Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Traksiyonel Alopesinin Trikoskopik Bulgularının Değerlendirilmesi
Evaluation of Trichoscopic Findings of Tractional Alopecia
Özlem KARADAĞ KÖSEa, Murat BORLUb
aDeri ve Zührevi Hastalıkları Bölümü, Saltat Polikliniği, İstanbul, TÜRKİYE
bDeri ve Zührevi Hastalıkları AD, Erciyes Üniversitesi Tıp Fakültesi, Kayseri, TÜRKİYE
Turkiye Klinikleri J Dermatol. 2019;29(1):7-14
doi: 10.5336/dermato.2019-64693
Article Language: TR
Full Text
ÖZET
 Amaç: Traksiyonel alopesinin klinik olarak değerlendirilmesinde videodermoskop ile trikoskopik incelemenin yerinin araştırılmasıdır. Gereç ve Yöntemler: Çalışmaya, polikliniğe saç dökülmesi şikâyetiyle ile başvuran, klinik ve histopatolojik inceleme sonrası traksiyonel alopesi tanısı alan dokuz hasta dâhil edildi. Hastaların yaş, cinsiyet, deri fototipi, hastalığın süresi, etiyolojisi, saçak bulgusu varlığı, alopesinin yerleşim yeri ve yaygınlığı kaydedildi. Tüm hastalarda alopesik alanın sınırından, vertikal ve horizontal inceleme için 4 mm'lik iki adet Punch biyopsi örneği alındı. Klinik fotoğraflar videodermoskop ile çekildi. Trikoskopik fotoğraflar, klinik fotoğrafların çekildiği videodermoskop ile X30'luk büyütmede elde edildi. Tüm klinik ve trikoskopik bulgular kaydedildi. Trikoskopik bulgular daha önceki yayınlarda tanımlanan bulgularla oluşturulan kontrol listesine göre incelendi. Bulgular: Vellus saçlar ve saç çapı değişkenliği tüm hastalarda saptandı. Kısa vellus saçlar, sarı nokta, folikül ağzı yokluğu ve pili torti %55,6 oranında izlendi. Boş foliküller, saç silendiri ve tül bulgusu ise %44,4 oranında saptandı. Kırık saçlar ise en nadir görülen foliküler trikoskopik bulguydu. Epidermal skuam ve perifoliküler eritem (%66,7) interfoliküler trikoskopik bulgular içinde en sık saptanan bulgular idi. Dallanan kırmızı çizgiler, kirli nokta, pembe-beyaz görünüm, balpeteği pigment paterni, iğne ucu ve fibrotik beyaz noktalar ise traksiyonel alopeside izlenen diğer interfoliküler bulgulardı. Sonuç: Çalışmamıza göre, traksiyonel alopeside videodermoskop ile yapılan trikoskopik inceleme, hastalığın tanısının konmasında faydalı bir yöntemdir.

Anahtar Kelimeler: Alopesi; dermoskopi; traksiyonel alopesi; trikoskopi; videodermoskopi
ABSTRACT
 Objective: The aim of this study is to investigate the significance of trichoscopy by videodermoscope in the clinical evaluation of traction alopecia. Material and Methods: Nine patients, who presented with hair shedding and were diagnosed as traction alopecia after clinical and histopathological evaluation, were included. The age, gender, skin phototype, duration of the disease, etiology, presence of fringe sign, location of the alopecia and the distribution were noted. Two different Punch biopsies of 4 mm were performed from the border of alopecic area for vertical and horizontal investigation in all patients. Clinical photos were undertaken with videodermoscope. Trichoscopic photos were held in 30 fold magnification by videodermoscopy which was used to take clinical photos. All clinical and trichoscopic findings were recorded. They were examined in accordance with the checklist which was described by the features of the previous publications. Results: Vellus hairs and hair diameter diversity were detected in all patients. Short vellus hair, yellow dot, absence of follicular openings and pili torti were shown in 55.6% of the patients. Empty follicles, hair casts and veil feature were established in 44.4% of cases. Broken hairs were the most uncommon follicular trichoscopic finding. Whereas epidermal squam and perifollicular erythema (66.7%) were the most common interfollicular trichoscopic findings. Arborizing red lines, dirty dots, pink-white appearance, honeycomb pigment pattern, pinpoint and fibrotic white dots were the other observed interfollicular features in traction alopecia. Conclusion: According to our study, trichoscopic examination held by videodermoscopy is a useful method in the diagnosis of traction alopecia.

