17.Dermoscopy and Scalp Biopsy in the Hair Transplant Evaluation

Aron G. Nusbaum and Antonella Tosti

Summary

While the majority of patients seeking hair restoration surgery have androgenetic alopecia, surgeons must be able to properly identify patients with other etiologies of hair loss. An invaluable tool to aid in scalp examination that is fairly easy to learn is dermoscopy, which involves the interpretation of magnified scalp images to identify changes not visible with the naked eye and can quickly provide the clinician with important diagnostic clues. This modality can detect characteristic features of many hair loss conditions and, for example, aids in the differentiation of scarring from nonscarring alopecia, androgenetic alopecia from telogen effluvium or alopecia areata incognita, and classic alopecia areata from other patchy alopecias. When findings are equivocal or a scarring alopecia is suspected, scalp biopsy is indicated, and dermoscopy-guided localization is recommended as it has shown to significantly increase diagnostic yield.

Key words

dermoscopy-guided localization - nonscarring alopecia - scarring alopecia - alopecia areata incognita - classic alopecia areata - telogen effluvium - patchy alopecias - interfollicular vascular patterns

• 1 Miteva M, Tosti A. Hair and scalp dermatoscopy.. J Am Acad Dermatol 2012; 67 (5) 1040-1048 PubMed

• 2 Miteva M, Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia.. J Eur Acad Dermatol Venereol 2012; 27 (10) PubMed

• 3 Torres F, Tosti A. Trichoscopy: an update.. G Ital Dermatol Venereol 2014; 149 (1) 83-91 PubMed

• 4 Olszewska M, Rudnicka L, Rakowska A, Kowalska-Oledzka E, Slowinska M. Trichoscopy.. Arch Dermatol 2008; 144 (8) 1007 PubMed

• 5 Lacarrubba F, Micali G, Tosti A. Scalp dermoscopy or trichoscopy.. Curr Probl Dermatol 2015; 47: 21-32 PubMed

• 6 Tosti A. Dermoscopy of hair and scalp disorders with clinical and pathological correlations. London, United Kingdom: Informa Healthcare; 2008

• 7 Ross EK, Vincenzi C, Tosti A. Videodermoscopy in the evaluation of hair and scalp disorders.. J Am Acad Dermatol 2006; 55 (5) 799-806 PubMed

• 8 Bernstein RM, Rassman WR. Follicular transplantation. Patient evaluation and surgical planning.. Dermatol Surg 18.7; 23 (9) 771-784, discussion 801–805 PubMed

• 9 Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations.. J Am Acad Dermatol 2014; 71 (3) 431.e1-431.e11 PubMed

• 10 Rebora A. Alopecia areata incognita: a hypothesis.. Dermatologica 18.7; 174 (5) 214-218 PubMed

• 11 Tosti A, Whiting D, Iorizzo M et al. The role of scalp dermoscopy in the diagnosis of alopecia areata incognita.. J Am Acad Dermatol 2008; 59 (1) 64-67 PubMed

• 12 Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Rudnicka L. Dermoscopy in female androgenic alopecia: method standardization and diagnostic criteria.. Int J Trichology 2009; 1 (2) 123-130 PubMed

• 13 Iorizzo M, Pazzaglia M, Starace M, Militello G, Tosti A. Videodermoscopy: a useful tool for diagnosing congenital triangular alopecia.. Pediatr Dermatol 2008; 25 (6) 652-654 PubMed

• 14 Fernández-Crehuet P, Vaño-Galván S, Martorell-Calatayud A, Arias-Santiago S, Grimalt R, Camacho-Martínez FM. Clinical and trichoscopic characteristics of temporal triangular alopecia: a multicenter study.. J Am Acad Dermatol 2016; 75 (3) 634-637 PubMed

• 15 Lacarrubba F, Micali G, Tosti A. Absence of vellus hair in the hairline: a videodermatoscopic feature of frontal fibrosing alopecia.. Br J Dermatol 2013; 169 (2) 473-474 PubMed

• 16 Baquerizo Nole KL, Nusbaum B, Pinto GM, Miteva M. Lichen planopilaris in the androgenetic alopecia area: a pitfall for hair transplantation.. Skin Appendage Disord 2015; 1 (1) 49-53 PubMed

• 17 Miteva M, Tosti A. Dermatoscopic features of central centrifugal cicatricial alopecia.. J Am Acad Dermatol 2014; 71 (3) 443-449 PubMed

• 18 Tosti A, Miteva M, Torres F, Vincenzi C, Romanelli P. Hair casts are a dermoscopic clue for the diagnosis of traction alopecia.. Br J Dermatol 2010; 163 (6) 1353-1355 PubMed

• 19 Lanuti E, Miteva M, Romanelli P, Tosti A. Trichoscopy and histopathology of follicular keratotic plugs in scalp discoid lupus erythematosus.. Int J Trichology 2012; 4 (1) 36-38 PubMed

• 20 Tosti A, Torres F, Misciali C et al. Follicular red dots: a novel dermoscopic pattern observed in scalp discoid lupus erythematosus.. Arch Dermatol 2009; 145 (12) 1406-1409 PubMed

• 21 Otberg N, Kang H, Alzolibani AA, Shapiro J. Folliculitis decalvans.. Dermatol Ther 2008; 21 (4) 238-244 PubMed

• 22 Rakowska A, Slowinska M, Kowalska-Oledzka E et al. Trichoscopy of cicatricial alopecia.. J Drugs Dermatol 2012; 11 (6) 753-758 PubMed

• 23 Dy LC, Whiting DA. Histopathology of alopecia areata, acute and chronic: Why is it important to the clinician?. Dermatol Ther (Heidelb) 2011; 24 (3) 369-374 PubMed

• 24 Horenstein MG, Jacob JS. Follicular streamers (stelae) in scarring and non-scarring alopecia.. J Cutan Pathol 2008; 35 (12) 1115-1120 PubMed

• 25 Ramos PM, Brianezi G, Martins AC, da Silva MG, Marques ME, Miot HA. Apoptosis in follicles of individuals with female pattern hair loss is associated with perifollicular microinflammation.. Int J Cosmet Sci 2016; 38 (6) 651-654 PubMed

• 26 Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women.. J Am Acad Dermatol 2004; 51 (2) 17.-18. PubMed

• 27 Whiting DA. Chronic telogen effluvium: increased scalp hair shedding in middle-aged women.. J Am Acad Dermatol 18.6; 35 (6) 899-906 PubMed

• 28 Stefanato CM. Histopathology of alopecia: a clinicopathological approach to diagnosis.. Histopathology 2010; 56 (1) 24-38 PubMed

• 29 Miteva M, Tosti A. Pathologic diagnosis of central centrifugal cicatricial alopecia on horizontal sections.. Am J Dermatopathol 2014; 36 (11) 859-864, quiz 865–867 PubMed