Alopecia areata

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Description This chapter describes the dermoscopy of alopecia areata
Author(s) Anna Waskiel Burnat · Lidia Rudnicka · Adriana Rakowska
Responsible author Anna Waskiel Burnat→ send e-mail
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Status update April 4, 2019
Status by Ralph P. Braun


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Trichoscopic findings of alopecia areata include black dots, broken hairs, exclamation mark hairs, tapered hairs, Pohl-Pinkus constrictions, yellow dots, short vellus hairs, upright regrowing hairs and pigtail hairs [4].


Trichoscopic feature Reported prevalence in %* (mean value**)
Yellow dots 6 - 100 (62)
Black dots 0 - 84 (53)
Exclamation mark hairs 12 - 71 (39)
Tapered hairs 5 - 81 (51)
Broken hairs 0 - 71 (49)
Short vellus hairs 34 - 100 (61)
Upright regrowing hairs 11 - 96 (23)
Pigtail (circle) hairs 4 - 61 (21)
Pohl-Pinkus constrictions 2 - 10 (4)

Adapted from Waśkiel et al. [5]


Active hair loss in alopecia areata is characterized by presence of black dots, broken hairs, exclamation mark hairs, tapered hairs and Pohl-Pinkus constrictions [6, 7] [8] [9] [10]. In long-lasting, non-active disease mainly yellow dots and short vellus hairs are observed [10].
Good response to the therapy of alopecia areata is characterized the reduction followed by the loss of exclamation mark hairs, broken hairs and black dots [11]. Yellow dots are the least responsive [11]. In initial hair regrowth, increased number of short vellus hairs is observed. With the continuation of the therapy they are substituted by fully pigmented terminal hairs so a decreased number of short vellus hairs may be detected [12]. Hair regrowth is characterized by presence of upright regrowing hairs and pigtail hairs [10].

AA1.jpg

Trichoscopy of alopecia areata with presence of exclamation mark hairs.

AA2.jpg

Black dots, yellow dots and broken hairs in patient with alopecia areata.

AA3.jpg

Multiple yellow dots in patient with inactive alopecia areata.


Trichoscopic findings of alopecia areata include black dots, broken hairs, exclamation mark hairs, tapered hairs, Pohl-Pinkus constrictions, yellow dots, short vellus hairs, upright regrowing hairs and pigtail hairs [4].


Trichoscopic feature Reported prevalence in %* (mean value**) Yellow dots 6 - 100 (62) Black dots 0 - 84 (53) Exclamation mark hairs 12 - 71 (39) Tapered hairs 5 - 81 (51) Broken hairs 0 - 71 (49) Short vellus hairs 34 - 100 (61) Upright regrowing hairs 11 - 96 (23) Pigtail (circle) hairs 4 - 61 (21) Pohl-Pinkus constrictions 2 - 10 (4) Adapted from Waśkiel et al. [5]

Active hair loss in alopecia areata is characterized by presence of black dots, broken hairs, exclamation mark hairs, tapered hairs and Pohl-Pinkus constrictions [6, 7] [8] [9] [10]. In long-lasting, non-active disease mainly yellow dots and short vellus hairs are observed [10]. Good response to the therapy of alopecia areata is characterized the reduction followed by the loss of exclamation mark hairs, broken hairs and black dots [11]. Yellow dots are the least responsive [11]. In initial hair regrowth, increased number of short vellus hairs is observed. With the continuation of the therapy they are substituted by fully pigmented terminal hairs so a decreased number of short vellus hairs may be detected [12]. Hair regrowth is characterized by presence of upright regrowing hairs and pigtail hairs [10].Big text

4. Rudnicka, L., et al., Trichoscopy update 2011. J Dermatol Case Rep, 2011. 5(4): p. 82-8. 5. Waskiel, A., et al., Trichoscopy of alopecia areata: An update. J Dermatol, 2018. 6. Guttikonda, A.S., et al., Evaluation of Clinical Significance of Dermoscopy in Alopecia Areata. Indian J Dermatol, 2016. 61(6): p. 628-633. 7. Inui, S., et al., Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases. Int J Dermatol, 2008. 47(7): p. 688-93. 8. Kibar, M., et al., Trichoscopic findings in alopecia areata and their relation to disease activity, severity and clinical subtype in Turkish patients. Australas J Dermatol, 2015. 56(1): p. e1-6. 9. Inui, S., T. Nakajima, and S. Itami, Coudability hairs: a revisited sign of alopecia areata assessed by trichoscopy. Clin Exp Dermatol, 2010. 35(4): p. 361-5. 10. Rudnicka, L., M. Olszewska, and A. Rakowska, Atlas of trichoscopy: dermoscopy in hair and scalp disease. 2012, London: Springer. 11. Ganjoo, S. and D.M. Thappa, Dermoscopic evaluation of therapeutic response to an intralesional corticosteroid in the treatment of alopecia areata. Indian J Dermatol Venereol Leprol, 2013. 79(3): p. 408-17. 12. El Taieb, M.A., et al., Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatol Ther, 2017. 30(1).