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Colored dots on trichoscopy—beware of artifacts

2018; Elsevier BV; Volume: 80; Issue: 6 Linguagem: Inglês

10.1016/j.jaad.2018.11.052

1097-6787

Sidharth Sonthalia, Pankaj Tiwary,

Cutaneous Melanoma Detection and Management

Successful trichoscopy, which is essential for evaluating scalp and hair disorders, warrants cognizance of artifacts that may mimic specific disorders. The peripilar sign, which is characterized by a perifollicular brown halo, is a specific finding of early androgenetic alopecia that reflects perifollicular inflammation. 1 Jain N. Doshi B. Khopkar U. Trichoscopy in alopecias: diagnosis simplified. Int J Trichology. 2013; 5: 170-178 Crossref PubMed Scopus (75) Google Scholar Many young patients use hair dyes and henna on account of premature canities. These chemicals penetrate hair follicles, giving a pseudoperipilar sign that is suggestive of early androgenetic alopecia (Fig 1). Confusion may also arise upon observation of colored dots simulating vessels or yellow dots stemming from the use of vermillion powder (traditionally applied over the anterior frontal hairline by married women of many Asian ethnicities) and powdered colors applied during Holi (the Indian Festival of Colors) (Fig 2). Fig 2A, Trichoscopic image from the anterior frontal region of the scalp of a married 30-year-old woman with female androgenetic alopecia. The presence of multiple scattered red dots may be confused with vessels; however, they are due to sprinkled particles of vermillion powder applied ritually over the anterior frontal hairline. Note the overall background color of pink-to–faint red, irregularly shaped red globules and clods (yellow arrows) and a dusky red pseudonit (white arrow), confirming the artifactual origin. B and C, Trichoscopic image from the midfrontal region of the scalp of a young adult man who was seen for dandruff in March, which is the typical month for celebrating the Festival of Colors in India. Apart from widespread white pseudonits that were suggestive of dandruff, dots and clods of multiple colors—pink (red arrow), yellow (yellow arrow), and green (green arrow)—were visible. The multicolored background, the shiny nature of the dots, and the patient's positive history of having played with Holi colors without proper shampooing 4 days previously confirmed the findings to be artifactual (B). Higher-magnification view the midfrontal region of the young man's scalp (C), confirming the suspicion. The irregularly shaped and multilayered pink clods (white arrows) and irregular yellow dot consisting of scattered pink granules are due to residual powdered colors used for playing. (A-C, E-scope video dermatoscope, Timpac Healthcare Pvt Ltd, New Delhi, India, polarized mode; original magnifications: A and B, ×20; C, ×70.) View Large Image Figure Viewer Download Hi-res image