影像与病理有一定相关性,可用于判断病情并指导治疗。     

Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases

Objective To determine dermoscopic findings of alopecia areata (AA) from a large‐scale study that can be used as clinical indicators of disease. Methods Dermoscopic examination of areas of hair loss on the scalp of 300 Asian patients with AA was performed using a DermLite® II pro, which can block light reflection from the skin surface without immersion gels. Using the Spearman rank‐order correlation coefficient by rank test, correlations between the incidence of each dermoscopic finding and the severity of disease and disease activity were examined. The sensitivity and specificity of the findings as diagnostic clues for AA were evaluated. Results Characteristic dermoscopic findings of AA included black dots, tapering hairs, broken hairs, yellow dots, and clustered short vellus hairs (shorter than 10 mm) in the areas of hair loss. Black dots, yellow dots, and short vellus hairs correlated with the severity of disease, and black dots, tapering hairs, broken hairs, and short vellus hairs correlated with disease activity. For diagnosis, yellow dots and short vellus hairs were the most sensitive markers, and black dots, tapering hairs, and broken hairs were the most specific markers. Conclusion Dermoscopic characteristics, such as black dots, tapering hairs, broken hairs, yellow dots, and clustered short vellus hairs, are useful clinical indicators for AA.     

斑秃的皮肤镜表现及对治疗的反应

目的 探讨斑秃患者皮肤镜征象表现及其在不同治疗方法治疗后消失的情况.方法 回顾性分析80例初诊或复发后初诊斑秃患者的初始皮肤镜征象以及在不同治疗方法治疗后消失的顺序,并分析其原因.结果 斑秃发病男女比例相近,平均发病年龄为26.5岁,平均病程为32.6个月,临床类型以斑片型多见;斑秃患者皮肤镜征象出现率由高到低依次为黄点（87.5％）、黑点（82.5％）、断发（77.5％）、短毳毛（76.25％）、感叹号发（45.0％）,黄点、断发、短毳毛与斑秃病程呈负相关,感叹号发与轻拉发实验呈正相关,黑点、断发、感叹号发两两之间亦呈显著正相关.二苯环丙烯酮（DPCP）组患者随访期间内均未见明显新生毛发,而另外3组有1种或以上皮肤镜征象消失的患者均伴有新生毛发增多.复方甘草酸苷组、复方倍他米松组、口服激素组中4种征象（黄点、黑点、断发、感叹号发）均有.患者治疗后征象最先消失比例最高的为感叹号发,平均时间为治疗后7.3周,第二消失比例最高的为黑点,平均时间为7.6周,第三消失比例较高的为断发,平均时间为8.2周,最后消失的为黄点,平均时间为8.4周,组间差异无统计学意义.结论 感叹号发与病情活动度呈正相关,DPCP组患者病程长,病情活动度少,以重型及难治型患者占大多数,治疗起效慢.治疗后皮肤镜征象的消失与治疗方法无关,与治疗起效时间有关,开始起效时间约在7.3周左右.超过随访时间所有征象均未消失的患者,说明病情活动未得到控制,需调整治疗方案.治疗起效后毛囊重新进入生长期,引起感叹号发首先消失,随之黑点、断发亦消失。     

Coudability hairs: a revisited sign of alopecia areata assessed by trichoscopy

Background. We have previously reported several trichoscopic (dermatoscopic) characteristics, such as black dots, ‘exclamation‐mark’ hairs, broken hairs, yellow dots and clustered short vellus hairs as being useful clinical indicators for alopecia areata (AA). ‘Coudability hairs’, which are normal‐looking hairs tapered at the proximal end, have been previously reported as another sign of AA. Aims. To use trichoscopy to evaluate coudability hairs as a clinical indicator for the disease activity of AA and a substitute‐marker for the hair‐pull test. Methods. Trichoscopic examinations of hair loss and perilesional areas on the scalps of 100 East Asian patients with AA were performed using a dermatoscope. Using Spearman’s rank‐order correlation coefficient by rank test, we examined the correlations of scores between coudability and AA disease activity, severity or duration and other trichoscopic features, and then evaluated the coudability score as a surrogate‐marker for the hair‐pull test. Results. Coudability scores correlated positively with AA disease activity, hair‐pull tests, short duration, black dots and exclamation‐mark hairs, and correlated negatively with short vellus hairs. Conclusions. Coudability hairs, more closely perceived by trichoscopy, are useful‐markers for disease activity in AA and provide a surrogate‐marker for the hair‐pull test.     

