Trichoscopic Clues for Diagnosis of Alopecia Areata and Trichotillomania in Asians

The study by Khunkhet, Vachiramon, and Suchonwanit, which included 52 patients with alopecia areata (AA) and 23 patients with trichotillomania (TTM), demonstrated that trichoscopy can be used to distinguish between AA and TTM in Asians. Key trichoscopic features indicative of AA were exclamation mark hairs, tapered hairs, yellow dots, and angulated hairs, while TTM was characterized by broken hairs of different lengths, trichoptilosis, V-sign, flame hairs, and hair powder. The study found that flame hairs were highly specific for TTM, and angulated hairs were specific for AA in Asians. It also noted that yellow dots were less prevalent in Asians than in Caucasians, possibly due to skin tone differences. The presence of hair powder in AA was reported for the first time, challenging the notion that it was exclusive to TTM. Despite limitations such as a small sample size and lack of histopathological confirmation in some cases, the study concluded that a comprehensive analysis of trichoscopic findings is essential for accurate diagnosis, as features can overlap and may not always be present.