Trichoscopy of Dissecting Cellulitis of the Scalp: Exclamation Mark Hairs and White Dots as Markers of Disease Chronicity

The document presents a retrospective multicenter study that aimed to describe the trichoscopic features of dissecting cellulitis of the scalp (DCS) and correlate them with the disease's evolution. The study included 18 patients diagnosed with DCS, with a mean age of 33.3 years and a mean disease duration of 3.2 years. Trichoscopic findings included yellow dots and black dots in 94% of patients, vellus hairs in 83%, broken hairs in 50%, red dots in 44%, white dots and brown-gray dots in 28%, comma hairs in 22%, and exclamation mark hairs in 11%. The study found that exclamation mark hairs were more likely to be present in patients with recent-onset DCS (mean time of evolution of 0.75 years), while white dots were more common in patients with longer disease duration (5 years). The study concluded that while trichoscopic findings in DCS are not entirely specific, they can be useful for diagnosis, with exclamation mark hairs indicating early DCS and white dots suggesting chronic DCS.