Reflectance Confocal Microscopy Can Differentiate Dermoscopic White Dots of the Scalp Between Sweat Gland Ducts or Follicular Infundibulum

The study, conducted on four men aged between 37 and 45 with advanced male pattern alopecia, utilized in vivo reflectance confocal microscopy (RCM) to distinguish dermoscopic white dots on the scalp as either sweat gland ducts or follicular infundibula. RCM provided real-time microscopic imaging of the superficial skin layers, revealing that the white dots corresponded to both empty and/or miniaturized hair follicles and sweat gland openings. This indicated that white dots are not a reliable indicator to differentiate between cicatricial and non-cicatricial alopecia. The study demonstrated that RCM is a useful noninvasive diagnostic tool for hair and scalp disorders, offering cellular-level resolution of skin structures.