The value of trichoscopy in the differential diagnosis of scalp lesions in pemphigus vulgaris and pemphigus foliaceus

BACKGROUND

Trichoscopy is becoming increasingly popular in diagnosing hair and scalpdiseases. Scalp involvement in pemphigus is common. The scalp may be the first oronly site of clinical manifestation of the disease.

OBJECTIVE

The aim of this study was to analyze whether trichoscopy may be useful in aidingdifferential diagnosis of scalp lesions in patients with pemphigus vulgaris andpemphigus foliaceus.

METHODS

Trichoscopy was performed in 19 patients with scalp lesions in the course ofpemphigus (9 patients with pemphigus vulgaris and 10 with pemphigus foliaceus). Inall patients, the diagnosis of scalp pemphigus was confirmed by histopathology.The working magnification was 20-fold and 70-fold.

RESULTS

The most frequently observed trichoscopy features of pemphigus lesions were:extravasations (18/19; 94.7%) and yellow hemorrhagic crusts (11/19; 57.9%). Yellowdots with whitish halo were observed in 6/19 (31.6%) patients with pemphigus.White polygonal structures were observed in pemphigus foliaceus (6/10; 60%), butnot in pemphigus vulgaris. Vascular abnormalities were more frequent in pemphigusvulgaris, when compared to pemphigus foliaceus, and were associated with a severecourse of disease. Linear serpentine vessels were the most frequent vascularabnormality in patients with pemphigus vulgaris and pemphigus foliaceus (77.8% and30%, respectively).

CONCLUSION

Trichoscopy may serve as a useful supplementary method in the differentialdiagnosis of pemphigus, especially in cases of desquamative or exudative lesionslimited to the scalp. Extravasations, yellow hemorrhagic crusts, yellow dots withwhitish halo, white polygonal structures and linear serpentine vessels aretrichoscopy features which may suggest the diagnosis of pemphigus.