Relevance of Trichoscopy in Differential Diagnosis of Focal Non-cicatricial Alopecia in Children

Overview

Alopecia is a common, distressing condition that is sometimes difficult to diagnose and treat. Losing hair is not usually health threatening; it can scar a young child's vulnerable self-esteem by causing immense psychological and emotional stress, not only to the patient, but also to the concerned parents and siblings; so the cause of hair loss should be diagnosed and treated early to overcome the resulting problems.

The majority of alopecia in children is presented as patchy alopecia, which is most commonly diagnosed as alopecia areata. However, other causes of patchy alopecia such as tinea capitis, trichotillomania, temporal triangular alopecia (TTA), nevus sebaceous and aplasia cutis congenita (ACC) can be easily missed. Trichoscopy (hair and scalp dermoscopy) is a non-invasive diagnostic tool that allows the recognition of morphologic structures not visible by the naked eye. Trichoscopy allows visualization of hair shafts at high magnification and performing measurements, such as hair shaft thickness, without the need of removing hair for diagnostic purposes. It also allows in vivo visualization of the epidermal portion of hair follicles and perifollicular epidermis. The advantages of trichoscopy in evaluating hair loss in children are numerous, as it is a fast in-office technique , non-invasive, inexpensive, and painless , and therefore it will be accepted by children and their parents. Tinea capitis and alopecia areata are considered to be the most common causes of hairless patches of the scalp in pediatrics. Tinea capitis especially non-scaly type may have the same clinical appearance of alopecia areata, so trichoscopy has recently become a useful diagnostic tool for alopecia areata and tinea capitis, especially in doubtful cases as lab investigations like fungal culture or biopsy may take several weeks.

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