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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Alopecia areata &#40;AA&#41; is a type of autoimmune noncicatricial alopecia&#46; Its prevalence is 0&#46;1&#8211;0&#46;2&#37; in the general population&#44; and the lifetime risk of having the disease is estimated to be 1&#46;7&#8211;3&#46;8&#37;&#46; The disease becomes chronic in 8&#37; of affected patients&#44; with no differences according to race&#44; sex&#44; or age&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;3</span></a> Familial incidence ranges from 10&#37; to 20&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> and the disease is associated with other autoimmune conditions in 30&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">AA affects the scalp in 90&#37; of patients&#44; although it can appear in other hairy areas such as the eyelids&#44; eyebrows&#44; and beard&#44; as well as the nails&#46; It can appear as a single or various well-delimited patches&#44; and with diffuse or complete hair loss&#46; Its course is variable and unpredictable&#46; No cure is known&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical findings and includes the patient&#39;s clinical history and a physical examination&#46; Evaluation of disease activity and severity at the first visit can provide important prognostic information on the disease and its treatment&#46; Clinical examination with trichoscopy is useful&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Trichoscopy refers to the application of dermoscopy on the scalp and hair&#46; This useful technique is simple&#44; noninvasive&#44; and easy to learn and reduces the need for more aggressive procedures such as biopsy&#46; Use of dermoscopy in the dermatology clinic can improve diagnosis of AA&#44; help to evaluate inflammatory activity&#44; identify signs of severity&#44; assess therapeutic control&#44; and reveal prognostic factors&#46; It is considered an essential additional technique in the trichology clinic&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The primary objective of this study was to review the most common findings in trichoscopy in AA to date and to determine their association with inflammatory activity&#44; severity&#44; and prognosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Trichoscopy Findings in Alopecia Areata</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Yellow dots</span><p id="par0030" class="elsevierStylePara elsevierViewall">Yellow dots are dilated infundibula filled with sebum&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;6&#44;7</span></a> They are regularly distributed in groups of 1&#44; 2&#44; or 3&#44; thus reflecting the number of shafts per follicular unit&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> They vary in color&#44; shape&#44; and size and may manifest as yellow&#44; yellow-pink&#44; yellow-brown&#44; whitish&#44; round&#44; or polycyclic dots or as dots with a double border and uniform color&#46; Hair may be absent or miniaturized&#44; cadaver&#44; or dystrophic&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;9&#44;10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The frequency of yellow dots varies with age&#44; Fitzpatrick skin phototype&#44; imaging technique applied &#40;polarized or nonpolarized light dermoscopy and use of immersion oil&#41;&#44; and the patient&#39;s shampooing habits&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> Yellow dots are less visible on yellow or dark skin &#40;phototypes IV&#8211;V&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;10</span></a> In the latter case&#44; empty follicles may appear white instead of yellow&#44; with the result that the follicle opening must be differentiated from eccrine ducts&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Yellow dots are present in 60&#37;&#8211;94&#37; of cases of AA&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#8211;14</span></a> They are less frequent in children because the sebaceous glands are not completely developed before puberty&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Yellow dots are a marker of severity&#44; since their frequency increases in chronic forms of AA&#44; where they are very numerous and regularly distributed&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">This trichoscopy finding is highly sensitive for diagnosis of AA&#44; although it is not very specific&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;16</span></a> It may be present&#44; albeit to a lesser extent&#44; in other types of alopecia&#44; such as discoid lupus erythematosus&#44; androgenetic alopecia&#44; trichotillomania&#44; chronic telogen effluvium&#44; tractional alopecia&#44; psoriasis&#44; kerion&#44; and congenital hypotrichosis<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;17&#44;18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Black dots</span><p id="par0055" class="elsevierStylePara elsevierViewall">Black dots are pigmented hairs broken at the level of the scalp&#44; where the root remains joined to the follicle opening&#44; somewhat resembling a comedo&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;7&#44;8</span></a> They correspond to inflammatory damage to the hair follicle leading to abrupt cessation of mitotic activity and weakening of the proximal portion of the hair shaft&#46; Hence&#44; the hair breaks as soon as it leaves the follicle opening&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Black dots vary in size&#44; and 2 or 3 dots may be grouped together&#44; thus demonstrating that all the hair shafts in a follicular unit are affected by the disease&#46; Black dots are slightly larger than the thickness of the terminal hair shafts in the anatomical region where they are found&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Black dots are observed in 50&#37; of cases of AA&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a> although case series report wide variations in frequency &#40;e&#46;g&#46;&#44; 