Alopecia areata: Clinical presentation, diagnosis, and unusual cases

Alopecia areata (AA) is a nonscarring hair loss disorder with a 2% lifetime risk. Most patients are below 30 years old. Clinical types include patchy AA, AA reticularis, diffuse AA, AA ophiasis, AA sisiapho, and perinevoid AA. Besides scalp and body hair, the eyebrows, eyelashes, and nails can be affected. The disorder may be circumscribed, total (scalp hair loss), and universal (loss of all hairs). Atopy, autoimmune thyroid disease, and vitiligo are more commonly associated. The course of the disease is unpredictable. However, early, long‐lasting, and severe cases have a less favorable prognosis. The clinical diagnosis is made by the aspect of hairless patches with a normal skin and preserved follicular ostia. Exclamations mark hairs and a positive pull test signal activity. Dermoscopy may reveal yellow dots. White hairs may be spared; initial regrowth may also be nonpigmented. The differential diagnosis includes trichotillomania, scarring alopecia, and other nonscarring hair loss disorders such as tinea capitis and syphilis.     

Trichostasis spinulosa of the scalp mimicking Alopecia Areata black dots

Alopecia areata is a common autoimmune disorder that leads to nonscarring hair loss. Black dots, also called comedo-like cadaver hairs, can be found in almost 50% of alopecia areata patients and indicate disease activity. Trichostasis spinulosa is a follicular disorder resulting from the retention of numerous hairs surrounded by a keratinous sheath in dilated follicles. Trichostasis spinulosa is a relatively common but underdiagnosed disorder of hair follicles. Here, we describe a man with alopecia areata of the eyebrows, androgenetic alopecia and trichostasis spinulosa at the vertex and show how dermoscopy can be useful in distinguishing black dots from Trichostasis spinulosa lesions.     

Utility of dermoscopy in alopecia areata

Background:

Alopecia areata (AA) shows several well-defined dermoscopic features which may help in confirming diagnosis in AA.

Aims:

We carried out a study to examine the dermoscopic features of AA and develop a protocol for diagnosis of AA by dermoscopy.

Materials and Methods:

Dermoscopy was performed in 66 patients with AA. Hanse HVS-500NP dermoscope (magnification of ×32 and ×140) was used.

Results:

The mean age of the patients (46 males and 20 females) was 26.85 years. The mean age of onset was 25.15 years. The mean duration of alopecia was 10.3 months. Most common AA in our study was patchy type (57/66, 87.7%). Single patch was seen in 24 patients and multiple patches in 33 patients. Diffuse AA was seen in five patients. Ophiasis and alopecia universalis were seen in two patients each. Nail changes were fine pitting (4), ridging (2), thinning of nail plate (2). Twenty nail dystrophy, distal onycholysis, striate leukonychia and coarse pitting were seen in one patient each. Intralesional triamcinolone acetonide was the most common therapy offered. Others were oral betamethasone minipulse therapy, dexamethasone pulse, minoxidil, anthralin and corticosteroids. The most common dermoscopic finding was yellow dots seen in 54 patients (81.8%), followed by black dots (44 patients, 66.6%), broken hairs (36 patients, 55.4%), short vellus hair (27 patients, 40.9%) and tapering hairs (8 patients, 12.1%).

Conclusions:

The most common dermoscopic finding of AA in our study was yellow dots, followed by black dots, broken hairs, short vellus hair and tapering hairs. Dermoscopic findings were not affected by the type of AA or the severity of the disease.     

