Trichoscopy of cicatricial alopecia

J Drugs Dermatol. 2012 Jun;11(6):753-8.


Background: Trichoscopy is widely used in differential diagnosis of non-cicatricial alopecia.

Objective: The aim of this prospective study was to identify possible characteristic trichoscopy patterns of diseases leading to primary cicatricial alopecia.

Methods: Trichoscopy was performed in a total of 1,884 consecutive patients presenting with hair loss. In this group, 84 patients were diagnosed with cicatricial alopecia and 1,800 patients with non-cicatricial alopecia. Sixty healthy persons served as healthy controls. Trichoscopy was performed with the use of Fotofinder II videodermoscopy system. Following unique or characteristic features were identified: scattered dark-brown discoloration of the skin, large yellow dots and thick arborizing vessels in cutaneous (discoid) lupus erythematosus (n=20), tubular perifollicular scaling and elongated blood vessels in lichen planopilaris (n=28), minor perifollicular scaling in frontal fibrosing alopecia (n=19), tufted hairs with starburst pattern perifollicular hyperplasia in folliculitis decalvans (n=9) and large, "3D" yellow dots imposed over dystrophic hairs in dissecting cellulitis (n=8).

Results: All patients with cicatricial alopecia trichoscopy showed white and milky-red areas lacking follicular openings. These features were not found in patients with non-cicatricial alopecia or healthy controls.

Conclusion: These results indicate that trichoscopy may be applied as a quick and non-invasive auxiliary method in differential diagnosis of diverse diseases leading to cicatricial alopecia, such as cutaneous lupus erythematosus, classic lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, and dissecting cellulitis.

MeSH terms

  • Adult
  • Alopecia / diagnosis*
  • Alopecia / pathology
  • Alopecia / therapy*
  • Dermoscopy / methods*
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Prospective Studies
  • Scalp Dermatoses / diagnosis*
  • Scalp Dermatoses / pathology
  • Scalp Dermatoses / therapy*