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104
L. Park et al.
Trichoscopy ofLocalized Cicatricial
Alopecia
Hair tufting, indicative of cicatricial alopecia, is
dened by the emergence of multiple hairs from
a single follicular ostium. The presence of more
than six hair shafts in one follicle is a hallmark of
folliculitis decalvans (Fig.9.16) [6].
White scales on the scalp can be best appreciated with dry trichoscopy. Perifollicular and
peripilar scales occur in conditions such as folliculitis decalvans (Fig. 9.17), discoid lupus,
lichen planopilaris, frontal brosing alopecia [7].
Initial stages of dissecting cellulitis (Fig.9.18)
features noncicatricial alopecia similar to alopecia
areata, including empty follicles, short hairs that
are regrowing or broken, and yellow and black
dots. As the condition advances, erythema, follicu-
Fig. 9.16 Folliculitis
decalvans. Hair tufts and
white scales
lar pustules, and keratotic plugs become more
noticeable. In its late stages, dissecting cellulitis is
characterized by white patches devoid of hair follicles and skin ssures through which hairs emerge.
In cases of discoid lupus erythematosus
(Fig.9.19), keratotic plugs, erythema, and scales
are present. Red dots representing inammatory
inltration around hair follicles with extravasation of red blood cells are often seen in early
acute discoid lupus erythematosus. Thick arborizing vessels may be seen as well. Hair tufts featuring less than four hair shafts per follicular
opening may be found. Milky-red patches and
the disappearance of follicular openings are seen
in the late stages. In darker skin color, pigment
loss from the inammation disrupting the pigment network may lead to speckled patterns of
blue-gray dots.
Fig. 9.17 Folliculitis
decalvans. Perifollicular
and peripillar scales
9 Trichoscopy
Fig. 9.18 Dissecting
cellulitis. Empty
follicles, short hairs, and
white patches
Fig. 9.19 Discoid lupus
erythematous.
Interfollicular, peripilar,
and perifollicular scales,
hair tufts, and dilated
thick arborizing vessels
105
Trichoscopy ofInammatory
Conditions
White scales and twisted or glomerular-like vessels arranged into rings are characteristic features
seen in psoriasis (Figs.9.20 and 9.21). Hair casts,
dened as scales surrounding a hair shaft, are
also frequently observed in psoriasis, although
also seen in various other conditions including
lichen planopilaris, discoid lupus, frontal brosing alopecia, traction alopecia, tinea capitis, and
folliculitis decalvans.
Trichoscopy of seborrheic dermatitis
(Fig.9.22) will frequently demonstrate arborizing vessels, adherent yellow scales and
interfollicular white scales, oily material, and
yellow dots.
In cases of keratosis pilaris (Fig.9.23), varying degrees of perifollicular erythema accompanied by keratotic plugs are observed.
The main trichoscopic characteristics of scalp
dermatomyositis (Fig.9.24) include the presence
of arborizing vessels, giant vessels or dilated tortuous vessels, diffuse and perifollicular scales,
and interfollicular or perifollicular pigmentation
[11].
Follicular mucinosis, also known as alopecia
mucinosa, is accompanied by perifollicular whitish rims, indicative of mucin accumulation,
alongside interfollicular brownish-yellow dots
(Fig.9.25). Mucin casts (Fig.9.26) encircling the
hair shafts are also a notable feature. Furthermore,
the presence of red dots and dilated capillary vessels can be observed [12].
106
Fig. 9.20 Psoriasis.
Thick white scales
Fig. 9.21 Psoriasis.
twisted red loops and
dotted (glomerular)
vessels
L. Park et al.
Fig. 9.22 Seborrheic
dermatitis. A serpentine
vessel (red arrow) and
perifollicular oily yellow
dots (yellow arrows)
9 Trichoscopy
Fig. 9.23 Keratosis
pilaris. Follicular
erythema
Fig. 9.24 Dermatomyositis. perifollicular
and peripillar scales
with tortuous vessels,
50×
107
Fig. 9.25 Follicular
mucinosis. White rims
around follicular ostia
and mucinous beard cast
108
Fig. 9.26 Follicular
mucinosis.
Accumulation of mucin
on the outer root sheath
Fig. 9.27 Acne
keloidalis nuchae.