Dry dermoscopy in clinical treatment of alopecia areata

Although dermoscopy is conventionally utilized with immersion gel for diagnosis of pigmented tumor, we utilized dry dermoscopy, which is dermoscopy without immersion gel, for clinical treatment of alopecia areata (AA). The scalp skin and hair of a 38-year-old Japanese male, and 23-, 22- and 47-year-old Japanese females with AA, whose normal hair color was black, were examined by dry dermoscopy. Exclamation mark hairs, short hairs, fractured hairs and black dots, all characteristic of AA, were detected by dry dermoscopy of the scalp of the 23-year-old female with ophiasis type AA. In the case of the 47-year-old female with round hair loss on the occipital scalp and diffuse hair loss over the fronto-vertical region, dry dermoscopy was useful for diagnosis of AA based on hair characteristic of AA. After she received corticosteroid pulse therapy with 500 mg of i.v. methylprednisolone on 3 successive days, her hair showed apparent regrowth and disappearance of the abnormal hairs characteristic of AA, evidenced by dry dermoscopy 1 month later. In a case of long-lasting AA in the 23-year-old female, we found a follicular plaque-like appearance at the opened hair follicle pores by dry dermoscopy. Histopathologically, the incompletely differentiated remnant hair shaft was packed in the follicular infundibulum. In addition, regrowing vellus hairs, which were difficult to clinically recognize, were detected by dry dermoscopy. Dry dermoscopy is therefore useful for both diagnosis and follow up of AA.     

103例学龄期儿童拔毛癖皮肤镜表现

目的:总结学龄期儿童拔毛癖患者皮肤镜表现.方法:回顾性研究2017年6月至2021年6月于我院诊治的103例拔毛癖患者临床资料.结果:103例患者中,男51例,女52例,平均年龄(10.20±2.75)岁.拔发部位位于头顶部(48.5％),单侧颞部(28.2％),双侧颞部(15.5％),额部(20.4％),枕部(5.8...     

Isolated eyebrow and eyelash trichotillomania mimicking alopecia areata

BACKGROUND: Isolated Trichotillomania (TM) of the eyebrows and eyelashes is occasionally seen and may be mistaken for alopecia areata (AA). OBJECTIVE: The clinical study of the patients with isolated eyebrows and eyelashes alopecia suggesting of TM. PATIENTS AND METHOD: Seven children and young adult patients who referred with recalcitrant eyebrows and eyelashes alopecia were diagnosed as TM based on the clinical criteria for TM. The hair specifications for TM were include: hairs are broken at different levels, they may be tufted, tortuous and some hair fibers may be abnormally longer than others. The hair follicles may be prominent. The patients and their parents studied for psychopathology using a semistructured interview based on the Diagnostic Statistical manual of Psychiatric disorders (DSM-1V) and maudsley inventory. RESULTS: Our clinical study, interview with the patients and their parents and the clinical criteria used to differentiate TM from AA all support the clinical diagnosis of TM. The patients and their parents mainly suffered from obsessive-compulsive disorders (OCD) and obsessive-compulsive spectrum disorders (OCSDs). CONCLUSION: TM as a hair pulling habit in patients with underlying psychopathology can be considered in cases with isolated eyebrows and eyelashes alopecia when the hair are broken at different levels. And they may be malaligned, nonuniform, tortuous, and tufted.     

二十甲营养不良合并普秃1例

患者女,50岁,全部头发伴部分体毛脱落6个月.双手足甲甲板相继浑浊、粗糙变形20年.皮肤科情况:头发几乎全部脱落,眉毛、睫毛、腋毛和阴毛部分脱落;二十甲甲板表面粗糙,有纵脊,状如砂纸.毛发镜检查:可见惊叹号样发、断发,黑点征(+)、黄点征(+).指甲皮肤镜检查:甲板浑浊不透明、角质层变厚粗糙、点蚀、纵脊.诊断:二十甲营...     

