2013.4-14.Importance

                                                                                                                            article in PDF  
Our Dermatol Online.  2013; 4(4): 501-502
DOI:.  10.7241/ourd.20134.128
Date of submission:  17.04.2013 / acceptance: 30.05.2013
Conflicts of interest: None
 

IMPORTANCE OF THE TRICHOSCOPY IN SCALP DYSESTHESIA

Maria Bibiana Leroux

Private Practice, Marull 575, Rosario, SF, Argentina
 

Corresponding author:  Dr Maria Bibiana Leroux    e-mail: leroux_mb@hotmail.com


 

Abstract
The trichoscopy has been incorporated as a first hand method in patients consulting for scalp problems. Magnifying glass or digital microscope that permit the direct visualization of the hair shaft and the perifolicullar skin are utilized to diagnose cicatricial and non-cicatricial alopecia. A female patient with an alopecia plaque associated with a scalp dysesthesia in which trichoscopy was very useful in its diagnosis is presented..
 
Key words:  trichoscopy; scalp dysesthesia; trichoteiromania

 

Introduction
The trichoscopy has been incorporated as a first hand method in patients consulting for scalp problems. Magnifying glass or digital microscope that permit the direct visualization of the hair shaft and the perifolicullar skin are utilized to diagnose cicatricial and non-cicatricial alopecia [1]. The primary psychiatric disorder case bears no skin condition. There are four types of underlying psychopathology. i.e., generalized anxiety, depressive, delusional and obsessive-compulsive disorder. In these cases it can always be observed self-inflicted scalp lesions. No signs of any other disease related to the hair or scalp findings observed are present. Trichotillomania, neurotic scalp excoriations, factitial dermatitis, delusions of parasitosis, scalp dysesthesia and psychogenic pseudo effluvium are among the dermatologic presentations [2].
 
Case Report
Material and Methods
Female patient, aged 55yr refers extreme sensitivity – burning sensation- in a circumscribed area of the hair scalp close to the top of the head with more than one year evolution. Personal history: depression. Physical examination: 3cm major axis oval alopecia plaque. Negative traction test (Fig. 1). The patient admits that has rubbed the lesion but did not self produce it. There are no other signs or symptoms of dermatological disorders neither in the skin nor in nails or hair.
Figure 1. Scalp alopecia plaque.

Results

– A previous scalp biopsy was histological negative.
– Negative medical workup. – Trichoscopic examination, 70x magnification: plaque peripheral zone preserved
– there are no alterations neither of the hair shaft nor of the perifolicullar skin. The lesion images show a great deal of broken hairs, many of them with distal end longitudinally divided in two or three portions, the so called trichoptilopsis (Fig. 2).
Figure 2. Multiple hair shaft with trichotilopsis, 70 X magnification.

Discussion

Due to the clinical signs and symptoms, the latter referred by the patient, scalp dysesthesia is considered as the probable diagnosis. It represents the manifestation of the coetaneous sensory disorders on the scalp. The role of substance P and others neuropeptides in the pathogenesis of this problem and the relation of such substances to the psyche and emotional stress need further studies. Seventy-six percent of patients show emotional disturbance, mainly depression, compulsive disorders and anxiety. The absence of clinical signs and symptoms permit to rule out temporal arteritis, tension headache or any other scalp pain etiology [2,3]. The dermatologic sign is a consequence of repeated rubbing of the scalp lesion. – Trichoteiromania – The trichoscopy permits to confirm the self traumatic etiology of the findings and perform a differential diagnosis with other disorders such as tinea capitis or scalp dermatitis [4-6].
 
Conclusion
The trichoscopy was very useful for the diagnosis and differential diagnosis with others scalp disorders.
 
REFERENCES
1. Ross EK, Vincenzi C, Tosti A: Videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol. 2006;55:799-806.
2. Trueb RM, Gieler U: Psychocutaneous disorders of Hair and scalp. In: Blume-Peytavi U, Tosti A, Whiting DA, Trueb R, editors. Hair growth and disorders. Berlin Heiderberg : Springer. 2008.p.408-42.
3. Hoss D, Segal S: Scalp dysesthesia. Arch Dermatol.1998; 134:327- 30.
4. Harth W, Hermes B, Niemeier V, Gieler U: Clinical pictures and classification of somatoform disorders in dermatology. Eur J Dermatol. 2006;16:607-14.
5. Reich S, Trüeb RM: Trichoteiromania. J Dtsch Dermatol Ges. 2003;1:22-8.
6. Freyschmidt-Paul P, Hoffmann R, Happle R: Trichoteiromania. Euro J Dermatol. 2001;11:369-71.


CONTENT

SERVICES

Other Resources

Our Dermatology Online

Home
Current Issue
All Issues
Instruction for authors
Submit Manuscripts
Ethics in Publishing
For Reviewers
Readers
About
Editors & Publishers 
Statistics
Copyright
Contact Us