Practical Dermoscopy
Hair Casts: Trichoscopic Clues
Vainas peripilares: claves tricoscópicas
A. Giacaman
, L.J. del Pozo Hernando, A. Martín-Santiago
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Departamento de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Giacaman, L.J. del Pozo Hernando, A. Martín-Santiago" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Giacaman" ] 1 => array:2 [ "nombre" => "L.J." "apellidos" => "del Pozo Hernando" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martín-Santiago" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021003094?idApp=UINPBA000044" "url" => "/00017310/0000011300000002/v1_202203040527/S0001731021003094/v1_202203040527/es/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => " Hair Casts: Trichoscopic Clues" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T176" "paginaFinal" => "T177" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Giacaman, L.J. del Pozo Hernando, A. Martín-Santiago" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Giacaman" "email" => array:1 [ 0 => "anizagiacaman@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L.J." "apellidos" => "del Pozo Hernando" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martín-Santiago" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vainas peripilares: claves tricoscópicas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 732 "Ancho" => 951 "Tamanyo" => 94840 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Frontal capillary hypodensity.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 51-year-old Colombian woman visited our department with predominantly frontal and bitemporal capillary hypodensity that had begun 10 years earlier (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Trichoscopy revealed miniaturization of the follicles, a fine pigmented reticulum, and hair casts (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">What is your Diagnosis?</p><p id="par0020" class="elsevierStylePara elsevierViewall">Traction alopecia</p><p id="par0025" class="elsevierStylePara elsevierViewall">Traction alopecia (TA) is caused by the direct mechanical damage done by hairstyles involving considerable traction<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. It is more frequent in women and has been reported in up to a third of African-American women, although it can affect all phenotypes<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. It is associated with the use of pony tails, plaits, extensions, chemical hair-shaft relaxers, turbans, and headbands<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a>. The condition is a reversible alopecia in the initial stages but progresses to permanent alopecia if the triggering factors are not corrected<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. Physical examination reveals the band sign that corresponds to an area immediately anterior to the area of alopecia, with shorter terminal hairs. The eyebrows, eyelashes, nails, and body hair are not involved.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the initial stages of TA, trichoscopy reveals miniaturization of the follicles and hair casts (HCs). Papules and/or pustules may also be observed, together with perifollicular erythema, black spots and the recently described flame or torch sign, which is more frequent in more pigmented phototypes, corresponding to white areas at the base of the terminal hairs.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In advanced stages, signs of cicatricial alopecia are observed<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The HCs tend to be found on the periphery of the alopecia plaque. They are present in more than 80% of cases of TA and correspond to grayish-white mobile cylindrical structures, located in the region proximal to the hair shaft, coinciding with the areas of maximum tension. Their presence indicates permanent traction, and they may, therefore, help to monitor cessation of this factor by the patient. HCs are not a specific sign. They can also be observed in seborrheic dermatitis and psoriasis of the scalp, and it is important to distinguish them from nits in order to avoid unnecessary treatments<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The differential diagnosis of TA includes other entities that may mimic or even coexist the condition, such as fibrosing frontal alopecia, androgenetic alopecia, alopecia areata, and trichotillomania, which do not present HCs<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. Biopsy should only be performed if the diagnosis is in doubt<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment is based on avoiding traction. Topical or intralesional corticosteroids, antibiotics, and minoxidil may be used in the initial stages. In advanced stages, camouflaging techniques and hair transplant may be considered<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Giacaman A, del Pozo Hernando LJ, Martín-Santiago A. Vainas peripilares: claves tricoscópicas. Actas Dermosifiliogr. 2022;113:176–177.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 732 "Ancho" => 951 "Tamanyo" => 94840 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Frontal capillary hypodensity.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 731 "Ancho" => 951 "Tamanyo" => 117746 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Temporal capillary hypodensity associated with a high-traction hairstyle.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 732 "Ancho" => 951 "Tamanyo" => 215843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hair casts in the region proximal to the shaft (arrow). Multiple empty follicular orifices (>) and fine hairs (*). Some dystrophic hairs (×). A fine pigmented reticulum can be observed on the interfollicular skin; this sign is present in dark phototypes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hair casts are a dermoscopic clue for the diagnosis of traction alopecia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Tosti" 1 => "M. Miteva" 2 => "F. Torres" 3 => "C. Vincenzi" 4 => "P. 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| 2022 September | 109 | 61 | 170 |
| 2022 August | 90 | 55 | 145 |
| 2022 July | 63 | 54 | 117 |
| 2022 June | 126 | 55 | 181 |
| 2022 May | 221 | 60 | 281 |
| 2022 April | 244 | 41 | 285 |
| 2022 March | 275 | 108 | 383 |
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