Keywords: Alopecia; dermoscopy; traction alopecia; trichoscopy; videodermoscopy
REFERENCES:
  1. Haskin A, Aguh C. All hairstyles are not created equal: what the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA). J Am Acad Dermatol. 2016;75(3):606-11. [Crossref] [PubMed]
  2. Polat M. Evaluation of clinical signs and early and late trichoscopy findings in traction alopecia patients with Fitzpatrick skin type II and III: a singlecenter, clinical study. Int J Dermatol. 2017;56(8):850-5. [Crossref] [PubMed]
  3. Billero v, Miteva M. Traction alopecia: the root of the problem. Clin Cosmet Investig Dermatol. 2018;11:149-59. [Crossref] [PubMed] [PMC]
  4. Karadağ Köse Ö, Güleç AT. Clinical evaluation af alopecias using a handheld dermatoscope. J Am Acad Dermatol. 2012;67(2): 206-14. [Crossref] [PubMed]
  5. Muñoz Moreno-Arrones O, vañó-Galván S. Bitemporal hair loss related to traction alopecia. Dermatol Online J. 2016;22(9).
  6. Shim WH, Jwa SW, Song M, Kim HS, Ko HC, Kim BS, et al. Dermoscopic approach to a small round to oval hairless patch on the scalp. Ann Dermatol. 2014;26(2):214-20. [Crossref] [PubMed] [PMC]
  7. Turan H, Uslu E, Başkan E, Aliağaoğlu C. [A dermoscopic clue for the diagnosis of traction alopecia: peripilar keratin casts: case report]. Turkiye Klinikleri J Dermatol. 2015;25(3):113-5. [Crossref]
  8. 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):1353-5. [Crossref] [PubMed]
  9. Barbosa AB, Donati A, valente NS, Romiti R. Patchy traction alopecia mimicking areata. Int J Trichology. 2015;7(4):184-6. [Crossref] [PubMed] [PMC]
  10. Mirmirani P, Khumalo NP. Traction alopecia: how to translate study data for public education--closing the KAP gap? Dermatol Clin. 2014;32(2): 153-61. [Crossref] [PubMed]
  11. Akingbola CO, vyas J. Traction alopecia: a neglected entity in 2017. Indian J Dermatol venereol Leprol. 2017;83(6):644-9. [Crossref] [PubMed]
  12. Zimmerman B, Ivars M, Cordoro KM. Bibbidi bobbidi bald: two ?hairowing? tales of Princess Package hairstyles. Pediatr Dermatol. 2018;35(3): 415-7. [Crossref] [PubMed]
  13. Samrao A, Price vH, Zedek D, Mirmirani P. The ?fringe sign? -a useful clinical finding in traction alopecia of the marginal hair line. Dermatol Online J. 2011;17(11):1. [Crossref]
  14. Pirmez R, vañó-Galván S. Acknowledging the pseudo ?fringe sign? in frontal fibrosing alopecia has diagnostic and prognostic implications. J Am Acad Dermatol. 2018;78(1):e19. [Crossref]
  15. Ross EK, vincenzi C, Tosti A. videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol. 2006;55(5): 799-806. [Crossref] [PubMed]
  16. Miteva M, Tosti A. ?A detective look? at hair biopsies from African-American patients. Br J Dermatol. 2012;166(6):1289-94. [Crossref] [PubMed]
  17. Karadağ Köse Ö, Güleç AT. [Evaluation of treatment response by using a handheld dermoscope in patients with alopecia areata]. Turk J Dermatol 2018;12:143-8. [Crossref]
  18. Inui S. Trichoscopy for common hair loss diseases: algorithmic method for diagnosis. J Dermatol. 2011;38(1):71-5. [Crossref] [PubMed]
  19. Zhang W. Epidemiological and aetiological studies on hair casts. Clin Exp Dermatol. 1995;20(3):202-7. [Crossref] [PubMed]
  20. Starace M, Patrizi A, Piraccinni BM. visualization of hair bulbs through the scalp: a trichoscopic feature of erosive pustular dermatitis of the scalp. Int J Trichology. 2016;8(2):91-3. [Crossref] [PubMed] [PMC]
  21. vincenzi C, Tosti A. Trichoscopy patterns. In: Tosti A, ed. Dermoscopy of the Hair and Nails. 2nd ed. Miami: CRC Press; 2016. p.1-20. [Crossref]
  22. Rakowska A, Olszewska M, Rudnicka L. Ectodermal dysplasia and other genetic syndromes associated with hair loss. In: Rudnicka L, Olszewska M, Rakowska A, eds. Atlas of Trichoscopy: Dermoscopy in Hair and Scalp Disease. 1 st ed. London: Springer; 2012. p.191-201. [Crossref]
  23. Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. 2012;67(5): 1040-8. [Crossref] [PubMed]
  24. Tosti A, Torres F, Misciali C, vincenzi C, DuqueEstrada B. The role of dermoscopy in the diagnosis of cicatricial marginal alopecia. Br J Dermatol. 2009;161(1):213-5. [Crossref] [PubMed]
  25. Karadağ Köse Ö, Borlu M. [Trichoscopy of diffuse syphilitic alopecia]. Turkiye Klinikleri J Dermatol. 2018;28(1):13-9. [Crossref]
  26. Karadağ Köse Ö, Güleç AT. Temporal triangular alopecia: significance of trichoscopy in differential diagnosis. J Eur Acad Dermatol venereol. 2015;29(8):1621-5. [Crossref] [PubMed]
  27. Lacarrubba F, Micali G, Tosti A. Absence of vellus hairs in the hairline: a videodermatoscopic feature of frontal fibrosing alopecia. Br J Dermatol. 2013;169(2):473-4. [Crossref] [PubMed]
  28. Rakowska A, Slowinska M, Kowalska-Oledzka E, Warszawik O, Czuwara J, Olszewska M, et al. Trichoscopy of cicatricial alopecia. J Drugs Dermatol. 2012;11(6):753-8.
  29. Miteva M, Tosti A. Dermatoscopic features of central centrifugal cicatricial alopecia. J Am Acad Dermatol. 2014;71(3):443-9. [Crossref] [PubMed]
  30. 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-e11. [Crossref]

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