Evaluation of Clinical Significance of Dermoscopy in Alopecia Areata

Background:Alopecia areata (AA) is a common, chronic inflammatory disease characterized by nonscarring hair loss on the scalp or any hair-bearing area of the body. Recently, dermoscopy, a noninvasive diagnostic procedure, has been employed for the diagnosis of AA.Aim:To evaluate various dermoscopic patterns in AA and correlate these patterns with the disease activity and severity.Results:A total of fifty patients of AA were recruited in the study. Female outnumbered males with the ratio being 1.173:1. Mean age of the patients was 25.06 years. Mean duration of disease was 14 months. The most common site involved was scalp (80%) and type noted was patchy (84%). Various dermoscopic patterns noted were yellow dots (YD) (88%), short vellus hair (66%), black dots (BD) (58%), broken hairs (BHs) (56%), tapering hair (TH) (26%), Coudability hairs (14%), pigtail hair (14%), and Pohl-Pinkus constrictions (2%). Statistically significant correlation was observed between BD, BHs, THs, and disease activity. No significant correlation was found between severity and any of the dermoscopic features.Conclusion:The most common dermoscopic pattern in our study was YD. Presence of BDs, BHs, and THs indicate active disease. Dermoscopic patterns were not affected by severity of the disease.     

'Black dots' seen under trichoscopy are not specific for alopecia areata

Background. ‘Black dots’ are macrocomedo‐like round structures localized to the follicular ostium, and are considered a specific trichoscopic feature of alopecia areata (AA). Aim. To characterize specific features of ‘black dots’, and assess their possible presence in common hair and scalp disorders. Methods. In total, 107 patients with hair loss [30 with alopecia areata (AA), 37 with androgenetic alopecia (AGA), 17 with chronic telogen effluvium (TE), 23 with other hair and scalp diseases] and 93 healthy controls were examined, using a videodermoscope with 20–70 times magnification. Results. There was a correlation between the black dots and the early acute phase of the various alopecia types with the presence of the black dots. Black dots were found in 11% (22/107) of patients with hair loss, including 53.3% (16/30) with AA; in 40% (2/5) of patients with severe chemotherapy‐induced alopecia, and in 100% of patients with dissecting cellulitis of the scalp (n = 2), hypotrichosis simplex (n = 1), and congenital aplasia cutis (n = 1). No black dots were seen in patients with AGA or TE. Conclusions. Black dots are not specific for AA, and may be present in other hair and scalp diseases.     

成人拔毛癖临床表现、皮肤镜特征和精神应激状态

目的:明确成人拔毛癖临床表现、皮肤镜特征和精神应激状态。方法:分析15例成人拔毛癖患者临床资料及皮肤镜特征,应用应激事件量表计算压力积分值并与17例斑秃及15例正常人进行比较。结果:15例拔毛癖患者中女10例,男5例,年龄18~51岁,平均35.67岁。拔发部位头顶部7例、颞部3例、枕部3例及额部2例。成人拔毛癖患者精神压力积分为98.33±11.23,高于正常成人的51.47±15.40(P0.05)。成人拔毛癖患者精神压力积分与斑秃患者(92.35±14.86)比较,无统计学意义(P0.05)。成人拔毛癖皮肤镜征象表现为黑点征14例(93.3%),断发13例(87.7%),新生短发、毳毛增多10例(66.7%),黄点征5例(33.3%)。结论:最常见拔发部位为头顶部,精神压力高于正常人,成人拔毛癖皮肤镜最常见特征为黑点征和断发。     

Tricoscopia en la alopecia areata

Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment.     

[Translated article] Trichoscopy in Alopecia Areata

Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body. Diagnosis is clinical but can be aided by trichoscopy, a simple, rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response. We review the usefulness of trichoscopy in alopecia areata. The most common trichoscopic findings are yellow dots, black dots, exclamation mark hairs, short vellus hairs, and coudability hairs. Other, less common, findings can also help establish a diagnosis. Good response to treatment is indicated by the disappearance of black dots, broken hairs, and exclamation mark hairs. The observation of yellow dots, by contrast, indicates chronic disease and poor response to treatment.     

