Clinical evaluation of alopecias using a handheld dermatoscope

Background: There are numerous reports of the value of videodermatoscopy in the clinical evaluation of alopecia. Studies performed with a handheld dermatoscope are scarce and limited to a few disease entities. Objective: The aim of this study was to evaluate the potential benefit of a handheld dermatoscope in the clinical diagnosis of alopecia. Methods: In all, 144 patients with alopecia and 144 age-and sex-matched control subjects were enrolled in the study. Diagnoses were established clinically, and confirmed by scalp biopsy in doubtful cases. Dermatoscopic examination was performed by a polarized-light handheld dermatoscope with a 10-fold magnification. The images were obtained by a digital camera with a 3-fold optical zoom. Results: The dermatoscopic patterns of circular hairs, dirty dots, epidermal scale, and pustules showed no statistically significant difference between patients and control subjects. The following features were significantly more common, or observed solely, in particular types of alopecia: hair diameter diversity, peripilar sign, and empty follicles in androgenetic alopecia; yellow dots, black dots, tapering hairs, and broken hairs in alopecia areata; absence of follicular openings, tufted hairs, white dots, follicular hyperkeratosis, pili torti, red dots, honeycomb pigment pattern, pink-white appearance, crusts, and pustules in primary cicatricial alopecias. Limitations: Evaluation of all primary cicatricial alopecias in the same cluster. Conclusions: We suggest that a polarized-light handheld dermatoscope attached to a digital camera provides a practical and useful aid for the clinical diagnosis of alopecias. (J Am Acad Dermatol 2012; 67: 206-14.)