Perifollicular scales and
hemorrhagic and
honey-colored crust
L. Park et al.
Trichoscopy examination of Acne keloidalis
nuchae (Fig. 9.27) may reveal follicular papules, pustules, scales around the follicles, and
crusts that are either hemorrhagic or honey-colored in early stages. Another feature commonly
seen is white rings around the hair follicles,
which suggests perifollicular brosis. In
advanced stages, tufted hair and enlarged follicular ostia can be seen.
Trichoscopy ofScalp Infestation
andInfection
The indicators of pediculosis capitis
(Figs. 9.28 and 9.29) include visible nits.
These can sometimes be incorrectly identified
as pseudo-nits or scales from other conditions
such as seborrheic dermatitis, debris, or hair
casts. Videodermoscopy for head lice reveals
nits. Additionally, trichoscopy aids in diagnosing phthiriasis pubis (crab lice), which can
infest the scalp hair or eyelashes (phthiriasis
palpebrarum).
Comma hairs, corkscrew hair, and zigzag
hairs (Fig. 9.30) are bent or twisted hairshaft
features often seen in tinea capitis. Another tricoscopic ndings of tinea capitis include Morse
code-like hairs, bent hairs, block hairs, and
i-hairs. Other common but nonspecic ndings
may include broken hairs, black dots, perifollicular scaling, and diffuse scaling [13].
9 Trichoscopy
Fig. 9.28 Pediculosis
capitis (a nit), 20×
Fig. 9.29 Pediculosis
capitis
(Videodermoscopic
observation), 50×
109
Fig. 9.30 Tinea capitus.
Comma hairs (red
arrows), zigzag hairs
(yellow arrow), and
corkscrew hairs (blue
arrow)
110
Fig. 9.31 Pili torti
(blue arrow)
Fig. 9.32 Nevus
comedonicus
L. Park et al.
Trichoscopy ofHair Shaft Disorders
Pili torti (Fig. 9.31) is characterized by the presence of the hair shaft attened and twisted 180
degrees along its longitudinal axis. This can manifest in a variety of inherited and acquired hair disorders [14].
Other: Follicular Disorders
Trichoscopy ndings of nevus comedonicus
(Fig. 9.32) demonstrate multiple well-dened
homogenous brown circles surrounding keratin
plugs in the hair follicles.
Trichosis spinulosa (Fig. 9.33) has a main
trichoscopic characteristic feature of black
dots, indicative of comedo-like cadaverized
hairs, resulting from the retention of hairs
Fig. 9.33 Trichostasis Spinulosa
within a keratinous sheath in dilated follicles
(Fig. 9.34). Other common ndings include
keratotic plugs and the retention of ne, vellus
hairs (Fig.9.35) [15].
9 Trichoscopy
Fig. 9.34 Trichostasis
Spinulosa. Black dots
Fig. 9.35 Trichostasis
Spinulosa. retention of
vellus hairs
111
Acknowledgement Authors extend our sincere gratitude
to Agnes Canazza for her generous time and effort in
assisting us with the retrieval of valuable images.
References
1. Miteva M, Tosti A. Hair and scalp dermatoscopy. J
Am Acad Dermatol. 2012;67(5):1040–8. https://doi.
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2013;5(4):170–8.
3. Ross EK, Vincenzi C, Tosti A. Videodermoscopy in
the evaluation of hair and scalp disorders. J Am Acad
Dermatol. 2006;55:799–806.
4. Lacarrubba F, Dall’Oglio F, Rita Nasca M, Micali
G.Videodermatoscopy enhances diagnostic capability in some forms of hair loss. Am J Clin Dermatol.
2004;5(3):205–8.
5. Vincenzi C, Tosti A.Trichoscopy patterns. In: Tosti A,
editor. Dermoscopy of the hair and nails. 2nd ed. Boca
Raton: CRC Press; 2016. p.1–20.
6. Pirmez R. The dermatoscope in the hair clinic:
trichoscopy of scarring and nonscarring alopecia. J
Am Acad Dermatol. 2023;89(2S):S9–S15.
7. Miteva M.Hair and scalp dermoscopy (Trichoscopy).
In: Miteva M, editor. Hair pathology with trichoscopic
correlations. Boca Raton: CRC Press; 2022. p.1–9.
