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hair and scalp evaluation

There are many disorders of hair and scalp including psoriasis, sebhorric dermatitis, alopecia areata, androgenetic alopecia, chronic telogen, effluvium, trichotillomania, and primary cicatrical alopecia. The traditional methods used for detection of these disorders are simple clinical examination and hair pull tests, but often scalp biopsies become a must - particularly in suspected cases of cicatrical alopecia, alopecia areata incognita and telogen effluvium. However, even pathological scalp biopsies do not always give accurate results. Therefore, newer methods employing superior detection devices such as dermoscopy becomes essential in improving diagnostic accuracy in this category of disorders.

Use of Dermoscopy for Evaluation

The use of dermoscopy has brought about considerable improvement in the detection of melanoma. The handheld dermoscope has revolutionized the manner in which pigmented lesions are classified accurately for appropriate therapy. It has also been seen that these useful instruments can bring about a marked improvement in the manner in which hair and scalp disorders are evaluated and diagnosed.

Particular features, like wide range hair caliber diversity in disorders like androgenetic alopecia (AGA), are better observed with dermoscopy than with the naked eye examination method. Moreover, dermoscopy has made it possible to reveal newer features of the disease like peripilar atropy in patients of AGA which are vitally significant pathologically as well as clinically.

What is Videodermoscopy?

This is an innovation and modification on the traditional hand held dermoscopy. Videodermoscopy enables dermatologists to view the scalp or skin surface at a rapid and higher resolution and up to several times more magnified. With this is the added ability of digitally recording the viewed images and storing them for posterity. Using videodermoscopy, a wide range of non-tumoral scalp and hair conditions can be examined and certain recognizable patterns can be readily identified.

The images in videodermoscopy are usually obtained by computerized polarized light using lenses with 20 to 70 factors of magnification with x10 increments. Alcohol is usually used as the interface liquid and both epiluminescent as well as non epiluminescent methods can be used. The digital images can be viewed on a high-resolution monitor and important images, which can be used later are stored.

The Features and Patterns revealed by Videodermoscopy

Vascular features are best observed employing the epiluminescent method. There are three vascular features noticeable. Interfollicular simple lasso shaped loops are observed in isolation, interfollicular twisted red loops are seen, which determine the presence of psoriasis and sebhorric dermatitis giving rise to the idea that vascular defects play an integral role in the development of psoriasis. Red lines having higher caliber than loops are also seen confirming that it relates to subpapillary plexus. An even honey-comb like pattern of pigment made up of brown rings is observed in the areas where hair is thin or non existent pointing to the problems of persistent and progressive alopecia areata, AGA, lichen planopilaris, folliculitis decalvans, chronic telogen effluvium or trichotillomania and can be attributed to excessive exposure to the sun.

With epiluminescent videodermoscopy, two peripilar patterns of yellow dots and white dots were clearly distinguishable. The yellow dots represent the distention of affected follicles with keratinous material and sebum, white dots determine sites of follicular degeneration and define primary cicatrical alopecia.

Videodermoscopy as a Compelling Device

Currently videodermoscopy is not an economical method, but as costs come down it will be a much-used instrument in every clinic. This is due to the fact that several patterns in the hair and scalp disorders have been readily identified that are significant in determining particular conditions opening new possibilities in detection and subsequent therapy. Finding of determining features of the two most commonly occurring hair and scalp disorders of psoriasis and alopecia areata confirm the fact that videodermoscopy is an inevitable detecting instrument.

Though twisted loops are not found solely in cases of psoriasis alone, a profusion of this feature at a low magnification determines the diagnosis of this disorder, as this feature is present in all cases of psoriasis unlike in sebhorric dermatitis and DLE. The presence or absence of twisted loops facilitates the diagnosis in cases that are mild and partially treated. Yellow dots are helpful in determining clinically difficult cases and are determining features of alopecia areata and advanced AGA. Only with the presence of yellow dots can alopecia areata be confirmed and differentiated from trichotillomania or telogen effluvium. Once determined through videodermoscopy, the need for biopsy may be reduced and is a boon especially in case of children for whom biopsy can lead to trauma.

Apart from this, videodermoscopy can help by monitoring the results of treatment, tracking of the development of the disease and correlating prognostic determinants, pathology and pathogenic factors with subsurface features.

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