Printer Friendly

Dermoscopy in selected disorders of scarring alopecia.

Byline: Md. Zeeshan, RKP Chaudhary, PK Roy and Abhijeet Kumar Jha

Keywords: Dermoscopy, lichen planopilaris (LPP), discoid lupus erythematosus (DLE), pseudopelade of brocq (PB).

Introduction

Scarring alopecia comprises a group of uncommon inflammatory hair loss disorders, which are characterized by permanent destruction of hair follicles. Dermoscopy does play an important role in improving our final diagnosis.

Methods

In this observational study, we included 18 patients irrespective of age and gender with clinically and histopathologically confirmed cases of lichen planopilaris (LPP), discoid lupus erythematosus (DLE), pseudopelade of Brocq (PB). Ethical clearance was obtained Institutional Ethical Committee. Inclusion criteria for study participation were, clinical and histopathological confirmed cases LPP, DLE, PB affecting the scalp. Patient demographics were recorded and the single most recently developed lesion was examined dermoscopically and histopathologically. Dermoscopy preceded histology, and no treatment was allowed in the interim. The most recently developed lesion of each patient was selected to be dermoscopically documented. Dermoscopic examination was performed with a hand-held dermatoscope (Dermlite DL4, 3gen) and the images were captured. The evaluated parameters included perifollicular changes, vascularity, white dots, keratin plugs, number of follicular ostia.

Histological diagnosis of LPP, DLE, PB was based on the identication of the characteristic features of each disease under microscopic examination.

Table 1 Dermoscopic characteristics of the patients

Pattern###LPP###DLE###PB

Perifollicular scaling###6###4###0

Pigment network###6###2###1

Branching vessels###0###4###0

White dots###6###2

White structureless areas###3###3

Blue gray dots###3###2###0

Keratin plugs###0###3###0

Decreases number of###6###4###6

follicular ostia

Rossettes###0###2###0

Bluish white veil like###3###1###0

Wickhams striae

Results

Perifollicular scales, white dots and blue-grey dots along with accentuation of honeycomb pattern were seen in LPP (Figure 1). Keratin plugs, white dots and blue-grey dots along with branching vessels were seen in DLE while there was lack of follicular ostia in PB (Figure 2, 3). The details of dermoscopic appearance has been depicted (Table 1).

Discussion

Lacarrubba et al.1 and Ross et al.2 initially described dermoscopic findings related to various scalp abnormalities such as androgenetic alopecia, alopecia areata, discoid lupus erythematosus, lichen planopilaris, psoriasis and seborrheic dermatitis. Histopathologically, the multiple blue-grey dots represent melanophages in the papillary dermis.3 This finding corresponds to the histopathological abnormalities found in lichen planopilaris and discoid lupus erythematosus resulting from interface dermatitis and the subsequent pigment incontinence. Nevertheless, it is interesting to note the two distinct patterns were found at dermoscopy. The first, referred to as a "speckled" pattern, is similar to the "peppering" described in melanoma lesions.3 Interesting finding in lichen planopilaris is tubular scaling which can helpful to differentiate it from DLE. The scales are entangling hair shaft up to 2-3 mm above scalp surface described as tubular scaling phenomenon.4

Our findings are in line with other studies, pigment network and bluish white veil like Wickham's striae seemed to be more prominent feature of LPP in our study

In DLE, the most common findings reported by Estrada et al.5 included white patches, branching capillaries, keratin plugs, and a reduction in the number of follicular ostia. Rosettes vary in size from 0.2-0.5 mm, and are believed to stem from an optical effect of the polarized light and its interaction with adnexal openings that are narrowed or filled with keratin; larger rosettes may be attributed to concentric perifollicular fibrosis.6 The author (AK Jha) has previously reported branching vessels, focal keratin plugs, perifollicular whitish halo, rosettes, and structureless white and brown areas on dermoscopy.7 Our study was in accordance with the previous reported studies.

The number of hair is characteristically reduced in scarring alopecia and may range from total absent hair in pseudopelade of Brocq.

Conclusion

Bluish white veil like WS, blue gray dots, perifollicular scaling and accentuation of honey comb pattern is highly suggestive of LPP, while keratin plugs and branching vessels in DLE. Dermoscopy thus is helpful in differentiating LPP, DLE and PB and obviating the need of biopsy in all cases.

References

1. Lacarruba F, Dall'Oglio F, Rita Nasca M, Micali G. Videodermatoscopy enhances diagnostic capability in some forms of hair loss. Am J Clin Dermatol. 2004;5:205

2. Ross EK, Vicenzi C, Tosti A. Videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol. 2006;55:799-806.

3. Ferreira CMM, Barcaui CB, Pineiro-Maceira J, eds. Dermatoscopia: aplicacao clinica e correlacao histopatologica. Sao Paulo: Atheneu; 2004. P. 31-45.

4. Nikam VV, Mehta HH. A Nonrandomized Study of Trichoscopy Patterns Using Nonpolarized (Contact) and Polarized (Noncontact) Dermatoscopy in Hair and Shaft Disorders. Int J Trichol. 2014;6(2):54-62.

5. Duque-Estrada B, Tamler C, Sodre CT, Barcaui CB, Pereira FB. Dermoscopy pattern of cicatricial alopecias resulting from discoid lupus erythematosus and lichen planopilaris. Ann Bras Dermatol. 2010;85:179-83.

6. Liebman TN, Rabinovitz HS, Dusza SW, Marghoob AA. White shiny structures: Dermoscopic features revealed under polarized light. J Eur Acad Dermatol Venereol. 2012;26:1493-7.

7. Jha AK, Sonthalia S, Sarkar R. Dermoscopy of discoid lupus erythematosus. Indian Dermatol Online J. 2016;7:458.
COPYRIGHT 2018 Knowledge Bylanes
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Journal of Pakistan Association of Dermatologists
Date:Dec 31, 2018
Words:956
Previous Article:Chronic urticaria and dyspepsia: Association and treatment, an experimental study.
Next Article:Rethinking the management of pedunculated melanomas: A case and discussion of an amelanotic pedunculated melanoma.
Topics:

Terms of use | Privacy policy | Copyright © 2022 Farlex, Inc. | Feedback | For webmasters |