Dermoscopy of Alopecia Areata

Alopecia areata is a type of hair disease showed hair loss or baldness. It happens when immune system mistakenly attacks hair follicles, causing hair loss. Some hair fall out and then regrow and may fall out again. While some alopecia areata will never regrow hair back. It varies in kinds of complicated situation. Dermoscopy is a special significant instrument to detect and diagnose alopecia areara.

What is alopecia areata?
Alopecia areata is one of the common types of hair loss. Alopecia areata most typically appearance on the scalp or beard, showing a round or oval bald patch, without hair. And alopecia areata also can happen on anywhere of the body. Alopecia areata is an autoimmune disease which caused by attack from immune system to hair follicles that form hair in skin.

What causes alopecia areate?
When immune system mistakenly attacks hair follicles, leading in alopecia areata. There are not clear reports about what exactly causes the immune attack on hair follicles, but some key factors include:
Genetic Factors: There are genetic factors in the development of alopecia areata due to it has a family tendency.
Autoimmune Factors:The immune system mistakenly targets hair follicles, resulting in hair loss.
Environmental Factors: An exotic virus or another substance happened in the body or other environmental changes may contribute to the development of alopecia areata.

Clinical features of alopecia areate
Alopecia areata usually presents as localized patchy hair loss, ranging from small round patches on the scalp to total body hair loss. It may also affect hair in other parts of the body. The typical clinical features of alopecia areata as following:
Patchy hair loss: Patchy hair loss is the most common form of presentation, with round or oval patches of hair loss and normal skin growth around the patches.
Distribution: Alopecia areata most often occurs on the scalp, but it may also occur in the beard, eyebrows, eyelashes and limbs. Complete follicular openings: The complete follicular openings are directly visible under the dermatoscope.
Positive pull test: Pulling hair will cause hair loss
Terminal hair: In bald patches, terminal hair is completely lost. Others: itching, burning or tingling, no active folliculitis and no symptoms such as erythema, desquamation or pustules around the hair follicles.

Dermatoscopic features of alopecia areata
Dermoscopy is a non-invasive aiding medical instrument that allows precise and tiny details of structures or patterns which are invisible by naked eyes. Dermoscopy of hair, also known as trichoscopy, is ideal and reliable device because it can eliminate light reflection and glare from the surface of the skin. Sometimes it is difficult to distinguish scarring alopecia from non-scarring alopecia, in which case dermoscopy can be really helpful. There are some key dermoscopic features like below:
Yellow spots: Yellow spots can be seen in both acute and chronic alopecia areata and they are yellow circular structures, usually located around the opening of the hair follicle. The presence of yellow spots may be related to inflammation and immune responses.
Black spots: Black spots is a common dermoscopic feature that indicates alopecia areata is in active state . Black spots present broken hairs at the opening of the hair follicle, usually black or brown. They may appear in the center or edges of hair loss patches.
Conical hair: This is a specific dermoscopic feature that shows tiny conical, short and spiky hair tapers gradually toward the scalp, similar to an exclamation point.
Broken hair: Broken hair are short, fractured and broken hairs usually appears in the affected area or the edges of hair loss patches.
Hypopigmentation villi: Hypopigmentation villi are hair that is sparse, short and light in color. This feature usually appears in remission of alopecia areata.

Uses of dermoscope in alopecia areata
Dermoscopy palys a crucial roles in the detection and diagnosis of alopecia areata. There are some typical uses:
1, According to dermatoscopic features of alopecia areata, dermoscopy can accurately distinguish alopecia areata from other types of hair loss, such as scarring alopecias, involutional alopecia, alopecia universalis, trichotillomania, and so on.
2, By dermoscope, skin doctors can exclude other possible causes, like fungal infection, etc.
3, Under the dermoscopy, it is clearly to evaluate the activity and severity of alopecia areata, then to make suitable treatment project

Dermoscopy for the treatment and follow up of alopecia areata
Evaluate the treatment effect: Dermoscopy can give feedback to the treatment effect of alopecia areata, So that skin doctor can analyse and evaluate if the treatment project need to be adjust or not.
Monitor relapse and detect new lesion: Dermoscopy, as a monitor, can inspect the whole process of alopecia areata, including its regrowth, relapse or new lesion.
Cooperate with treatment: By using of dermoscopy and combining with internal and external medication or other treatment methods, it greatly increase the cure effect of alopecia areata.

Notes of the use of dermoscopy in self-examination
It is no doubt that dermoscopy is very useful and reliable device in the diagnosis of alopecia areata. While, there are some notes when people use dermoscopy for self-examination.
Firstly, it is important to rightly operate a dermoscopy and carefully observe the alopecia areata in the process of the examination.
Secondly, skin doctors can compare and analyse the changes of images under dermoscopy, or images photoed by dermoscopy.
Thirdly, when a suspicious finding happened, it is necessary to ask a professional dermatologist for help.

Alopecia areata is a autoimmune skin disease. Even in some cases, hair can regrow back. But it takes undefined time. It may take 6 weeks or 1 year or more long time for hair regrowing. When hair regrow, and it may fall out again. Such situations happen time and again. And some alopecia areata represents, and it will not regrow any more. The development of alopecia areata is very complicated, so it is very important to use dermoscopy to detect and monitor alopecia areata.

No matter patients or skin doctors, all of them should know how to use dermoscopy in right ways. Especially, patients who have alopecia areata diagnosed. Pay more attention to alopecia areata and keep self-examination by dermoscopy. Any suspicious findings, keep in touch with professional skin doctors and cooperate with doctors in diagnosis and treatment.