0&#37;&#8211;84&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> 44&#37;&#8211;70&#37;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a>&#41;&#46; The presence of black dots is affected by the skin phototype of the study population&#44; since the hair color and cuticle also change&#46; Black dots are found more frequently in patients with skin phototypes III-IV than in Whites &#40;mean&#44; 57&#37;&#8211;63&#37; vs&#46; 49&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In children&#44; black dots should be differentiated from the rectangular black granular structures that are characteristic of loose anagen syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Black dots are characteristic of AA and are indicative of active disease&#46; When found in larger numbers&#44; they point to a poor prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">13&#44;14&#44;17</span></a> They are also considered a negative predictive marker of response to treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> However&#44; they are not considered a specific sign&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;8</span></a> since they may be present in other diseases&#44; such as trichotillomania &#40;main differential diagnosis&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">13&#44;19</span></a> tinea&#44; dissecting cellulitis of the scalp&#44; chemotherapy-induced alopecia&#44; lichen planopilaris&#44; discoid lupus erythematosus&#44; traction alopecia&#44; cutis aplasia&#44; androgenetic alopecia&#44; and alopecia occurring after laser hair removal or after a trichogram&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;14&#44;16</span></a> Topical immunotherapy combined with anthralin stains the follicle openings&#44; leading them to resemble black dots<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Exclamation mark hairs</span><p id="par0080" class="elsevierStylePara elsevierViewall">Exclamation mark hairs are broken hairs with a fine&#44; hypopigmented proximal end and a thicker&#44; hyperpigmented distal end&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;16&#44;22</span></a> They may result from a transient cellular degeneration phase between a precortical keratinocyte phase and defective cortical differentiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Exclamation mark hairs are observed at the edge of active lesions&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;17&#44;20</span></a> both to the naked eye and in trichoscopy&#59; the former measure 1&#8211;3<span class="elsevierStyleHsp" style=""></span>cm in length and the latter measure 1&#8211;5<span class="elsevierStyleHsp" style=""></span>mm&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> Optical microscopy shows the distal ends of these stems to be irregular &#40;frayed&#41; in 77&#46;8&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The prevalence of this finding in AA ranges between 12&#37; and 71&#37;&#44; with a mean of 39&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> Exclamation mark hairs are found mainly in the acute&#44; progressive form and in the stable phase of AA&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">18&#44;23</span></a> They indicate the activity and severity of the disease and are a negative prognostic marker&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> Their presence could be a positive predictive marker of the response to corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Exclamation mark hairs are characteristic of AA&#46; However&#44; they can also be found in trichotillomania&#44; traction alopecia&#44; tinea capitis&#44; chemotherapy-induced alopecia&#44; anagen effluvium caused by poisoning&#44; and&#44; to a lesser extent&#44; in androgenetic alopecia<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;14</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Tapered hairs</span><p id="par0100" class="elsevierStylePara elsevierViewall">Tapered hairs are very similar to exclamation mark hairs&#44; with a finer proximal end and a thicker distal end&#46; However&#44; the difference is that they are longer&#44; to the extent that they fall outside the visual field of the dermoscope&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> Tapered hairs are terminal hairs that are normal in length&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> They are visible to the naked eye and are usually found around lesions&#46; Tapered hairs are indicative of activity and are considered negative predictive markers of hair regrowth&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> They appear during the early stages of the disease and precede the appearance of black dots and exclamation mark hairs&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;6</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">According to various studies&#44; the frequency of tapered hairs in AA ranges from 5&#37; to 81&#37;&#44; with a mean of 51&#37;&#46; Moreover&#44; they are observed in patients with trichotillomania&#44; malnutrition&#44; chemotherapy-induced alopecia&#44; anemia&#44; and chronic poisoning<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Coudability hairs</span><p id="par0110" class="elsevierStylePara elsevierViewall">The term &#8220;coudability hairs&#8221; derives from the similarity of the hairs to a coud&#233; catheter&#46; Coudability hairs bend easily when pressure is applied toward the interior of the scalp&#44; leading to a twist in the axis&#44; where damage and narrowing of the hair shaft occur&#46; The proximal end is thinner&#44; and the length is normal&#46; The proximal narrowing of the hair shaft could be due to a rapid anagen-to-catagen transition&#44; thus highlighting a pathological adaptability mechanism&#46; The kinked hairs represent a less severe injury of the hair follicle&#44; which would lead to dystrophic anagen and narrowing of the proximal shaft&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> Couldability hairs have been associated with the inflammatory activity of the