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Chinmanat Tangjaturonrusamee, M.D.
Institute of Dermatology
Hair and scalp Dermoscopy
Outline
�Dermoscopy on the normal scalp
�Pattern of clinical presentation
• Scalp
• Hair
�Clinical implementation
Dermoscopy – x10 to x30 Videodermoscopy – x10 to
x1000 �Camera + lenses + computer storage
Normal scalp
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Follicular unit – 1-5 hair
follicles
40x
312
Normal scalp – Simple red
loops�Simple red loop = Pinpoint red dots
�Arborizing red line – wider caliber
Arborizing red line
Ross, J Am Acad Dermatol 2006; 55: 799-806.
Children – Dirty dots
20x
Children - Dirty dots
� sebaceous gl. activity à repel debris
Tosti, Arch Dermatol 2009; 145(5): 600-1.
20x 70x
Vascular pattern
Red loops
�Normal scalp
- simple red loops
�Psoriasis
- twisted red loops
� Psoriasis
� Seborrheic dermatitis
� Folliculitis decalvans
70x
Arborizing red line
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Psoriasis vs Seborrheic
dermatitis�Psoriasis
- red dots
- twisted red loops
- glomerular vessels
�Seborrheic dermatitis
- arborizing vessels
- atypical red vessels
- no red dots
Kim, Br J Dermatol 2011; 164(3): 652-6.
Psoriasis
Kim, Br J Dermatol 2011; 164(3): 652-6.
Red dots & globules
Glomerular vessels
Twisted red loops
Seborrheic dermatitis
Kim, Br J Dermatol 2011; 164(3): 652-6.
Atypical red vessels
Arborizing vessels
Pigment pattern
Honeycomb pigment pattern
�Normal scalp
- diffuse, homogenous
�Chronic alopecia
- patchy, scar
scar
honeycomb
honeycomb
40x 40x
Peripilar signs
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Yellow dots
= yellow round dots
40x 40x
AA AGA
AA, AGA,
Trichotillomania, Dissecting cellulitis,
Cong. hypotrichosis
Yellow dots
Dilated infundibulum with
keratinous material
Tosti, Arch Dermatol 2011; 147(1): 61-4.
Pinpoint white dots
�Regularly distributed
�Scalp with normal interfollicular epidermis
20x
Pinpoint white dots
Small pinpoint white dots = Epidermal portion of
eccrine sweat duct
Abraham, J Am Acad Dermatol 2010; 63: 721-2.
Normal,
FFA, LPP, AA, AGA,
CCCA
White patch - Scarring alopecia
20x
Follicular red dots - DLE
Tosti, Arch Dermatol 2009;145(12):1406-9.
Widened infundibula plugged by keratin
Dilated vessels and extravasated erythrocytes
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Peripilar sign – AGA
�Perifollicular inflammation à PIH
Tosti, J Am Acad Dermatol. 2012 [Epub ahead of print]
Hair presentation
Hair diversity > 20% - AGA
20x
Vellus
Black dots (Cadaverized hairs)
�Destroyed hair shaft à broken hair
Cadaverized hair
Broken hair40x
AA, Trichotillomania,
T. capitis
AA vs Trichotillomania (TT)
�Exclamation mark hair
**characteristic of AA
�Coiled hair
**characteristic of TT
AA TT
Coiled
Coiled
Broken
Broken
Broken
Exclamation
10x 10x
Abraham, An Bras Dermatol 2010; 85(5): 723-6.
Comma hair - Tinea capitis
Tosti, Mycoses 2011; 54(1): 87-8.
40x
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Corkscrew hair - Tinea capitis
Hughes, Arch Dermatol 2011 Mar;147(3):355-6.10x
Ectothrix
40x
Hair shaft disorders
Monilethrix
Int J Trichology. 2010 Jan-Jun; 2(1): 56–59.
Trichorrhexis nodosa
Int J Trichology. 2011 Jul-Dec; 3(2): 105–106.
Why is dermoscopy useful?
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Nonscarring or scarring
alopecia?
Scarring alopecia – DLE, LPP
Cicatricial white patch
Blue grey dots*
Broken hair
*Duque-Estrada, An Bras Dermatol 2010; 85: 179-83.
40x
AA or Trichotillomania ? Trichotillomania – Coiled hairs
40x
Tinea capitis Alopecia areata
Comma hair
Broken hair
Dystrophic hair
Exclamation hair
Slowinska, J Am Acad Dermatol 2008;59:S77-9.
Dermatoscopy guided scalp Bx
LPP FFA DLE
Tosti, J Eur Acad Dermatol Venereol 2012 Mar 26 [Epub ahead of print]