8. Rudnicka L, Oszewska M, Rakowska A, editors. Atlas
of trichoscopy-dermoscopy in hair and scalp disease.
1st ed. London: Springer-Verlag; 2012.
9. Ummiti A, Priya P, Chandravathi PL, Kumar
C.Correlation of trichoscopic ndings in androgenetic
alopecia and the disease severity. Int J Trichology.
2019;11:118–22.
10. Polat M. Evaluation of clinical signs and early and
late trichoscopy ndings in traction alopecia patients
with Fitzpatrick skin type II and III: a single-center,
clinical study. Int J Dermatol. 2017;56(8):850–5.
https://doi.org/10.1111/ijd.13599.
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11. Żychowska M, Reich A.Dermoscopy and trichoscopy
in dermatomyositis—a cross-sectional study. J Clin
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12. Yamagishi H, Ota M, Nobeyama Y, Asahina A.Case
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Ciechanowicz P, Olszewska M, Rudnicka
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doi.org/10.1007/s13555- 019- 00350- 1.
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The Transcriptomics
andEpigenomics ofHair Follicles
RaquelCuevas-Diaz Duran,
EmmanuelMartinez- Ledesma,
MelissaGarcia-Garcia, AndreaSarro- Ramírez,
CarolinaGonzalez-Carrillo,
DeniseRodríguez-Sardin,
andAlejandroCardenas-Lopez
10
Introduction
The skin is the largest organ of the human body,
and it is also one of the most complex ones. Skin
consists of a diverse variety of epithelial and
mesenchymal cell types that perform coordinated
functions underlying homeostasis. The skin
appendages include sebaceous glands, apocrine
and eccrine sweat glands, hair follicles (HF), and
nails. HFs not only play an important role as a
protein ber factory and sensory organ, but they
R. Cuevas-Diaz Duran (*)
Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, NL, Mexico
CapilarFix®, Monterrey, NL, Mexico
e-mail: raquel.cuevas.dd@tec.mx
E. Martinez-Ledesma
Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, NL, Mexico
Institute for Obesity Research, Tecnologico de
Monterrey, Monterrey, NL, Mexico
e-mail: juanemmanuel@tec.mx
M. Garcia-Garcia · A. Sarro-Ramírez ·
C. Gonzalez-Carrillo
CapilarFix®, Monterrey, NL, Mexico
e-mail: dra.melissa@capilarx.com
D. Rodríguez-Sardin · A. Cardenas-Lopez (*)
CapilarFix®, Monterrey, NL, Mexico
NeoMedics®, Monterrey, NL, Mexico
e-mail: dra.denise@capilarx.com;
dr.cardenas@capilarx.com
are also important for skin regeneration after
injury. HFs are mini organs of the skin that are
formed at an early embryonic stage through
interactions between neuroectodermal and mesodermal stem cells, namely, epithelial, neural
crest, and mesenchymal [1, 2]. Each of these
stem cells gives rise to different populations of
HF cells, highlighting their diversity. Furthermore,
the HF is the only mammalian organ that undergoes cyclic transformations throughout its entire
adult life, recapitulating embryonic growth. HFs
cycle through periods of regeneration and rapid
growth (anagen), apoptosis-driven regression
(catagen), and relative quiescence (telogen) [3,
4]. This hair cycling is controlled by autocrine
and paracrine signals that trigger changes in both
cell state and cell identities.
HFs are characterized by highly heterogeneous cell subpopulations that work coordinately
to periodically regenerate the hair shaft. Previous
studies have tried to describe the heterogeneity of
HFs, but they have been biased because of the use
of a priori dened markers for cell enrichment
[5–9]. These studies have also been limited by
low sensitivity or small numbers of analyzed
genes. Even so, these studies have uncovered
more than 20 keratinocyte cell subpopulations
and states, numerous broblasts and immune cell
subtypes, melanocytes, and dermal papilla cells.
Fortunately, advances in high throughput next
generation sequencing technologies are changing
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2024
P. J. Panagotacos, H. Maibach (eds.), Hair Loss, Updates in Clinical Dermatology,
https://doi.org/10.1007/978-3-031-74314-6_10
113