One Year Hospital Based Observational Study Of Trichoscopy Findings In Alopecia Areata

Abstract

Introduction: Hair loss or alopecia is a disorder that can have serious impact on one’s standard of living. Alopecia, depending on the hair follicle damage can be cicatrical (scarring) or non-cicatricial (non-scarring). Alopecia areata is mainly a chronic immunologically mediated inflammatory disease of anagen which can lead to relapsing, non-scarring hair loss. It is characterized by patchy loss of hair of the scalp, sometimes the body but not associated with any inflammation. The diagnosis of AA can sometimes be challenging and it becomes difficult to assess the severity by naked eye. A dermoscope is a non-invasive, diagnostic tool which is used to examine the minute presenting patterns of skin lesions and also the subsurface skin structures which are invisible to the eye. The term “trichoscopy” was coined for dermoscopy of hair and scalp. In trichoscopy, hair, scalp is visualized at a greater magnification. This also helps in seeing the epidermis of the hair follicle and also the peri-follicular epidermis. Certain measurements like hair shaft thickness can be made using this method. Trichoscopy can also be used to see certain patterns in alopecia areata. These include the follicular changes, shaft changes and also inter follicular changes. These patterns will help to diagnose and to determine the disease activity and severity of AA. Objective: One year hospital based observational study of trichoscopy findings in alopecia areata. Materials and method: This was a one year hospital based observational study consisting of 60 patients with clinically diagnosed as having alopecia areata , irrespective of age or sex. Patients having alopecia areata with other hair and scalp disorders were excluded. Clinical photographs were taken after informed consent and hair pull test was performed. Trichoscopic examination of the scalp and hair was performed using a videodermatoscope- Dinolite premier am4113zt modeland trichoscopic images were recorded. The various trichoscopic features in aa were noted and the results were tabulated. Results: alopecia areata was more common in males (65%) with sex ratio of male to female ratio was 1.85:1. The most common age group affected was between 21-30years (40%). Most patients (36.67%) presented with in one month of disease onset. Scalp was the frequently involved site (86.67%) and patchy alopecia was the frequent (83.33%) clinical pattern of presentation. The characteristic follicular features of AA. on trichoscopy noted were black dots, yellow dots and empty hair follicles. Black dots were the commonest finding (63.33%) and had positive correlation with activity of AA. .The characteristic hair patterns noted were broken hair, micro-exclamation mark hair, coudability hair, short vellus hair and less commonly, pigtail hair, upright regrowing hair, tulip hair, monilethrix-like hair and i-hair. Broken hair, micro-exclamation mark hair and coudability hair were commonly seen in active cases with micro-exclamation hair being more specific to active disease.The inter-follicular features noted were honey-coomb pattern, erythema and arborizing blood vessels with erythema being most common finding. The characteristic nail changes seen were pitting and longitudinal ridges.72% of cases that had clinically inactive disease showed active disease on trichoscopy. Conclusion: According to our study, trichoscopic features of alopecia areata are characteristic and may prove invaluable in the treatment of the condition. The characteristic follicular features of aa on trichoscopy noted were black dots, yellow dots and empty hair follicles. The characteristic hair patterns noted were broken hair, micro-exclamation mark hair, coudability hair, short vellus hair and less commonly, pigtail hair, upright regrowing hair, i-hair, tulip hair &monilethrix-like hair. Micro-exclamation mark hair, coudability hair, black dots, and broken hair showed positive correlation with disease activity. Of these, micro-exclamation mark hair was the specific marker of active disease and black dots, coudability hair, broken hair and was the sensitive markers of active disease. Many patients who had clinical inactive disease were found to have active disease on trichoscopy. Hence trichoscopy would aid in diagnosing aa in doubtful cases with the help of characteristic findings which may evade the need for biopsy. Trichoscopy acts as a highly accurate and sensitive method for detecting disease activity which would help in early active treatment. It also acts as a tool in assessing the progression of the disease and response to treatment.