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- Presentation
Trichoscopy Features of Non-Scarring and Scarring Hair Loss
Description
The talk reviews the main trichoscopic findings in non-scarring and scarring hair loss. For non-scarring alopecias, alopecia areata is characterized by broken hairs, black dots, exclamation mark hairs, and yellow dots; trichotillomania shows broken hairs of different lengths; tinea capitis shows comma hairs, corkscrew hairs, Morse code hairs, and zigzag hairs depending on the fungal pattern; androgenetic alopecia is suggested by hair shaft diameter diversity and miniaturization; and acute telogen effluvium is often normal on trichoscopy but may show short regrowing hairs. For scarring alopecias, the key feature is loss of follicular openings. Lichen planopilaris and frontal fibrosing alopecia show perifollicular scaling, with frontal fibrosing alopecia also lacking vellus hairs at the hairline. Discoid lupus tends to have more diffuse inflammation with diffuse scale, speckled blue-gray dots, loss of the pigmented network, and additional findings such as vascular changes, keratotic plugs, pigment changes, and follicular red dots, which may suggest better regrowth. Central centrifugal cicatricial alopecia can show diameter diversity, perifollicular scaling, erythema, and white-gray halos. Dissecting cellulitis and folliculitis decalvans are presented as staged or feature-rich scarring disorders with findings such as erythema, pustules, keratotic plugs, white scarring areas, and hair tufts.
View moreConclusions
- Trichoscopy provides reliable pattern-based clues that help distinguish major causes of hair loss, especially when clinical appearance alone is ambiguous.
- Non-scarring alopecias tend to preserve follicular openings, whereas scarring alopecias are marked by their loss.
- Alopecia areata is suggested by exclamation mark hairs, black dots, and yellow dots caused by broken or empty follicles.
- Trichotillomania is best recognized by broken hairs of different lengths due to hair pulling.
- Tinea capitis shows fungal-related shaft deformities such as comma hairs, corkscrew hairs, Morse code hairs, and zigzag hairs, with patterns that may hint at the infecting organism.
- Androgenetic alopecia is characterized by hair shaft diameter diversity and follicular miniaturization, with more than 20% thin hairs being strongly suggestive.
- Acute telogen effluvium is often clinically diagnosed and may show short regrowing hairs on trichoscopy, but trichoscopy can also be normal.
- Lichen planopilaris and discoid lupus erythematosus can be differentiated by their trichoscopic distribution patterns, with LPP more perifollicular and DLE more diffuse.
- Additional features such as scaling pattern, pigment incontinence pattern, and pigmented network preservation or loss further help separate DLE from LPP.
- Follicular red dots in discoid lupus may indicate a better chance of hair regrowth.
- Frontal fibrosing alopecia is distinguished by perifollicular scaling and, especially, loss of vellus hairs at the hairline.
- CCCA commonly shows diameter diversity, perifollicular scaling, and white-gray halos indicating perifollicular fibrosis.
- Dissecting cellulitis and folliculitis decalvans evolve through inflammatory and scarring stages, with trichoscopy revealing stage-specific pustules, erythema, keratotic plugs, and hair tufting.
- Overall, trichoscopy is a practical diagnostic tool that improves recognition, classification, and management of both non-scarring and scarring alopecias.
- Pirmez R. Trichoscopy 101 for alopecia diagnoses. F 104 – Hair Disorders Made Easier.
- 4th World Congress of Trichoscopy. 29th October - 1st November 2026, Rio de Janeiro-RJ. Theme: All about hair: from diagnosis to treatment.