Perifollicular and interfollicular skin surface

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 Author(s): Lidia Rudnicka, Anna Waskiel Burnat, Adriana Rakowska

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Description	This chapter describes the perifollicular and interfollicular criteria as seen in trichoscopy (dermoscopy of hair and scalp)
Author(s)	Anna Waskiel Burnat · Lidia Rudnicka · Adriana Rakowska
Responsible author	Anna Waskiel Burnat → send e-mail
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Status update	January 21, 2019
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Scalp, Hair: dermoscopy, Trichoscopy, Follicules, Follicular signs Perifollicular and interfollicular skin surface – cite! Perifollicular and interfollicular skin surface (message) Perifollicular and interfollicular skin surface – participate!

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In trichoscopy, following perifollicular and interfollicular skin surface abnormalities may be observed: scaling, discoloration, discharge and surface structure.

Scaling

Epidermal scaling can be divided into perifollicular and diffuse [13].

Mild diffuse scaling may be observed in healthy persons with dry skin. White moderate to severe diffuse scaling is detected in psoriasis, discoid lupus erythematosus and contact dermatitis. Yellowish moderate to severe diffuse scaling is presented in seborrheic dermatitis, discoid lupus erythematosus and ichthyosis [13].

White perifillicular, tubular scaling is characteristic for lichen planopilaris. In folliculitis decalvans, yellowish, tubular with collar formation is observed [13]. It needs to be emphasized, that diffuse “scaling” with formation of white perifollicular clusters may be present in monoclonal gammopathy [13].

Discoloration

Brown areas in trichoscopy may occur in three different patterns.
Honeycomb pattern comprises a homogenous, mosaic or contiguous brown rings. It may be observed in chronically sun-exposed areas of thinning or complete hair loss and the scalp of dark-skinned patients [17]. Perifollicular brown coloration results from perifollicular lymphocytic infiltration [14] and is commonly detected in androgenetic alopecia, telogen effluvium. It may be presented in up to 10% of hair follicle openings in healthy persons [14, 18]. Scattered brown discoloration is typical feature of discoid lupus erythematosus [5].

Pink, “strawberry ice cream” areas are characteristic trichoscopic findings of cicatricial alopecia and correspond to early fibrosis [5].

Red areas may be observed in case of inflammation, extravasation, epidermal detachment and vascular abnormalities [13].

White areas are common feature of cicatricial alopecia and correspond to late fibrosing process [5]. They may be also observed in epidermal detachment and edema [13].

Yellow areas are detected in dissecting cellulitis, follicular pustules, dissecting cellulitis and bacterial infections [13].

Discharge

Yellow or yellow-red discharge is detected in folliculitis decalvans, bacterial infections, dissecting cellulitis or tinea capitis [13].

Surface structure

Starburst pattern hyperplasia results from fibrosis and is characteristic trichoscopic findings of folliculitis decalvans [5].