Assessment, reliability, and validity of trichoscopy in the evaluation of alopecia in women

Abstract

Background: Alopecia in women is generally difficult to diagnose clinically. Trichoscopy may help make the correct diagnosis in doubtful cases. Objective: The aims of the study were to assess the trichoscopic features of different types of alopecia in women, the reliability of trichoscopy vis-à-vis clinical findings, and the validity of trichoscopy in cases with a doubtful clinical diagnosis. Methods: A hospital-based observational, cross-sectional study was carried out on female patients with alopecia. A trichoscopic diagnosis was made and correlated with a clinical diagnosis. The validity of trichoscopy in doubtful cases was evaluated by reporting the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic value. Results: On trichoscopy, increased hair diameter diversity > 20%, single-hair follicular unit, vellus hair, peripilar sign, and focal atrichia were commonly seen in female pattern hair loss. In telogen effluvium, there was a scarceness of specific findings. In cicatricial alopecias, loss of follicular ostia, erythema, white macules, blue-gray dots, white dots, tufted hair, and keratotic follicular plugging were observed. A good agreement between trichoscopy and clinical diagnosis was found (Cohen’s Kappa = 0.824; 95% confidence interval, 0.756–0.892). The validity of trichoscopy in doubtful cases was evaluated using the validity parameters, which were high in all alopecias. Limitations: Histopathology testing was not done in all patients. Conclusion: Trichoscopy helped reach a definitive diagnosis in patients in whom the clinical diagnosis was doubtful. Thus, trichoscopy is a sensitive and specific investigation that can be valuable in women with alopecia.

Keywords

• Trichoscopy
• Alopecia
• Female pattern hair loss
• Telogen effluvium
• Scarring alopecia
• Sensitivity of trichoscopy