Follicular Red Dots: A Normal Trichoscopy Feature in Patients with Pigmentary Disorders?

    June 2013 in “ Anais Brasileiros de Dermatologia ”
    Rodrigo Pirmez, Juan Piñeiro‐Maceira, Bárbara Cristina Rodrigues de Almeida, Celso Tavares Sodré
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    TLDR Follicular red dots may be a normal feature seen in people with less skin pigmentation, not necessarily indicating a scalp disorder.
    In a study from 2013, five patients with pigmentary disorders (four with albinism and one with vitiligo) were examined for the presence of follicular red dots (FRD) during scalp examination using trichoscopy. The study found that FRD, previously associated with active discoid lupus erythematosus (DLE) and a better prognosis, were present in these patients without hair or scalp disorders, suggesting that FRD may be related to the rich vasculature surrounding normal hair follicles. This was supported by histopathology in one patient with female pattern hair loss (FPHL) and vitiligo, where a biopsy of a FRD showed no damage to the hair follicle or signs of DLE. The study concluded that FRD might be a normal trichoscopic feature due to visible vasculature in patients with a lack of skin pigmentation and that the absence of FRD could indicate hair follicle damage with a poor prognosis. However, this was a small case series, and further research is needed to understand the nature and implications of FRD in scalp disorders.
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