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angulated hairs &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; blue arrow&#41;&#44; and hairs with Pohl-Pinkus or monilethrix-like constrictions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; red arrow&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis&#63;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Alopecia areata &#40;AA&#41; in the active phase&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Trichoscopy is a simple and accessible technique for direct observation of the scalp&#44; follicular orifices&#44; and hair follicles with a dermatoscope&#44; and is used for the diagnosis&#44; follow-up&#44; and treatment monitoring of alopecia patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Characteristic features of AA are the presence of exclamation-mark hairs&#59; yellow dots&#44; which correspond to dilated follicular orifices containing keratin plugs&#59; hairs with a tapered proximal end&#59; short vellus hairs &#40;isolated or clustered&#41;&#59; zigzag hairs&#59; curved hairs&#59; and Pohl-Pinkus constrictions&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">According to Inui et al&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> AA severity is positively correlated with the presence of black and yellow dots&#44; negatively correlated with short vellus hairs&#44; and uncorrelated with the presence of tapered or broken hairs&#46; Those authors also proposed that AA activity is correlated positively with broken hairs&#44; black dots&#44; and tapered hairs&#44; and negatively with short vellus hairs&#46; The most specific diagnostic findings of AA revealed by trichoscopy include black dots&#44; tapered hairs&#44; and broken hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The main trichoscopic differential diagnosis is trichotillomania&#46; In trichotillomania it is more common to observe broken hairs of variable length&#44; tricoptilosis or split ends &#40;longitudinal fracture of the hair shaft at the distal end&#41;&#44; V sign&#44; flame hairs &#40;broken hairs with a translucent distal end&#41;&#44; and hair powder&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In cicatricial alopecia&#44; obliteration of the follicular orifices is more commonly observed&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Pohl-Pinkus constrictions cause progressive and irregular narrowing along the length of the hair shaft&#46; Because these constrictions tend to cause breakage of the hair shaft&#44; they are rarely observed in trichoscopy of AA &#40;2&#37; of cases&#41;&#46; Pohl-Pinkus constrictions are the result of abrupt and repeated arrest of the metabolic and mitotic activity of the hair follicle caused by an internal or external factor&#44; and are observed in many congenital and acquired chronic processes&#44; including AA&#44; chemotherapy-induced alopecia&#44; severe malnutrition&#44; interferon alfa-2c treatment&#44; and severe systemic infections&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Detection of Pohl-Pinkus constrictions in AA helps confirm the diagnosis&#44; and in some cases enables the identification of flare-ups&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Practical Dermoscopy
Pohl-Pinkus Constrictions in Trichoscopy. What Do They Mean?
Constricciones de Pohl-Pinkus en tricoscopia. ¿Qué indican?
A. Lobato-Berezoa,
Autor para correspondencia
allobe@hotmail.es

Corresponding author.
, F. Olmos-Alpistea, R.M. Pujola, D. Saceda-Corralob
a Departamento de Dermatología, Hospital del Mar-Parc Salut Mar, Barcelona, España
b Departamento de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
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        "titulo" => "Constricciones de Pohl-Pinkus en tricoscopia&#46; &#191;Qu&#233; indican&#63;"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Image of the border of the alopecic plaque acquired using a DermLite II Hybrid dermatoscope &#40;3Gen Inc&#46;&#44; CA&#44; USA&#41;&#46; Red arrows&#44; hairs with Pohl-Pinkus or monilethrix-like constrictions&#59; green arrows&#44; exclamation-mark hairs with a thickened distal end&#59; yellow arrows&#44; yellow dots&#59; orange arrows&#44; short vellus hairs&#59; blue arrow&#44; angulated hair&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 26-year-old woman with a single patch of alopecia in the right temporal region that had appeared 2 months earlier&#46; Physical examination revealed a patch of alopecia &#40;6&#46;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>3&#160;cm&#41; with well-defined borders that responded positively in the hair-pull test &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Trichoscopy of one of the borders revealed the presence of exclamation-mark hairs with a thickened distal end &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; green arrow&#41;&#44; yellow dots &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; yellow arrow&#41;&#44; short vellus hairs &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; orange arrow&#41;&#44; angulated hairs &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; blue arrow&#41;&#44; and hairs with Pohl-Pinkus or monilethrix-like constrictions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; red arrow&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis&#63;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Alopecia areata &#40;AA&#41; in the active phase&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Trichoscopy is a simple and accessible technique for direct observation of the scalp&#44; follicular orifices&#44; and hair follicles with a dermatoscope&#44; and is used for the diagnosis&#44; follow-up&#44; and treatment monitoring of alopecia patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Characteristic features of AA are the presence of exclamation-mark hairs&#59; yellow dots&#44; which correspond to dilated follicular orifices containing keratin plugs&#59; hairs with a tapered proximal end&#59; short vellus hairs &#40;isolated or clustered&#41;&#59; zigzag hairs&#59; curved hairs&#59; and Pohl-Pinkus constrictions&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">According to Inui et al&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> AA severity is positively correlated with the presence of black and yellow dots&#44; negatively correlated with short vellus hairs&#44; and uncorrelated with the presence of tapered or broken hairs&#46; Those authors also proposed that AA activity is correlated positively with broken hairs&#44; black dots&#44; and tapered hairs&#44; and negatively with short vellus hairs&#46; The most specific diagnostic findings of AA revealed by trichoscopy include black dots&#44; tapered hairs&#44; and broken hairs&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The main trichoscopic differential diagnosis is trichotillomania&#46; In trichotillomania it is more common to observe broken hairs of variable length&#44; tricoptilosis or split ends &#40;longitudinal fracture of the hair shaft at the distal end&#41;&#44; V sign&#44; flame hairs &#40;broken hairs with a translucent distal end&#41;&#44; and hair powder&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> In cicatricial alopecia&#44; obliteration of the follicular orifices is more commonly observed&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Pohl-Pinkus constrictions cause progressive and irregular narrowing along the length of the hair shaft&#46; Because these constrictions tend to cause breakage of the hair shaft&#44; they are rarely observed in trichoscopy of AA &#40;2&#37; of cases&#41;&#46; Pohl-Pinkus constrictions are the result of abrupt and repeated arrest of the metabolic and mitotic activity of the hair follicle caused by an internal or external factor&#44; and are observed in many congenital and acquired chronic processes&#44; including AA&#44; chemotherapy-induced alopecia&#44; severe malnutrition&#44; interferon alfa-2c treatment&#44; and severe systemic infections&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> Detection of Pohl-Pinkus constrictions in AA helps confirm the diagnosis&#44; and in some cases enables the identification of flare-ups&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Lobato-Berezo A&#44; Olmos-Alpiste F&#44; Pujol RM&#44; Saceda-Corralo D&#46; Constricciones de Pohl-Pinkus en tricoscopia&#46; &#191;Qu&#233; indican&#63;&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;315&#8211;316&#46;</p>"
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