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Hair and scalp examination techniques can be classified into three categories: noninvasive methods (clinical history, general examination, photography, hair count, weighing shed hair, pull test, global hair counts, dermoscopy, electron microscopy, laser scanning microscopy, etc.); semi‐invasive methods (the trichogram, unit areatrichogram); and invasive methods (biopsies in cicatritial alopecia). Scalp dermoscopy or trichoscopy is one of thenoninvasive techniques for the evaluation of patients with hair loss that allows for magnified visualization of the hair and scalp skin. It may be performed with a manual dermoscope (10× magnification) or a videodermoscope (up to 1000× magnification). This method is simple, quick, and easy to perform, is well‐accepted by patients, and is useful for monitoring treatment, determining severity of the disease and follow‐up. It is a simple, minimally invasive and rapid technique for measuring hair follicle activity. Trichogram represents a semi‐invasive technique for the evaluation of patients with hair loss that allows the microscopic examination of hairs plucked from the scalp and provides information about the state of the proximal end of the hair shaft and the distal end. The trichogram is a useful complementary tool for clinical evaluation, diagnosis, and the monitoring of treatment response.

Amicrobial pustulosis of the folds (APF) is a chronic, relapsing sterile pustular eruption involving the main cutaneous flexures, scalp, and periorificial regions occurring mostly in young females. It is characterized histopathologically by intraepidermal spongiform pustules with a neutrophilic infiltrate in the dermis. APF is a rare condition that has been reported in association with various immunological abnormalities or autoimmune diseases. We describe here a 37-year-old woman with APF associated with Sjögren’s syndrome.

Pilomatricoma (PM) is an asymptomatic, slowly growing, benign skin tumour originating from primitive cells of the hair matrix and hair shaft and appears mostly on the head, neck, and the upper extremities. Typical lesion is usually characterized by a solitary, firm, deep-seated dermal or subcutaneous nodule, covered by normal or erythematous skin, and usually varying in size from 0.5 to 3 cm. Bullous appearance can occur on the lesions of bullous PM and anetodermic PM which are located in the rare atypical forms of PM. Here, we present an 11-year-old girl with an anetodermic PM on her right arm that showed thick-walled flaccid bullous formation over it.

