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      Scalp Dermatoscopic Findings in Androgenetic Alopecia and Their Relations with Disease Severity

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          Abstract

          Background

          Clinicians are searching for new methods to diagnose and predict the course of androgenetic alopecia noninvasively.

          Objective

          Our aim is to evaluate trichoscopic findings and their relations with disease severity in androgenetic alopecia.

          Methods

          The videodermatoscopic findings of 143 female and 63 male patients with androgenetic alopecia were compared with each other, with those of healthy subjects (n=100), and with those of patients with other nonscarring alopecias (n=208). Mann-Whitney U-test, χ 2 analyses, and logistic regression analysis were used for statistical analysis.

          Results

          No statistically significant relation was found between trichoscopic findings and severity in male androgenetic alopecia (MAGA) on the basis of the modified Hamilton Norwood scale (among 7 degrees); however, multihair follicular unit and perifollicular pigmentation were related to low severity whereas white dots, honeycomb pattern pigmentation, and brown dots were related to high severity. On the other hand, according to the Ludwig classification, arborizing red lines were related to low severity and brown dots were related to high severity, whereas there was no difference in stages between the Ebling and Olsen classifications in female androgenetic alopecia (FAGA). In the characteristic trichoscopic findings in this study, perifollicular pigmentation was found as a normal feature of the scalp, whereas multihair follicular unit and honeycomb pigment pattern, which were previously considered as normal features, were observed to be related to androgenetic alopecia.

          Conclusion

          No relation was found between MAGA severity and trichoscopic findings, as well as between FAGA severity according to different disease severity classifications and trichoscopic findings.

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          Most cited references35

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          Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex.

          Androgenetic alopecia in the female occurs much more frequently than is generally believed. The condition is still considered infrequent, for it differs, in its clinical picture and in the sequence of events leading to it, from common baldness in men. To facilitate an early diagnosis (desirable in view of the therapeutic possibilities by means of antiandrogens) a classification of the stages of the common form (female type) of androgenetic alopecia in women is presented. The exceptionally observed male type of androgenetic alopecia can be classified according to Hamilton or to the modification of this classification proposed by Ebling & Rook.
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            Videodermoscopy in the evaluation of hair and scalp disorders.

            The standard methods used to diagnose scalp and hair disorders (eg, simple clinical inspection, pull test, biopsy) vary in sensitivity, reproducibility, and invasiveness. Studies on a few entities suggest that use of dermoscopy can improve clinical accuracy, but further investigation is needed. We sought to: (1) characterize features of several nontumoral scalp and hair conditions using videodermoscopy; and (2) assess the potential usefulness of videodermoscopy in the clinical evaluation of these conditions. Images (x20-70 magnification) obtained with videodermoscopy from 220 patients with various scalp and hair disorders and 15 unaffected control subjects were reviewed for distinguishing features. Conditions evaluated included psoriasis (23), seborrheic dermatitis (26), alopecia areata (58), androgenetic alopecia (64), chronic telogen effluvium (7), trichotillomania (12), and primary cicatricial alopecia (30). Clinical features evident to the naked eye were seen in great detail when videodermoscopy was used. Novel features (eg, yellow dots in alopecia areata) were also identified. Findings require confirmation by blinded, prospective investigation. Use of videodermoscopy in the clinical evaluation of scalp and hair disorders improves diagnostic capability beyond simple clinical inspection and reveals novel features of disease, which may extend clinical and pathogenetic understanding.
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              Diagnostic and predictive value of horizontal sections of scalp biopsy specimens in male pattern androgenetic alopecia.

              Vertical sections of small scalp biopsy specimens are often inadequate for the diagnosis of male pattern androgenetic alopecia (MPAA). Quantitative analysis of follicular structures in horizontal sections can provide more information. Our purpose was to establish better diagnostic criteria by comparing horizontal and vertical sections of scalp biopsy specimens from MPAA and normal control subjects and to determine the predictive value of horizontal sections, by relating counts of follicular structures in MPAA to subsequent hair regrowth from topical minoxidil therapy. Paired 4 mm punch biopsy specimens were taken from 22 normal control subjects and 106 patients with MPAA, for horizontal and vertical sectioning. In horizontal sections, hair bulbs, terminal anagen, catagen and telogen hairs, telogen germinal units, and vellus hairs were counted, as were follicular units and stelae. The diagnosis of MPAA was confirmed by finding decreased terminal hairs and increased stelae and vellus hairs. The average horizontal section contained 22 terminal and 13 vellus hairs, a 1.7:1 ratio. Changes compatible with MPAA were found in most vertical and horizontal sections, but horizontal sections were required for follicular counts and showed terminal:vellus hair ratios diagnostic of MPAA in 67% of cases. Of 44 patients treated with topical minoxidil, five with less than 2 follicular structures/mm2 showed no hair regrowth, 32 with 2 to 4 follicular structures/mm2 showed regrowth in 72%, and seven with more than 4 follicular structures/mm2 showed regrowth in 86% of cases. In MPAA with no significant inflammation, regrowth occurred in 77% of cases, versus 55% in cases with significant inflammation. Horizontal sections of scalp biopsy specimens in MPAA provide more diagnostic information than vertical sections and appear to have a predictive value for hair regrowth.
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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
                August 2014
                31 July 2014
                : 26
                : 4
                : 478-484
                Affiliations
                Department of Dermatology, Beypazarı Public Hospital, Ankara, Turkey.
                [1 ]Department of Dermatology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
                [2 ]Department of Biostatistics, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey.
                Author notes
                Corresponding author: Melike Kibar, Department of Dermatology, Beypazarı Public Hospital, Ankara 06000, Turkey. Tel: 90-506-2924963, Fax: 90-312-7632296, kibarmelike@ 123456hotmail.com
                Article
                10.5021/ad.2014.26.4.478
                4135103
                25143677
                29425ba7-4a20-4c1f-b7cc-9f73f8440776
                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
                : 01 April 2013
                : 09 September 2013
                : 14 September 2013
                Categories
                Original Article

                Dermatology
                androgenetic alopecia,dermoscopy,trichoscopy
                Dermatology
                androgenetic alopecia, dermoscopy, trichoscopy

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