Comparative Analysis of Trichoscopic Features in Women with Androgenetic Alopecia and Telogen Effluvium

Abstract

Comparative Analysis of Trichoscopic Features in Women with Androgenetic Alopecia and Telogen Effluvium

Abstract

Purpose: Female androgenetic alopecia (FAGA) and telogen effluvium (TE) are two of the most common causes of hair loss in women. Due to the considerable overlap in their clinical features, accurate differentiation is essential for appropriate treatment planning. Material and Methods: This cross-sectional study included 110 female patients clinically diagnosed with FAGA or TE at the Department of Dermatology, XXX University. Trichoscopic images of the frontal and occipital scalp regions were obtained at 40× magnification. The presence of predefined trichoscopic features was assessed by two blinded dermatologists. Results: Trichoscopic findings associated with FAGA included hair diameter diversity (p<0.001), short vellus hairs (p<0.001), increased single-hair follicular units (p < 0.001), yellow dots (p < 0.001), white dots (p=0.006), and a honeycomb pigmentation pattern (p < 0.001). In contrast, perifollicular scaling (p=0.030) and simple red loops (p=0.008) were associated with TE. A comparative analysis of the frontal and occipital scalp regions revealed more pronounced thinning, a higher ratio of vellus hairs, and greater follicular miniaturization in FAGA patients (all p<0.05). Conclusion: This study highlights the utility of trichoscopy as a practical tool in the differential diagnosis of FAGA and TE.

Keywords

• Androgenetic alopecia
• telogen effluvium
• female pattern hair loss
• trichoscopy
• dermoscopy
• women
• differential diagnosis

References

1. Starace M, Orlando G, Alessandrini A, Piraccini BM. Female Androgenetic Alopecia: An Update on Diagnosis and Management. Am J Clin Dermatol. 2020;21:69-84.
2. Tsutsui GM, Ramos PM, Miot HA. Prevalence of female pattern hair loss in a multiracial population. J Am Acad Dermatol. 2022;86:962-964.
3. Adriana Rakowska, Monika Slowinska, Elzbieta Kowalska-Oledzka, Malgorzata Olszewska, Lidia Rudnicka. Dermoscopy in Female Androgenic Alopecia: Method Standardization and Diagnostic Criteria. Int J Trichology. 2009;1:123–130.
4. Alessandrini A, Bruni F, Piraccini BM, Starace M. Common causes of hair loss - clinical manifestations, trichoscopy and therapy. J Eur Acad Dermatol Venereol. 2021;35:629-640.
5. Harrison S, Sinclair R. Telogen Effluvium. Clin Exp Dermatol 2002;27:389-395.
6. Karadağ Köse Ö, Güleç AT. Clinical evaluation of alopecias using a handheld dermatoscope. J Am Acad Dermatol. 2012;67:206-14.
7. Inui S, Nakajima T, Itami S. Scalp dermoscopy of androgenetic alopecia in Asian people. J Dermatol. 2009;36:82–85.
8. Kuczara A, Waśkiel-Burnat A, Rakowska A, Olszewska M, Rudnicka L. Trichoscopy of Androgenetic Alopecia: A Systematic Review. J Clin Med. 2024;13:1962.

9. Kaliyadan F, Nambiar A, Vijayaraghavan S. Androgenetic alopecia: an update. Indian J Dermatol Venereol Leprol. 2013;79:613-25.
10. Tawfik SS, Sorour OA, Alariny AF, Elmorsy EH, Moneib H. White and yellow dots as new trichoscopic signs of severe female androgenetic alopecia in dark skin phototypes. Int J Dermatol. 2018;57:1221-1228.
11. Lima CDS, Lemes LR, Melo DF. Yellow dots in trichoscopy: relevance, clinical significance and peculiarities. An Bras Dermatol. 2017;92:724-726.
12. Zhang X, Caulloo S, Zhao Y, Zhang B, Cai Z, Yang J. Female pattern hair loss: clinico-laboratory findings and trichoscopy depending on disease severity. Int J Trichology. 2012;4:23–28.
13. Ross EK, Vincenzi C, Tosti A. Videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol. 2006;55:799–806.
14. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152:466-73.
15. Olsen EA. Female pattern hair loss. J Am Acad Dermatol. 2001;45:S70–S80.
16. Herskovitz I, de Sousa IC, Tosti A. Vellus hairs in the frontal scalp in early female pattern hair loss. Int J Trichology. 2013;5:118-20.