Varma, Kumar, Mahadik, and Agrawal: Evaluation of trichoscopic features in female pattern hair loss


Introduction

Initially the term ‘diffuse alopecia’ was widely used for hair loss in women but with the demonstration of male hormones in its pathogenesis, the term androgenetic alopecia was established.1 FPHL was thought to be the variant of same entity but the definite evidence is still lacking. The term ‘patterned baldness’ is described as decrease in hair fiber production and their eventual miniaturization. It presents with thinning and shortening of hair with increase in central parting.

Its incidence increases with age and the age of onset is usually 18-45 years with the second peak of incidence noted between 50-60 years of age.2

Trichoscopic patterns observed in patients of FPHL include:

  1. Hair diameter variability of more than 20% is diagnostic, especially in frontoparietal region.3

  2. Peri pilar sign is a light brown atrophic area seen during the early stages and correlates with the inflammatory infiltrate.4

  3. Scalp pigmentation is a patchy honeycomb pattern due to penetration of ultraviolet radiation through thin hair.

  4. White dots are seen in later grades.

  5. Yellow dots result due to accumulation of sebum in dilated hair follicles.

  6. Focal atrichia is complete atrophy of pilosebaceous units.

Some of the trichoscopic findings were found to be overlapping in the same patient. It serves as an important tool to establish the diagnosis and to know the pathological response in these patients.

Materials and Methods

This observational study was conducted in department of dermatology of R.D. Gardi Medical College, Ujjain to evaluate the trichoscopy findings in patients of female pattern hair loss. The study period was from September 2020 to October 2021. Written consent and ethical clearance from Institutional Ethical Committee was taken.

Detailed history regarding onset, duration, progression, medical and family history was taken. Thorough clinical examination was done to look for specific features of patterned baldness like diffuse thinning over crown and increase in central parting.

Trichoscopic examination was done using handheld Dermlite DL4 dermoscope (10x) and digital photographs were taken using iPhone XR. Findings were summarized and discussed in detail.

Inclusion criteria

Female patients with clinical features suggestive of patterned hair loss.

Exclusion criteria

Females on corticosteroids, chemotherapeutic drugs and hair growth promoters.

Results

Out of 37 cases examined for female pattern hair loss, majority of them belonged to the age group of 37-45 years (48.6%). The mean age of presentation found to be was 33.9±7.8 years. The mean duration of hair loss noted was 4.32 years in our study.

Among the clinically diagnosed 37 cases, trichoscopic findings seen were peri pilar sign (23 cases), hair diameter variability (23 cases), white dots (15 cases), scalp pigmentation (17 cases) and focal atrichia (15 cases).

Table 1

Distribution of patients according to age

Age group

Frequency

Percentage

18-26 years

9

24.3%

27-36 years

10

27%

37-45 years

18

48.6%

Total

37

100%

Table 2

Distribution of patients according to duration ofhair loss

Duration

Frequency

Percentage

1-3 years

12

32.4%

4-6 years

18

48.6%

7-9 years

7

18.9%

Total

37

100%

Table 3

Distribution of patients according to trichoscopyfindings

Trichoscopy findings

Present

Absent

n

%

n

%

Hair diameter variability

23

62.2

14

37.8

Peri pilar sign

23

62.2

14

37.8

White dots

15

40.5

22

59.5

Scalp pigmentation

17

45.9

20

54.1

Focal atrichia

15

40.5

22

59.5

Figure 1

Peripilar sign

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a929fd20-3ccb-4f37-ab5b-06af16768693image1.png
Figure 2

Variability in hair shaft diameter and decrease in number of hair per follicular unit

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a929fd20-3ccb-4f37-ab5b-06af16768693image2.png
Figure 3

Normal density over occipital scalp

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a929fd20-3ccb-4f37-ab5b-06af16768693image3.png
Figure 4

Scalp pigmentation

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a929fd20-3ccb-4f37-ab5b-06af16768693image4.png
Figure 5

Focal atrichia

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a929fd20-3ccb-4f37-ab5b-06af16768693image5.png
Figure 6

White dots

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a929fd20-3ccb-4f37-ab5b-06af16768693image6.png

Most common finding observed was hair diameter variability and peripilar sign in 62.2% of females whereas the least common findings noted were white dots and focal atrichia in 40.5% females.

