Trichoscopic Insights in Hair Loss Patients


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Introduction :
Hair loss is a common reason for dermatology consultations. Its causes can be classified as scarring
and non-scarring alopecia. The diagnosis approach relies on clinical, trichoscopic, and histological
evidence. The aim of the study was to establish an epidemiological profile of patients consulting for
hair loss and establish a correlation between trichoscopic findings and the epidemioclinical
characteristics of patients.
Material and methods:
This is a prospective descriptive and analytical study conducted within the dermatology department
of Cheikh Khalifa Hospital over a period of 30 months, involving one 175 cases. Were included in this
study all patients presenting with hair loss based on clinical, dermoscopic, or histological criteria.
Data collection and analysis were done on microsoft excel software and SPSS version 22. The
statistical test was considered statistically significant at p < 0.05.
The average age of our patients was 33.2 years. 69.1% of our patients had non-scarring alopecia. This
group is dominated by androgenetic alopecia (50 cases), alopecia areata (30 cases), telogen effluvium
(19 cases), traction alopecia (16 cases), tinea capitis (4 cases), and trichotillomania (2 cases). 30.9% of
our patients had scarring alopecia, distributed as follows: 28 cases of lichen plan pilaris, 16 cases of
frontal fibrosing alopecia, 9 cases of lupus erythematosus discoid, and only 1 case of centrifugal
central vertex alopecia. Vellus hairs were significantly associated with a younger age. Corkscrew hairs
were significantly associated with the pediatric population. Scalp erythema, and peripilar scales were
significantly associated with phototype IV. Hair shafts and reduced hair density were significantly
associated with phototype VI. Vellus hair, one hair per hair follicule and anisotrichia superior to
twenty percent were significantly associated with androgenetic alopecia. Exclamation point hair,
circular hair, black and yellow dots, were significantly associated with alopecia aerate. Distal and
proximal hair casts and absence of follicular openings were significantly associated with traction
alopecia. Perifollicular pigmentation and perifollicular fibrosis were significantly associated with
lichen plano pilaris. Loss of follicular openings and ivory-white-colored background were significantly
associated with frontal fibrosing alopecia. Dilated and arborizing vessels and Keratotic plugs were
significantly associated with discoid lupus erythematosus.
In an updated review published by L. Fernández-Domper et al. about trichoscopic features for the
most common hair loss disorders, hair shaft variability, predominance of follicles with a single
hair were the most common signs for androgenetic alopecia, yellow and black dots and exclamation
point hairs were the most common features of alopecia areata which aligns with our study.
Regarding scarring alopecias, Kose et al.’s study, found that perifollicular pigmentation and
perifollicular casts were the most common signs of lichen plano pilaris. As for frontal fibrosing
alopecia, the signs described were the absence of follicular openings, an ivory-white colored
background, and perifollicular erythema. Our results are thus comparable to this study.
As research in the field of trichology continues to expand, trichoscopy has significantly contributed to
improving the accuracy of diagnoses, allowing for a more targeted and effective approach for
treatment of hair and scalp disorders.