Dermoscopic features of various scalp and hair disorders

	Follicular ostia	Perifollicular skin	Vascular pattern	Hair shafts
Nonscarring alopecias
Androgenetic alopecia	Increased number of single-hair follicles, yellow dots	Peripilar sign	Increased number of arborizing vessels commonly seen since concomitant seborrheic dermatitis is common	Hair diameter variability* Short, thin, regrowing hairs (<0.03 mm diameter)
Alopecia areata	Broken hairs, black dots, yellow dots^¶, increased number of regularly distributed, pinpoint white dots (pigmented scalp)			Exclamation point hairs^Δ, broken hairs, circle hairs, coudability^◊
Telogen effluvium				Short, regrowing hairs of normal (>0.03 mm) thickness
Traction alopecia				The alopecic patch has few terminal hairs but retains vellus hairs, hair casts along the hair shafts at the periphery of the patch^§
Trichotillomania				Broken hairs of varying length, flame hairs^¥, question mark hairs^‡
Cicatricial alopecias
Central centrifugal cicatricial alopecia	Irregular distribution of pinpoint white dots	Peripilar gray-white halo, white patches
Discoid lupus erythematosus	Follicular keratotic plugs, red dots, blue-gray dots in speckled pattern	Loss of pigment network (in highly pigmented scalp)	Enlarged, branching, tortuous vessels	Peripilar casts
Dissecting cellulitis of the scalp	Black dots, yellow dots, follicular keratotic plugging, regrowing hairs, loss of follicular ostia in persistent disease
Folliculitis decalvans	Hair tufting	Severe scaling, pustules, crusts	Twisted red loops	Thick, peripilar casts
Frontal fibrosing alopecia	The cicatricial band shows loss of follicular ostia The new hairline shows reduction of follicular ostia and few, occasional black dots			Absence of vellus hairs at frontal hairline, peripilar casts, pili torti, broken hairs
Lichen planopilaris	Loss of follicular ostia, blue-gray dots in target pattern (highly pigmented scalp)			Peripilar casts, pili torti, broken hairs
Inflammatory scalp disorders
Psoriasis		Interfollicular, whitish scales, follicular ostia might not be visible	Red dots at low magnification, twisted capillary loops at high magnification (≥40x)
Seborrheic dermatitis		Yellow/white scales	Increased number of arborizing vessels
Infectious and parasitic disorders
Pediculosis capitis		Lice		Nits
Piedra, black				Dark nodules surrounding hair shafts
Piedra, white				Yellow or beige nodules or sheaths around hair shafts
Tinea capitis	Black dots	Diffuse scale, pustules		Broken hairs, comma hairs, corkscrew hairs
Trichomycosis axillaris				Yellow concretions surrounding hair shafts

* Hair diameter variability – Terminal hair shafts of varying diameter.
¶ Yellow dots are not visible in children as sebaceous glands are not active. Yellow dots are rare in the highly pigmented scalp.
Δ Exclamation point hairs – Broken hairs with a dark, thick tip.
◊ Coudability hairs – Hairs of normal length that are tapered at the proximal end.
§ Hair casts in traction alopecia correspond to detached root sheaths.
¥ Flame hairs – Short, broken hairs with wavy configuration at distal end.
‡ Question mark hairs – Short hair with a coiled tip.

Graphic 115000 Version 3.0

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Dermoscopic features of various scalp and hair disorders