disease<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">17&#44;26</span></a> and are a pathognomonic sign of AA&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">17&#44;18</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Broken hairs</span><p id="par0115" class="elsevierStylePara elsevierViewall">Broken hairs are caused by a cross-sectional fracture of a previously weakened hair shaft&#46; They may also result from rapid growth of partially destroyed hairs&#44; which are seen as black dots&#46; In contrast with exclamation mark hairs&#44; which have a fine and hypopigmented end&#44; broken hairs are short&#44; with a hair shaft that is normal in appearance&#44; except at the distal end&#44; where it is irregular and torn&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Broken hairs predominate in acute AA<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;9&#44;18</span></a> and are negative prognostic markers&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> They are observed in 0&#37;&#8211;71&#37; of cases of AA &#40;mean&#44; 49&#37;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;18</span></a> as well as in trichotillomania&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;4</span></a> tinea capitis&#44; traction alopecia &#40;traumatic&#41;&#44; primary cicatricial alopecia&#44; androgenetic alopecia&#44; and telogen effluvium&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The camouflage products used by patients&#44; such as hair thickening fibers&#44; can be confused with broken hairs<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Vellus hairs</span><p id="par0130" class="elsevierStylePara elsevierViewall">Vellus hairs have a pigmented proximal end and the same thickness along the shaft&#46; They are indicative of regrowth&#44; spontaneous disease remission&#44; and favorable response to treatment&#46; They vary in length depending on disease stage&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#44;20&#44;24</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Vellus hairs are found in 34&#37;&#8211;100&#37; of cases and are more frequent in patients with light skin phototypes &#40;48&#37;&#8211;100&#37;&#41; than in those with dark phototypes &#40;34&#37;&#8211;94&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> They are the most common trichoscopy sign in long-term AA&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#44;24</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Vellus hairs are a poorly specific sign&#46; They are reported in trichotillomania&#44; tinea capitis&#44; traction alopecia&#44; traumatic alopecia&#44; congenital triangular alopecia&#44; telogen effluvium &#40;chronic and acute&#41;&#44; and primary cicatricial alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;4&#44;24</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Upright regrowing hairs</span><p id="par0145" class="elsevierStylePara elsevierViewall">Regrowing hairs are new&#44; healthy hairs that grow vertically&#46; They have a thick&#44; pigmented proximal end and a tapered distal end&#46; They are usually upright or slightly bent&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;6</span></a> These hairs are a marker of regrowth and a positive predictive therapeutic marker&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Upright regrowing hairs are seen more often in children&#44; probably because more extensive growth of the hair is more common at this age&#46; They are not pathognomonic of AA and are observed in acute telogen effluvium&#44; trichotillomania&#44; tinea capitis&#44; and temporal triangular alopecia&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;24</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pigtail &#40;circle&#41; hairs</span><p id="par0155" class="elsevierStylePara elsevierViewall">Pigtail hairs are short&#44; regularly curled regrowing hairs that take on a circular or oval shape&#46; They are considered a positive predictor of regrowth in patients with acute or diffuse AA after treatment or in patients who achieve spontaneous remission&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;11&#44;21</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Pigtail hairs are uncommon and more frequently found in children&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#44;24</span></a> Their prevalence varies according to the study&#44; ranging from 4&#37; to 61&#37; &#40;mean&#44; 21&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Pigtail hairs are not a specific sign&#44; as they can also be seen in chemotherapy-induced alopecia&#44; at the edge of cicatricial alopecia&#44; in tinea capitis&#44; in trichotillomania&#44; and in temporal triangular alopecia &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;24</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Pohl-Pinkus constrictions</span><p id="par0170" class="elsevierStylePara elsevierViewall">The term Pohl-Pinkus constrictions was coined by the German dermatologist Joseph Pohl-Pinkus in 1885&#46; It refers to narrowing of a hair along the length of the shaft&#46; These constrictions are due to rapid and sudden suppression of metabolic and mitotic activity in the follicle caused by both external and internal factors&#46; Therefore&#44; Pohl-Pinkus constrictions are the point where the lesion occurs &#40;several constrictions can be observed in recurrent episodes&#41;&#46; Narrowing is progressive and irregular along the shaft&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;24&#44;27</span></a> It is uncommon in AA &#40;2&#37;&#8211;10&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Pohl-Pinkus constrictions are not exclusive to AA and can also be seen in chemotherapy-induced alopecia&#44; cicatricial alopecia&#44; after severe infections&#44; after major blood loss&#44; in nutritional deficiencies&#44; after therapy with interferon&#44; and in localized hereditary hypotrichosis<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">24&#44;27</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Other Trichoscopy Findings in Alopecia