Discussion

The mean age of presentation in our study was found to be 33.9±7.8 years. This was concordant with the study of Zhang et al.5 conducted in 60 patients having the mean age of 34±10.6 years whereas the mean age of presentation was found to be 31.17 years in a study of Tandon et al.6 conducted at RML Hospital, New Delhi.

The mean duration of hair loss was found to be 4.3±2 years in our study. This was in agreement with the study conducted by Zhang et al. 5 having the mean duration of 4.49±3.76 years while the study conducted by Tandon et al. 6 showed the mean duration of 5.1 years.

Hair diameter variability and peri pilar sign was found in maximum number of females in our study (62.2%). This was concordant with the study conducted by Tosti et al. 7 showing variability in thickness as the most common finding. Hair diameter variability of >20% is suggestive of miniaturization whereas peri pilar sign is a brown atrophic area around the follicle indicating peri follicular infiltrate. However, Zhang et al. 5 found scalp pigmentation as the most common trichoscopy finding. It results due to penetration of ultra violet rays through thin hair and bald scalp. It was found in only 45.9% females in our study. Zhang et al.5 showed significant association of scalp pigmentation and focal atrichia (pencil-erased focal hair loss) with grade of hair loss with these findings being more evident in higher grades whereas such association was absent in our study. Other findings included white dots and yellow dots. White dots signify eccrine gland pores whereas yellow dots represent empty follicles filled with sebum. These trichoscopy findings help in differentiating female pattern hair loss from its very close differential chronic telogen effluvium.

Conclusion

The definite diagnosis of female pattern hair loss is difficult to be established solely on the basis of clinical examination due to its close resemblance with chronic telogen effluvium. Hence, trichoscopy serves as an important non-invasive tool to ascertain the diagnosis in these females.

Source of Funding

No financial support was received for the work within this manuscript.

Conflict of Interest

None.

References

1 

J Hamilton Male hormone stimulation is prerequisite and an incitant in common baldnessAm J Anat19427134518010.1002/aja.1000710306

2 

E A Olsen Female pattern hair lossJ Am Acad Dermatol2002453708010.1067/mjd.2001.117426

3 

O De Lacharrière C Deloche C Misciali B M Piraccini C Vincenzi P Bastien Hair diameter diversity: A clinical sign reflecting the follicle miniaturizationArch Dermatol200113756416

4 

A Ummiti P Priya P Chandravathi C Kumar Correlation of trichoscopic findings in androgenetic alopecia and the disease severityInt J Trichology20191131182210.4103/ijt.ijt_103_17

5 

X Zhang S Caulloo Y Zhao B Zhang Z Cai J Yang Female pattern hair loss: Clinico-laboratory findings and trichoscopy depending on disease severityInt J Trichology20124123810.4103/0974-7753.96082

6 

S Tandon P Arora R K Gautam M Bhardwaj U Garga N Sharma Correlation between clinical features, biochemical parameters, and histopathological findings in women with patterned baldness: Study from North IndiaJ Cutan Aesthet Surg201912142810.4103/JCAS.JCAS_30_18

7 

A Tosti B M Piraccini A D-Eb Sisti Hair loss in womenMinerva Ginecol200961544552



jats-html.xsl

© This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Article highlights
  • Article tables
  • Article images

Article History

Received : 22-10-2021

Accepted : 19-11-2021

Available online : 13-12-2021


View Article

PDF File   Full Text Article


Copyright permission

Get article permission for commercial use

Downlaod

PDF File   XML File   ePub File


Digital Object Identifier (DOI)

Article DOI

https://doi.org/10.18231/j.ijced.2021.055


Article Metrics






Article Access statistics

Viewed: 159

PDF Downloaded: 71



Open Abstract (Increase article citation) Wiki in hindi