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Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair.

Kibar M, Aktan Ş, Bilgin M - Indian J Dermatol (2015 Jan-Feb)

Bottom Line: Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3(®)).Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4).In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Muş Bulanık Government Hospital, Muş, Turkey.

ABSTRACT

Background: Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE).

Objectives: The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis.

Materials and methods: Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3(®)). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4).

Results: Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis.

Conclusion: This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.

No MeSH data available.


Related in: MedlinePlus

Hidden hairs on the scalp of a patient with psoriasis (upper) and seborrheic dermatitis (lower) (×100 magnification)
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Figure 2: Hidden hairs on the scalp of a patient with psoriasis (upper) and seborrheic dermatitis (lower) (×100 magnification)

Mentions: Seborrheic dermatitis demonstrates psoriasiform hyperplasia and perifollicular predominantly lymphocytic infiltrates and focal parakeratosis particularly at the lips of follicular ostia (“shoulder parakeratosis”) histologically. Scalp involvement of psoriasis often shows more significant plaque formation caused by marked epidermal hyperplasia. Besides less common psoriatic lesions also include the follicular variant with perivascular and perifollicular inflammatory infiltrates and follicular plugging.[1314] Due to these epidermal and perifollicular inflammation in these diseases, pilosebaseous unit with proximal hair shaft may look relatively hidden under a white-grey epidermal proliferation. Kim et al.[l0] investigated the hair shafts of scalp psoriasis and seborrheic dermatitis with atomic force microscopy and observed macropits on hair shafts. These perifollicular and epidermal proliferation and infiltration together with an altered hair shaft with macropits would cause the proximal hair shaft look like hidden under this thickened epidermis and so we thought to describe this appearance as HH with trichoscopy [Figure 2].


Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair.

Kibar M, Aktan Ş, Bilgin M - Indian J Dermatol (2015 Jan-Feb)

Hidden hairs on the scalp of a patient with psoriasis (upper) and seborrheic dermatitis (lower) (×100 magnification)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318061&req=5

Figure 2: Hidden hairs on the scalp of a patient with psoriasis (upper) and seborrheic dermatitis (lower) (×100 magnification)
Mentions: Seborrheic dermatitis demonstrates psoriasiform hyperplasia and perifollicular predominantly lymphocytic infiltrates and focal parakeratosis particularly at the lips of follicular ostia (“shoulder parakeratosis”) histologically. Scalp involvement of psoriasis often shows more significant plaque formation caused by marked epidermal hyperplasia. Besides less common psoriatic lesions also include the follicular variant with perivascular and perifollicular inflammatory infiltrates and follicular plugging.[1314] Due to these epidermal and perifollicular inflammation in these diseases, pilosebaseous unit with proximal hair shaft may look relatively hidden under a white-grey epidermal proliferation. Kim et al.[l0] investigated the hair shafts of scalp psoriasis and seborrheic dermatitis with atomic force microscopy and observed macropits on hair shafts. These perifollicular and epidermal proliferation and infiltration together with an altered hair shaft with macropits would cause the proximal hair shaft look like hidden under this thickened epidermis and so we thought to describe this appearance as HH with trichoscopy [Figure 2].

Bottom Line: Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3(®)).Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4).In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Muş Bulanık Government Hospital, Muş, Turkey.

ABSTRACT

Background: Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE).

Objectives: The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis.

Materials and methods: Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3(®)). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4).

Results: Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis.

Conclusion: This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.

No MeSH data available.


Related in: MedlinePlus