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Atlas Of Trichoscopy: Dermoscopy In Hair And Sc...

There are currently no literature data addressing the usefulness of trichoscopy (ordermoscopy in general) in the differential diagnosis of pemphigus, except a case reportof hair casts in a 57-year-old patient with pemphigus vulgaris.28 Hair casts are 3-7-mm-long, whitish oryellowish tubular structures which envelop the hair shafts.16,34 In this firstdescription, Pirmez suggested that hair casts develop in pemphigus vulgaris in amechanism associated with acantholysis within the outer root sheet.28 As the hair grows, the outer root sheathkeratinocytes move up through the follicular openings to form the hair cast. Thisphenomenon could be considered a Nikolsky's sign in the scalp hair follicles12 and may be explained by the distributionof desmoglein 3 within outer root sheath. Desmoglein 3 is expressed throughout alllayers of outer root sheath, in areas of tricholemmal keratinization, and in the basallayer of the outer root sheath in areas of epidermal keratinization.35 The hypothesis of Pirmez may beconfirmed by the findings of Delmonte et al12, who described three cases ofpemphigus vulgaris in whom the hairs plucked from both lesional and perilesional skinwere anagen hairs with intact root sheaths. In our study hair casts were observed inonly 11.1% of patients with pemphigus vulgaris and in 20% of patients with pemphigusfoliaceus. In all cases the presence of hair casts was associated with long-lastingdiffuse scaling, but average PDAI for scalp was 4.3, what reflects intermediate activityof scalp involvement in the course pemphigus. Our data may indicate that hair casts inpemphigus are rather a sign of severe diffuse scaling (similar to Pityriasisamiantacea) than a direct reflection of acantholysis.36

Atlas of Trichoscopy: Dermoscopy in Hair and Sc...

Trichoscopy (dermoscopy of the hair and scalp) is a technique that improves diagnostic accuracy and follow-up with hair and scalp disorders. Although several studies of trichoscopy have been made in Caucasian and Asian populations, little has been published regarding trichoscopy findings in skin of color, despite the great prevalence of hair diseases in populations with this kind of skin. The aim of this review was to describe the trichoscopic features of normal scalp and of hair disorders in patients with dark skin phototypes. This will help dermatologists to distinguish between unique trichoscopic features of dark skin, and allow them to provide more accurate diagnoses and treatments for these patients.

Trichoscopy is a method of hair and scalp evaluation and is used for diagnosing hair and scalp diseases.[1] The method is based on dermoscopy. In trichoscopy hair and scalp structures may be visualized at many-fold magnification. Currently magnifications ranging from 10-fold to 70-fold are most popular in research and clinical practice.[2]

The method was developed by groups of dermatologists directed by: Lidia Rudnicka in Poland, Antonella Tosti and Giuseppe Micali in Italy and Shigeki Inui in Japan. In 2004 Francesco Lacarrubba and coworkers first described videodermoscopic features of alopecia areata (micro-exclamation hairs, yellow hyperkeratotic hair follicle openings, and black cadaverized hairs. In 2005 Malgorzata Olszewska and Lidia Rudnicka first used videodermoscopy for evaluation of disease severity in androgenic alopecia and for monitoring treatment efficacy.[3] Characteristic images of female androgenic alopecia included hair shaft heterogeneity and increased percentage of thin (below 30 micrometers) hairs at the vertex. The Polish group then developed criteria to diagnose female androgenic alopecia based solely on videodermoscopy images. In 2006 Elizabeth K Ross and coworkers specified videodermoscopy features of different acquired hair and scalp diseases.[4] In 2008 Adriana Rakowska and coworkers first showed usefulness of trichoscopy in diagnosing children with congenital hair shaft abnormalities. It was shown that this method is especially helpful in diagnosing monilethrix, Netherton syndrome and other pediatric diseases.[5] In 2008 the first atlas containing trichoscopy images was published by Antonella Tosti.[6]

Previous studies have also described peripilar sign and yellow dots as the features of androgenic alopecia.[7] An approximately 1 mm brownish hyperpigmented halo around the follicular ostium reflects the presence of perifollicular lymphocytic infiltration, typical of the early stage of the disease.[15] However, in our study, it was found in only 43 (18.7%) cases in the frontal scalp. Similarly, another study done on Asian population showed that perifollicular pigmentation was less appreciated on the Asian scalp compared with the white population.[19] Yellow dots are the most common feature of alopecia areata, but it may be present in a wide spectrum of hair diseases, and thus it is not very specific for FPHL.[20] These dots represent empty follicular ostium and persistent sebaceous gland even after severe miniaturization of the follicles.[15] We found yellow dots in 17 (7.4%) cases suggesting this change is rare in the early stage of the disease. However, our findings should be interpreted with caution here since we used non-polarized dermoscopy in our study.

Also, the hair changes, which we have studied, were able to differentiate the frontal scalp finding of early FPHL from normal control. Our study finding suggests that the occipital area in cases and controls have similar dermoscopic picture. So, in cases of early FPHL, the occipital area may serve as a reliable comparison zone for analysis of frontal scalp by dermoscopy.

When the first edition of this pioneering text was published, only a few dermatologists were trained to utilize the dermatoscope for the diagnosis and follow-up of hair diseases. The technique is now more popular worldwide, prompting the development of this updated second edition, which now includes a section devoted entirely to nail dermoscopy and also covers many hair disorders that were not previously discussed.

Topics covered include alopecias, hair shaft disorders, hair root evaluation, pediatric hair disorders, hair weathering, inflammatory scalp disorders, infections, dermoscopy of the black scalp, body hair disorders, and dermoscopy-guided biopsies.

Also covered is dermoscopy of the nail plate, the proximal nail fold, the hyponychium, and the distal edge of the nail plate. The book discusses inflammatory nail disorders, traumatic nail disorders, onychomycosis, melanonychia, and nail tumors. This essential new edition facilitates diagnosis of hair disorders and provides clinicians with important clues about disease stage and progression.

Antonella Tosti, MD, is a professor of clinical dermatology at the University of Miami Health System. She is a worldwide recognized expert in hair and nail disorders and has been invited to lecture at major international conferences. She is the author of Dermoscopy of Hair and Scalp Disorders, the first hair and scalp dermoscopy atlas ever published. She is also editor of five textbooks on diagnosis and treatment of hair disorders and three textbooks on nail disorders. Dr. Tosti is the main author of the chapter on nail disorders in several major textbooks and an expert in patch testing for diagnosis of contact allergy. Dr. Tosti is member of numerous dermatological societies and is the author or co-author of more than 600 scientific publications. 041b061a72


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