Use of trichoscopy for the diagnosis of alopecia areata coexisting with primary scarring alopecia in a female hair loss patient

Despite patchy hair loss being typically observed in alopecia areata (AA), similar lesions can be seen in other forms of alopecia and the diagnosis is sometimes challenging. Of note, patchy primary scarring alopecia (SA) needs to be clearly distinguished from AA as SA can leave permanent hair loss. Herein, we report a previously unreported case of AA coexisting with SA successfully diagnosed by detailed trichoscopic investigation. A 42‐year‐old woman visited us with patchy hair loss lesions on the scalp. On physical examination, alopecic lesions sized up to 2 cm in diameter were observed in the right temporal and parietal regions. A gentle hair pull test collected dystrophic anagen hairs from some patches. Trichoscopy detected tapering hairs and black dots. The diagnosis of AA was made. However, some reddish patches were totally hair pull test negative, urging us to further evaluate the remaining lesions. Additional trichoscopic investigation revealed the disappearance of follicular ostia and the presence of a white and milky‐red area and peripilar scales, suggestive of SA. In histology, the clinically AA lesion showed peribulbar cell infiltration, while the potentially SA lesion demonstrated inflammatory cell infiltration around the isthmus and the decrease in hair follicles, some of which were replaced by fibrotic tissue. The final diagnosis of AA coexisting with SA was made. Intralesional corticosteroid injection improved AA but not SA. These findings emphasize the need for thorough trichoscopic examination for accurate diagnoses of rare hair loss conditions.     

Trichoscopy for common hair loss diseases: algorithmic method for diagnosis

In recent years, the usefulness of trichoscopy (scalp dermoscopy) has been reported for hair loss diseases. Here, characteristic trichoscopic features of common hair loss diseases are described using a DermLite II pro or Epilight eight. Characteristic trichoscopic features of alopecia areata are black dots, tapering hairs (exclamation mark hairs), broken hairs, yellow dots and short vellus hairs. In androgenetic alopecia (AGA), hair diameter diversity (HDD), perifollicular pigmentation/peripilar sign and yellow dots are trichoscopically observed. In all cases of AGA and female AGA, HDD more than 20%, which corresponds to vellus transformation, can be seen. In cicatricial alopecia (CA), the loss of orifices, a hallmark of CA, and the associated changes including perifollicular erythema or scale and hair tufting were observed. Finally, an algorithmic method for trichoscopic diagnosing is proposed.     

Trichoscopy of alopecia areata: An update

The diagnosis of alopecia areata is usually based on clinical manifestations. However, there are several hair and scalp disorders that share similar clinical features with alopecia areata, such as tinea capitis, trichotillomania or traction alopecia. Trichoscopy as a fast, non‐invasive and easy‐to‐perform technique may help to identify subtle details and establish the correct diagnosis. The aim of this review is to present the spectrum of trichoscopic findings in alopecia areata. A systematic review of the published work was performed by searching the PubMed, Scopus and EBSCO databases, complemented by a thorough hand search of reference lists. Of 427 articles retrieved, 30 studies were eligible for quantitative analysis. The reported features of alopecia areata were: yellow dots (6–100% patients), short vellus hairs (34–100%), black dots (0–84%), broken hairs (0–71%) and exclamation mark hairs (12–71%). Tapered hairs (5–81%) were reported in few studies, but a relatively high frequency of this finding in alopecia areata may indicate their important role in the differential diagnosis of hair loss. Rarely reported features, which include upright regrowing hairs (11–96%), pigtail (circle) hairs (4–61%) and Pohl‐Pinkus constrictions (2–10%), may also be helpful in the diagnosis of alopecia areata. There is no pathognomonic trichoscopic marker for alopecia areata and the most common trichoscopic features are not the most specific. Therefore, the diagnosis should be based on the coexistence of several trichoscopic findings, not on the presence of a single feature.