Areata</span><p id="par0180" class="elsevierStylePara elsevierViewall">Other interesting trichoscopy findings have been reported&#46;</p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Honeycomb pattern</span><p id="par0185" class="elsevierStylePara elsevierViewall">Honeycomb pattern is a reticular structure comprising multiple rings that are between yellow and brown in color&#46; The rings are arranged homogeneously side-by-side or mosaic-fashion in areas chronically exposed to direct sunlight and lacking in hair&#46; Honeycomb pattern has been observed in 13&#37; of cases and is considered a marker of chronic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;4&#44;8</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Dirty dots</span><p id="par0190" class="elsevierStylePara elsevierViewall">Dirty dots are nonmicrobial environmental particles that disappear after shampooing&#46; They can be brown&#44; black&#44; red&#44; yellow&#44; or blue and can appear as loose fibers&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Dirty dots are more common in children and elderly people and are considered to mimic black dots&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;29</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">White dots</span><p id="par0200" class="elsevierStylePara elsevierViewall">The 2 types of white dots are large white dots and small pinpoint white dots&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;11</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">Large white dots&#44; which are present in chronic AA&#44; are irregular and correspond to areas of follicular fibrosis&#46; Pinpoint white dots are regular&#44; smaller&#44; and correspond to the openings of the eccrine sweat glands&#46; They can be found in sun-exposed areas and in dark skin phototypes&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;4&#44;17</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Tulip hairs</span><p id="par0210" class="elsevierStylePara elsevierViewall">Tulip hairs differ from exclamation mark hairs in that they narrow slightly with diminished coloring at their proximal end and have a darker distal end&#44; where the hair fractures&#46; Incidence ranges from 2&#37; to 10&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;6</span></a> They are not characteristic of AA and can be observed in trichotillomania<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Usefulness of Trichoscopy for Monitoring of Treatment and Application of Trichoscopy Findings in Alopecia Areata</span><p id="par0215" class="elsevierStylePara elsevierViewall">The trichoscopy findings set out above are directly related to various aspects of AA&#46; Some are associated with the inflammatory activity of the disease&#44; duration of alopecia&#44; severity of the clinical picture&#44; clinical presentation&#44; and response to treatment&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inflammatory activity in AA&#58;</span> Inflammatory activity determines whether the hair is being attacked by an inflammatory infiltrate that is leading to hair loss and impeding regrowth&#46; The main trichoscopy findings are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Duration&#58;</span> AA can be defined as acute&#44; when hair loss in a specific area is gradual with positive results in the traction test and trichogram&#44; and chronic&#44; when hair loss in a specific area is long-term and persistent without regrowth &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Severity&#58;</span> Severity is classed according to hair loss and is considered an important prognostic factor&#46; Clinical evaluation should be based on the Severity of Alopecia Tool&#44; which scores the percentage of hair follicles lost &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Clinical&#58;</span> AA has several forms of presentation&#58; as a single patch&#44; various patches &#40;multifocal&#41;&#44; total &#40;loss of all the hair on the scalp&#41;&#44; universal &#40;loss of hair on the scalp and the rest of the body&#41;&#44; and diffuse or incognita &#40;characterized by rapid and diffuse thinning and increased loss&#41;&#46; It can also be classified as ophiasic&#44; when hair loss occurs along the frontal&#8211;parietal&#8211;occipital hairline &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Predictors&#58;</span> Predictors can be positive or negative&#46; Positive predictors indicate a greater probability of regrowth and can be observed in trichoscopy &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">As mentioned above&#44; trichoscopy plays a key role in monitoring of treatment in AA&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Patients who receive topical treatment with local UV-A phototherapy and methoxypsoralen gel combined with minoxidil 5&#37; solution have been shown to have &#8220;hidden hairs&#8221; in the proximal part of the hair follicle<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> and peripilar sign as an indication of growth&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Treatment with intralesional triamcinolone acetonide has been shown to lead to regrowth of nonpigmented vellus hairs and the transformation of vellus hair to terminal hair&#46; In addition&#44; exclamation mark hairs&#44; broken hairs&#44; and black dots disappeared earlier than yellow dots&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Platelet-rich plasma &#40;PRP&#41; and intralesional corticosteroids were compared in AA in patches&#46; Reductions were recorded in both groups in the number of broken hairs&#44; exclamation mark hairs&#44; tapered hairs&#44; black dots&#44; and upright regrowing hairs&#44; whereas no significant changes were observed for yellow dots or vellus hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">The efficacy of PRP was compared with that of topical minoxidil 5&#37;&#46; The authors reported an increase in the number of short regrowing hairs and a decrease in the number of yellow spots with minoxidil solution&#44; whereas with