Trichostasis Spinulosa of the Scalp Mimicking Alopecia Areata Black Dots

The document describes a case where a 56-year-old man with a history of male pattern alopecia and no personal or familial history of alopecia areata (AA) presented with eyebrow loss. Upon examination, he had hair thinning on the scalp and multiple follicular dark structures on the vertex that resembled AA black dots. Dermoscopy revealed these structures to be tufts of vellus hairs, characteristic of trichostasis spinulosa (TS), a common but underdiagnosed follicular disorder. The patient also had concurrent androgenetic alopecia. Dermoscopy of the eyebrows confirmed AA due to the presence of yellow dots and true comedo-like cadaver hairs. The patient's scalp biopsy confirmed androgenetic alopecia and TS. He received intralesional triamcinolone injections for AA of the eyebrows with partial response. The document highlights the usefulness of dermoscopy in distinguishing between AA and TS, emphasizing its role in improving diagnostic accuracy and guiding appropriate treatment.