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The characteristic trichoscopic features aid in the diagnosis of trichotillomania and alopecia areata in skin of color, which in turn reduces the need for invasive procedures. 

The diagnosis of hair loss is focused on history taking, scalp biopsy, and histopathological findings. Trichoscopy aids in identifying diagnostically challenging conditions such as alopecia areata (AA) and trichotillomania (TTM). 

This multicenter comparative study aimed to describe the trichoscopic features of TTM and AA in skin of color. The comparative trichoscopic features were successfully identified and can be incorporated into the established features for a quick and efficient bedside diagnosis of these hair loss conditions. The findings are published in the Indian Journal of Dermatology.

Baseline Characteristics

At different tertiary care hospitals in India, 24 TTM and 50 AA patients were recruited and blindly evaluated by dermatologists for trichoscopic findings. The mean age of the AA and TTM patients was 30 years and 23.4 years, respectively.

Distinct Hair Shaft Features in Alopecia Areata and Trichotillomania Patients

The significant hair shaft features in AA patients were pigtail, white, exclamation mark, tapered, clustered vellus, clustered regrowing, and coudability hair. On the contrary, the significant hair shaft features in TTM patients included the burnt matchstick sign, hair powder, flame hair, broken hair having different lengths, coiled hair, fractured hair, trichoptilosis, mace hair, and the V sign. 

Tapered hair in TTM patients is a result of mechanical pull. V-hair is of greater importance in TTM patients and occurs when the breakage of two hair strands occurs at the same hair length. Regarding hair shaft features, there are no significant differences across AA and TTM groups based on the occurrence of tulip hair and broom hair.

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Hair Follicle Opening Features in Non-Scarring Alopecia

The predominant hair follicle opening features in AA patients included yellow and black dots. Conversely, TTM patients demonstrated a predominance of perifollicular hemorrhage.

This study has identified the characteristic features of trichoscopy in individuals suffering from AA or TTM, facilitating a quick bedside diagnosis of the condition and limiting the need for invasive diagnostic procedures. Dermatologists can utilize this in making TTM and AA diagnoses in skin of color.


Mani, S., Raut, A., Shekhar Neema, Manish Khandare, Golas, P., Sandhu, S., Kothari, R., Rajput, G. R., & Oberoi, B. (2023). Trichoscopy in Alopecia Areata and Trichotillomania in Skin of Colour: A Comparative Study. 68(1), 78–84. https://doi.org/10.4103/ijd.ijd_587_22