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GENERAL INSTRUCTIONS

General Instructions:

You will find a list of True/False statements following each case history. Select any statements, which you believe to be true. There may be one, more than one or no true statements for any given case. Choose the correct risk, diagnosis and disposition for each case. Then, turn the page to find a detailed discussion and pearls for each case.

CASE 1

CASE 1 HISTORY

A 14-year-old adolescent girl has a history of tinea capitis successfully treated with systemic antifungals. Three months later she developed diffuse hair shedding and mild thinning.

Trichoscopy/dermoscopy demonstrates (Choose the correct answer or answers. One, several, or no answers can be correct.)

  1. Exclamation mark hairs

  2. Broken hairs of different lengths

  3. Black dots

  4. Hair coudability

  5. Short regrowing hairs of different lengths

DIAGNOSIS (Choose the correct answer.)

  • ☐ Tinea capitis

  • ☐ Trichotillomania

  • ☐ Alopecia areata

  • ☐ Monilethrix

  • ☐ Trichorrhexis nodosa

  • ☐ Androgenetic alopecia

DISEASE STAGE (Choose the correct answer.)

  • ☐ Acute

  • ☐ Chronic

DIAGNOSIS (Choose the correct answer.)

  • ☐ Tinea capitis

  • ☐ Trichotillomania

  • ☑ Alopecia areata

  • ☐ Monilethrix

  • ☐ Trichorrhexis nodosa

  • ☐ Androgenetic alopecia

DISEASE STAGE (Choose the correct answer.)

  • ☑ Acute

  • ☐ Chronic

DERMOSCOPIC CRITERIA

  • Broken hairs with different lengths (black arrows)

  • Exclamation mark hairs (red arrows)

  • Black dots (black circles)

ANSWERS

Answers: 1,2,3

Discussion:

  • Trichoscopy/Dermoscopy demonstrates broken hairs with different lengths.

    • The terms dermoscopy and trichoscopy are often used interchangeably in the context of this application of the technique

  • Broken hairs with different lengths can be seen in:

    • Alopecia areata

    • Chemotherapy-induced alopecia

    • Tinea capitis

    • Trichotillomania

  • There are also exclamation mark hairs characterized by:

    • Dark thick and frayed tips.

    • Proximal portions are pale and tapered.

  • Exclamation mark hairs are almost exclusively seen in alopecia areata.

  • The only other condition where they are seen is in chemotherapy-induced alopecia.

  • There are black dots/macules, corresponding to hair shafts broken off at the skin surface.

  • Black dots are also commonly found in tinea capitis.

  • This suggests the tinea might still be active.

  • Yellow dots are not visible.

    • Yellow dots correspond to infundibula filled with sebum and keratinous debris. They are usually not seen in children.

  • Trichoscopic features in alopecia areata:

    • Exclamation mark hairs.

    • Broken hairs with different lengths.

    • Yellow dots.

    • Black dots.

    • Pseudo-monilethrix: irregularly located multiple hair shaft restrictions, usually seen in only a few hairs.

    • Circle hairs: short, thin, coiled hairs.

    • Coudability: proximal narrowing of the hair shaft, seen at periphery of the alopecia.

    • Short vellus hairs: light, short, thin, regrowing hairs.

    • Pinpoint white dots ...

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