White and yellow dots as new trichoscopic signs of severe female androgenetic alopecia in dark skin phototypes.

BACKGROUND

Androgenetic alopecia or female pattern hair loss is the condition that most commonly leads to hair loss in adult females. The trichoscope is used for the early diagnosis of the disease. The study aims at finding a possible association between trichoscopic signs and disease severity in dark-skinned females.

METHODS

This was an observational study involving trichoscopic examination of 129 females with different hair disorders.

RESULTS

Clinical and trichoscopic examination revealed 79 patients with androgenetic alopecia. All patients showed hair shaft diameter diversity. The predominance of one hair per follicle was found in 97.4% (77/79), peripilar brown halo in 32.9% (26/79), peripilar white halo in 10.1% (8/79), and honeycomb-like scalp pigmentation in 17.7% (14/79) of patients, yellow dots in 15.2% (12/79), white dots in 20.3% (16/79), and hidden hair in 7.6% (6/79). Yellow dots and white dots were positively correlated with the advanced Ludwig and Sinclair staging of hair loss. Peripilar sign, honeycomb pigmentation, and white dots were associated significantly with darker skin types. The other 50 patients were diagnosed with the following: normal healthy controls (10/50), telogen effluvium (25/50), alopecia areata (4/50), fibrosing alopecia in pattern distribution (4/50), folliculitis decalvans (2/50), discoid lupus erythematosus (1/50), lichen planopilaris (2/50), frontal fibrosing alopecia (1/50), and end-stage cicatricial alopecia (1/50).

CONCLUSIONS

The yellow dot and white dot signs are suggested as new dermoscopic findings in advanced androgenetic alopecia. Peripilar sign, honeycomb pigmentation, and white dots are characteristic signs of female androgenetic alopecia in ethnic groups of darker skin.