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

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          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® 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.

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          Most cited references12

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

          To determine dermoscopic findings of alopecia areata (AA) from a large-scale study that can be used as clinical indicators of disease. 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. 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. Dermoscopic characteristics, such as black dots, tapering hairs, broken hairs, yellow dots, and clustered short vellus hairs, are useful clinical indicators for AA.
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            Histopathology of alopecia: a clinicopathological approach to diagnosis.

            Interpretation of the histopathological findings of primary scarring and non-scarring alopecias may prove daunting. This is especially true if the biopsy specimen is inadequate, and the clinical history and pattern of the alopecia are not known. Common forms of scarring alopecias discussed here are the lymphocytic (discoid lupus erythematosus, lichen planopilaris, central centrifugal cicatricial alopecia, pseudopelade of Brocq), the neutrophilic (folliculitis decalvans, dissecting folliculitis), and the mixed (acne keloidalis) entities. The non-scarring alopecias reviewed are androgenic alopecia, telogen effluvium, alopecia areata, trichotillomania and traction alopecia. In all cases of primary alopecia, adequate tissue sampling and appropriate laboratory processing, in combination with pertinent clinical information, provide the key to diagnosis.
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              Comma hairs: a dermatoscopic marker for tinea capitis: a rapid diagnostic method.

              Dermatoscopy and videodermatoscopy have been used for several years in the diagnosis of skin disorders. We sought to determine whether tinea capitis (TC) shows characteristic videodermatoscopy features that may facilitate its differentiation from alopecia areata (AA). Two patients with TC caused by Microsporum canis, confirmed by mycological culture and fluorescence under Wood lamp, were examined with videodermatoscopy and results were compared with videodermatoscopy results of 12 patients with AA. The distinctive and most prominent feature of TC was presence of commalike structures (comma hairs). These were accompanied by broken and dystrophic hairs. Videodermatoscopy features of AA included exclamation mark hairs, vellus and dystrophic/cadaverized hairs, and yellow dots corresponding to hyperkeratotic hair follicle plugs. This study was conducted on two patients, both with M canis infection. Comma hairs were observed as a distinctive videodermatoscopy feature of M canis-induced TC. This finding was not observed in AA, typified generally by exclamation mark hairs.
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                Author and article information

                Journal
                Ann Dermatol
                Ann Dermatol
                AD
                Annals of Dermatology
                Korean Dermatological Association; The Korean Society for Investigative Dermatology
                1013-9087
                2005-3894
                April 2014
                30 April 2014
                : 26
                : 2
                : 214-220
                Affiliations
                [1 ]Department of Dermatology, Pusan National University School of Medicine, Busan, Korea.
                [2 ]Medical Research Institute, Pusan National University School of Medicine, Busan, Korea.
                Author notes
                Corresponding author: Moon-Bum Kim, Department of Dermatology, Pusan National University School of Medicine, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-870, Korea. Tel: 82-51-240-7338, Fax: 82-51-245-9467, drkmp@ 123456hanmail.net
                Article
                10.5021/ad.2014.26.2.214
                4037675
                24882977
                06995830-b668-492e-abcc-c89013a316d5
                Copyright © 2014 The Korean Dermatological Association and The Korean Society for Investigative Dermatology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 June 2012
                : 24 May 2013
                : 24 May 2013
                Categories
                Original Article

                Dermatology
                alopecia,dermoscopy
                Dermatology
                alopecia, dermoscopy

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