Absence of Vellus Hair in the Hairline: A Videodermatoscopic Feature of Frontal Fibrosing Alopecia

    August 2013 in “ British Journal of Dermatology ”
    Francesco Lacarrubba, Giuseppe Micali, Antonella Tosti
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    TLDR Lack of small, fine hair on the front hairline is a key sign of frontal fibrosing alopecia.
    In a retrospective analysis of videodermatoscopy (VD) images from 34 women with pathologically confirmed frontal fibrosing alopecia (FFA) exclusively involving the frontotemporal area, researchers found that the absence of vellus hairs in the frontotemporal hairline was a significant VD feature, observed in 94% of cases. Other VD features included perifollicular scaling in 79% of cases, absence of follicular openings in 65% of cases, brown halos/white dots in 44% of cases, pili torti in 26% of cases, and black dots/broken hairs in 15% of cases. The study concluded that the absence of vellus hair in the frontotemporal hairline is a simple diagnostic VD hallmark of FFA, which could be useful in early stages of the disease and in differential diagnosis from other types of alopecia involving the scalp margin in female patients. This feature was not observed in other types of hair loss such as androgenetic alopecia, alopecia areata, or traction alopecia, which were analyzed for comparison.
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