Dermoscopy Patterns of Cicatricial Alopecia Resulting from Discoid Lupus Erythematosus and Lichen Planopilaris

Background: Dermoscopy is an important tool for the diagnosis of benign and malignant melanocytic diseases. Recently, this method has also been found to be extremely useful in the diagnosis and follow-up of alopecias.

Objective: The objective of this study was to describe dermoscopic findings in patients with clinical and histopathological characteristics of cicatricial alopecia.

Methods: A descriptive cross-sectional study was conducted in which 14 patients with cicatricial alopecia were selected based on clinical and histopathological evaluation of the scalp. The underlying cause was classic lichen planopilaris in four cases, frontal fibrosing alopecia in five and discoid lupus erythematosus in the remaining five. The patients were evaluated using videodermoscopy and conventional dermoscopy (with a handheld dermoscope), performed independently by three different examiners. Magnification ranged from 10x to 70x.

Results: Principal findings in cases of discoid lupus erythematosus were: white patches, branching capillaries, keratin plugs and areas of reduced follicular ostia; in classic lichen planopilaris: perifollicular scales, white dots and reduced follicular ostia; and in frontal fibrosing alopecia: reduced follicular ostia, perifollicular scales, perifollicular erythema and branching capillaries. The blue-grey dots described in this paper were a novel feature in scalp dermoscopy.

Conclusions: The use of dermoscopy for the clinical evaluation of the scalp in cases of cicatricial alopecia improves diagnostic capacity beyond simple clinical inspection and reveals novel features of the disease.