PRP&#44; the number of pigmented hairs increased and that of vellus hairs and yellow dots decreased&#46; In addition&#44; the response was earlier and more effective&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">One research group developed a scoring system for patients with rapidly progressive AA in order to predict the outcome of treatment with intravenous corticosteroid pulses&#46; The system was based on statistical correlations using analysis of digital trichoscopy images&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0275" class="elsevierStylePara elsevierViewall">Trichoscopy is a simple&#44; fast&#44; noninvasive&#44; and indispensable technique in the dermatology clinic&#46; It can improve diagnosis&#44; evaluate disease activity and severity&#44; and enables early and better therapeutic control&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">The most frequent trichoscopy findings in AA are yellow dots&#44; black dots&#44; broken hairs&#44; exclamation mark hairs&#44; tapered hairs&#44; coudability hairs&#44; and vellus hairs&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Trichoscopy findings have been associated with disease activity&#44; potential response to treatment&#44; severity and duration of alopecia&#44; and the patient&#39;s clinical condition&#46; Knowledge of these findings can help the dermatologist to tailor treatment of AA&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0290" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres1828770"
          "titulo" => "Graphical abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:3 [
          "identificador" => "xres1828769"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        2 => array:2 [
          "identificador" => "xpalclavsec1594445"
          "titulo" => "Keywords"
        ]
        3 => array:3 [
          "identificador" => "xres1828771"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0015"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "xpalclavsec1594446"
          "titulo" => "Palabras clave"
        ]
        5 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        6 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Trichoscopy Findings in Alopecia Areata"
          "secciones" => array:10 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Yellow dots"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Black dots"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Exclamation mark hairs"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Tapered hairs"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Coudability hairs"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Broken hairs"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Vellus hairs"
            ]
            7 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Upright regrowing hairs"
            ]
            8 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Pigtail &#40;circle&#41; hairs"
            ]
            9 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Pohl-Pinkus constrictions"
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0065"
          "titulo" => "Other Trichoscopy Findings in Alopecia Areata"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Honeycomb pattern"
            ]
            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Dirty dots"
            ]
            2 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "White dots"
            ]
            3 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Tulip hairs"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Usefulness of Trichoscopy for Monitoring of Treatment and Application of Trichoscopy Findings in Alopecia Areata"
        ]
        9 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Conflict of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-10-01"
    "fechaAceptado" => "2022-08-07"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1594445"
          "palabras" => array:2 [
            0 => "Dermoscopy of scalp"
            1 => "Videodermoscopy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1594446"
          "palabras" => array:2 [
            0 => "Dermatoscopia del cuero cabelludo"
            1 => "Videodermatoscopia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Alopecia areata is an autoimmune disease that affects the hair follicle and can present as bald patches on the scalp and hair loss in other parts of the body&#46; Diagnosis is clinical but can be aided by trichoscopy&#44; a simple&#44; rapid technique that reduces the need for invasive procedures and can also help with monitoring treatment response&#46; We review the usefulness of trichoscopy in alopecia areata&#46; The most common trichoscopic findings are yellow dots&#44; black dots&#44; exclamation mark hairs&#44; short vellus hairs&#44; and coudability hairs&#46; Other&#44; less common&#44; findings can also help establish a diagnosis&#46; Good response to treatment is indicated by the disappearance of black dots&#44; broken hairs&#44; and exclamation mark hairs&#46; The observation of yellow dots&#44; by contrast&#44; indicates chronic disease and poor response to treatment&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La alopecia areata es una enfermedad autoinmune que afecta al fol&#237;culo piloso&#46; Se presenta en forma de placas alop&#233;cicas e incluso p&#233;rdida de pelo corporal&#46; El diagn&#243;stico es cl&#237;nico&#46; Sin embargo&#44; la tricoscopia&#44; una t&#233;cnica valiosa no invasiva&#44; simple y r&#225;pida&#44; mejora el diagn&#243;stico&#44; la monitorizaci&#243;n del tratamiento y reduce la necesidad de procedimientos invasivos&#46; Realizaremos una descripci&#243;n de la utilidad de la tricoscopia en la alopecia areata&#46; Los hallazgos tricosc&#243;picos m&#225;s frecuentes de la alopecia areata son los puntos amarillos&#44; los puntos negros&#44; pelos en signo de exclamaci&#243;n&#44; pelos vellosos cortos y pelos acodados&#46; Sin embargo&#44; existen otros hallazgos menos frecuentes pero &#250;tiles para realizar el diagn&#243;stico&#46; La buena respuesta al tratamiento implica la desaparici&#243;n de los puntos negros&#44; los pelos rotos y los pelos en signo de exclamaci&#243;n&#44; pero la presencia de los puntos amarillos indica enfermedad cr&#243;nica y mala respuesta&#46;</p></span>"
