Trichoscopy of Alopecia Areata: An Update

March 2018 in “ The Journal of Dermatology ”

Anna Waśkiel, Adriana Rakowska, Mariusz Sikora, Małgorzata Olszewska, Lidia Rudnicka

alopecia areata trichoscopy yellow dots short vellus hairs black dots broken hairs exclamation mark hairs tapered hairs upright regrowing hairs pigtail hairs Pohl-Pinkus constrictions

Studysummary This review presents various trichoscopic findings for diagnosing alopecia areata but reports no new clinical results, emphasizing that no single marker is pathognomonic and multiple features should be considered together.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document reviewed trichoscopic findings in alopecia areata, revealing that no single feature is diagnostic on its own, but a combination of findings can aid in diagnosis. The most common features observed were yellow dots, short vellus hairs, black dots, broken hairs, and exclamation mark hairs. The review analyzed 30 studies, with the largest including 300 patients, and noted that features like tapered hairs, upright regrowing hairs, pigtail hairs, and Pohl-Pinkus constrictions were less common but still relevant. It was found that certain markers, such as black dots, exclamation mark hairs, and broken hairs, correlate with disease activity, while short vellus hairs may indicate initial hair regrowth. The review concluded that trichoscopy is valuable for differentiating alopecia areata from other hair loss conditions and for monitoring treatment efficacy.

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research Dermoscopy of Alopecia Areata in Retrospective Analysis

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research Trichoscopic Clues for Diagnosis of Alopecia Areata and Trichotillomania in Asians

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research Platelet-Rich Plasma Versus Minoxidil 5% in Treatment of Alopecia Areata: A Trichoscopic Evaluation

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research Trichoscopy as a Useful Method to Differentiate Tinea Capitis from Alopecia Areata in Children at Zagazig University Hospitals

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research ULBP3: A Marker for Alopecia Areata Incognita

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research Relevance of Trichoscopy in the Differential Diagnosis of Alopecia: A Cross-Sectional Study from North India

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research Trichoscopy Findings in Loose Anagen Hair Syndrome: Rectangular Granular Structures and Solitary Yellow Dots

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research Trichoscopic Findings of Hair Loss in Koreans

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research Scalp Dermoscopy or Trichoscopy

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research Different Trichoscopic Features of Tinea Capitis and Alopecia Areata in Pediatric Patients

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research Dermoscopic Findings of Alopecia Areata in Dark-Skinned Individuals: An Analysis of 116 Cases

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research A Nonrandomized Study of Trichoscopy Patterns Using Nonpolarized (Contact) and Polarized (Noncontact) Dermatoscopy in Hair and Shaft Disorders

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research Dermoscopic Approach to a Small Round to Oval Hairless Patch on the Scalp

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research Trichoscopic Findings in Alopecia Areata and Their Relation to Disease Activity, Severity, and Clinical Subtype in Turkish Patients

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research Dermoscopic Evaluation of Therapeutic Response to an Intralesional Corticosteroid in the Treatment of Alopecia Areata

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research Black Dots Seen Under Trichoscopy Are Not Specific for Alopecia Areata

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research Diffuse Alopecia Areata Is Associated With Intense Inflammatory Infiltration and CD8+ T Cells in Hair Loss Regions and an Increase in Serum IgE Level

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research Advances in the Management of Alopecia Areata

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research Trichoscopy Update 2011

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research Clinical Evaluation of Alopecias Using a Handheld Dermatoscope

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research Utility of Dermoscopy in Alopecia Areata

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research Light Microscopy of the Hair: A Simple Tool to Untangle Hair Disorders

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research Trichoscopy for Common Hair Loss Diseases: Algorithmic Method for Diagnosis

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research Pinpoint White Dots in the Scalp: Dermoscopic and Histopathologic Correlation

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research Coudability Hairs: A Revisited Sign of Alopecia Areata Assessed by Trichoscopy

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research Alopecia Areata Incognita: A Hypothesis

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research Trichoscopy in the Healthy Female: Method Standardization and Norms for Measurable Parameters

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research Dermoscopy in Female Androgenic Alopecia: Method Standardization and Diagnostic Criteria

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research Dermoscopy Findings of Alopecia Areata in an African-American Patient

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research Comma Hairs: A Dermatoscopic Marker for Tinea Capitis

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research Clinical Significance of Dermoscopy in Alopecia Areata: Analysis of 300 Cases

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research The Role of Scalp Dermoscopy in the Diagnosis of Alopecia Areata Incognita

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research Videodermoscopy in the Evaluation of Hair and Scalp Disorders

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research Weathering of Hair in Trichoteiromania

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research The Pattern and Profile of Alopecia Areata in Singapore: A Study of 219 Asians

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