      ]
    ]
    "multimedia" => array:10 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 689
            "Ancho" => 755
            "Tamanyo" => 72845
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Black dots&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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            "Ancho" => 755
            "Tamanyo" => 123149
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Yellow dots&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 500
            "Ancho" => 755
            "Tamanyo" => 71134
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Blue arrows&#44; exclamation mark hairs&#59; red arrows&#44; broken hairs&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 493
            "Ancho" => 755
            "Tamanyo" => 52011
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tapered hairs&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 610
            "Ancho" => 755
            "Tamanyo" => 110942
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Pigtail &#40;circle&#41; hairs&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 427
            "Ancho" => 755
            "Tamanyo" => 39876
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Pohl-Pinkus constrictions&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 552
            "Ancho" => 805
            "Tamanyo" => 116686
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Tulip hairs&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Signs of activity<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yellow dots<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;8&#44;14</span></a>Exclamation mark hairs<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;18&#44;23</span></a>Broken hairs<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#8211;10</span></a> Tapered hairs<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;6&#44;23</span></a>Pohl-Pinkus constrictions<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23&#44;27</span></a>Coudability hairs<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#44;25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Signs of inactive disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yellow dots<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;4&#44;18</span></a>Vellus hair<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;4&#44;18</span></a>Empty follicular openings<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a>White dots<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Signs of regrowth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Upright regrowing hairsPigtail hairsVellus hairs<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">By severity &#40;more severe&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yellow dotsBlack dotsReduced vellus hairsHoneycomb hyperpigmentationWhite dotsCumulus-like clustered white dots<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">By severity &#40;less severe&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exclamation mark hairs<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#44;4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">By disease duration &#40;acute&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exclamation mark hairsBlack dotsVellus hairs<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">By disease duration &#40;chronic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smooth and fine scalp hairPresence of follicular openings that are obstructed by keratotic plugs known as yellow dots<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a>Scant regrowth of pigmented hairs and homogeneous distribution<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">While different forms are observed&#44; the manifestations are similar to the response of the hair follicle to the inflammatory process in the area of the hair bulb&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#44;11</span></a></p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Trichoscopy Findings in Alopecia Areata&#58; Association With Disease Activity&#44; Severity&#44; and Duration&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Trichoscopy findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alopecia areata incognita &#40;AAI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pigtail hairs &#40;57&#46;9&#37;&#41;Regrowing hairsBlack dotsDiffuse yellow dots<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> affecting mainly the occipital and parietal areas and proportional to severity<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diffuse alopecia areata&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follicular inflammatory damage is much greater than in AAIGreater presence of dystrophic hairsBlack dots &#40;36&#37;&#41;Yellow dots in the parietal and anterior-temporal areas of the scalp<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alopecia incognita&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yellow dotsShort vellus hairs&#44; 96&#37; sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AA with ophiasic pattern&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Black dotsAbsence of yellow dots<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">34&#44;35</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AA total and universal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Positive predictive markers&#58;</span>Pigmented vellus hairsUpright regrowing hairs<span class="elsevierStyleItalic">Predictive markers that are not useful for evaluating the response to treatment&#58;</span>Black dotsBroken hairsExclamation mark hairsTapered hairsPohl-Pinkus constrictions<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
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