Trikoskopi, saçlı deri dermatoskopisi olarak tanımlanan alopesi tanısında kullanılan invaziv olmayan bir yöntemdir. Videodermatoskop aracılığıyla yüksek büyütme ile saç, kaş ve kirpikler incelenilip ölçülebilmektedir. Trikoskopi ile saç şaftı, saç folikül açıklıkları, perifoliküler epidermis, kutan mikro damarlanmaları değerlendirilebilmektedir. Terminal, vellüs saç ve 1-2 milimetrelik mikro-ünlem işareti ayırımı da yapılabilmektedir. Trikoskopi bu şekilde sikatrisyel ve sikatrisyel olmayan alopesilerin ayırımında da yardımcı olabilmektedir. En son olarak da alopesilerde trikoskopik bulgulara göre algoritmik yaklaşımlar geliştirilmiştir.Bu araştırma sikatrisyel olmayan alopesilerde trikoskopik bulgular ve alopesi şiddeti, aktivitesi ve klinik alt tipi ile trikoskopik bulguların ilişkisini araştırmak amacıyla planlandı. Dokuz Eylül Üniversitesi Tıp Fakültesi Deri ve Zührevi Hastalıkları Anabilim Dalı polikliniği'ne saç dökülmesi yakınması ile başvuran sikatrisyel olmayan alopesi tanısı alan 305 hasta ve yakınması olmayan benzer yaş grubundan 108 kontrol olgusu videodermatoskop (MoleMax® III) ile çoklu resim alınarak değerlendirildi. Hasta grubunu 63 erkek androgenetik alopesi (MAGA), 138 kadın androgenetik alopesi (FAGA), 5 erkek paterni kadın androgenetik alopesi (FAGAM), 22 telogen effluvium (TE), 39 alopesi areata (AA), 4 trikotilomani (TC), 112 ekzema seboreikum ve 31 psoriyazis tanılı, 305 hasta oluşturdu. Alopesi areata ve androgenetik alopesili olguların hastalık şiddet ve aktivitesi belirlendi. Trikoskopik veriler Mann-Whitney U testi, lojistik regresyon analizi, Ki kare analizi ve oran testi kullanılarak karşılaştırıldı.Çalışma sonuçlarına göre FAGA.M'lı olgularda hastalık evresi ile trikoskopik bulgular arasında ilişki izlenmezken FAGA'lı olgularda erken evrede beyaz skuam, glomerüler damar, dallanmış kırmızı çizgiler, ileri evrelerde ise kahverengi noktalar daha fazla saptandı. Erken evre MAGA'lı olgularda perifoliküler pigmentasyon ve tek pilosebase uniteden birden fazla saç çıkması, ileri evre MAGA'lı olgularda ise balpeteği pigment paterni, beyaz nokta ve kahverengi noktalar daha fazla izlendi. MAGA ve FAGA trikoskopik bulgular açısından kendi aralarında oran testi ile karşılaştırıldığında FAGA'lı kadınlarda perifoliküler pigmentasyon, MAGA'lı erkeklerde ise kahverengi noktalar, sarı noktalar ve beyaz noktalar anlamlı olarak daha fazla izlendi. Aynı değerlendirme psoriyazis ve seboreik ekzema için yapıldığında ise psoriyaziste kırmızı nokta ve globüller, atipik kırmızı damar, şekilsiz kırmızı alan, taşlı yüzük damar damar ve kıl proksimalinde beyaz-gri peçe görünümü, seboreik ekzemada ise burgulu kırmızı anslar ve virgül damar anlamlı olarak daha sık görüldü.AA'lı olgularda izlenen ve ilk kez tarafımızca tanımlanmış olan trikoskopik özellikler; küme yapmış beyaz noktalar, tek pilosebase uniteden çok sayıda saç çıkması, siyah noktasal pigmentasyon, kıl proksimalinde beyaz-gri peçe görünümü ve dallanmış kırmızı çizgiler olarak belirlendi. Hastalık aktivitesinin sabit olduğu hastalarda atipik kırmızı damar ve beyaz noktalar, progresif olduğu hastalarda ise ünlem işareti saç anlamlı olarak daha fazla izlenirken, AA hastalık şiddetinin hafif olduğu grupta ünlem işareti saç, fazla olduğu grupta ise balpeteği pigment paterni, küme yapmış beyaz noktalar ve siyah noktasal pigmentasyon daha sık saptandı. AA şiddetinin yüksek olma olasılığı balpeteği pigment paterni izlenenlerde 36.2, beyaz nokta izlenenlerde 7, küme yapmış beyaz nokta izlenenlerde 7, siyah noktasal pigmentasyon izlenenlerde 17 kat, düşük olma olasılığı ise ünlem işareti görülenlerde 4.6 kat olarak belirlendi. Tüm alopesi hastalarında beyaz nokta, perifoliküler pigmentasyon ve balpeteği pigment paterni ile deri tipi arasında ilişki bulunmadı. Kontrol grubunda 25 yaş altındaki hastaların trikoskopik verileri, 50 yaş üzerindekilerle karşılaştırıldığında genç olgularda perifoliküler pigmentasyon ve tek pilosebase uniteden birden fazla saç çıkması anlamlı olarak daha fazla izlendi.Sonuç olarak çalışmamızda bugüne kadar alopesilerde dermatoskopik çalışmalarda tespit edilen dermatoskopik ayırt edici yapılara ek olarak; tek folikül ağzından çok sayıda kıl şaftı çıkması, kıl proksimalinde beyaz-gri peçe görümü, kahverengi nokta, küme yapmış beyaz noktalar, siyah noktasal pigmentasyon ve taşlı yüzük damar olmak üzere 6 yeni dermatoskopik ayırt edici yapı tanımlandı. Ayrıca AGA'da dermatoskopik ayırt edici yapılar ile klinik şiddet arası ilişki ilk kez ortaya konuldu. Scalp dermatoscopy termed as trichoscopy is a new noninvasive method for diagnosis of hair loss. It uses videodermoscopy (or dermoscopy) to visualize and measure scalp hair, eyebrows and eyelashes at high magnification. Structures which may be visualized by trichoscopy include hair shafts, hair follicle openings, the perifollicular epidermis and cutaneous microvasculature. Trichoscopy allows distinguishing between terminal hairs and vellus hairs and this method enables visualization of micro-exclamation mark hairs which may be 1 to 2 mm or less in length. Consequently, trichoscopy helps distinguishing cicatricial alopecia from noncicatricial alopecia. Lately trichoscopic findings allowed an algorithmic approach in hair loss.This study is designed to evaluate the correlation between trichoscopic findings and disease severity, activity and clinical subtype in noncicatricial alopecia. Multipl images obtained with videodermoscopy (MoleMax® III) from 305 patients with various scalp and hair disorders who referred to Dokuz Eylül University School of Medicine Department of Dermatology out-patient clinic with the complaint of hair loss and 108 unaffected control subjects were reviewed for distinguishing trichoscopic features. Conditions evaluated included psoriasis (n: 31), seborrheic dermatitis (n :112), alopecia areata (n: 39), female androgenetic alopecia (n: 138), male androgenetic alopecia (n: 63), female androgenetic alopecia of male pattern (n: 5), telogen effluvium (n: 22) and trichotillomania (n: 4). Disease severity and activity were estimated for AA and AGA. Trichoscopic findings of the patients were compared by using Mann-Whitney U test, logistic regression analysis, Chi square analysis and ratio test.There was no statistically significant difference between disease severity and trichoscopic findings in FAGAM patients. White scales, glomerular vessels and arborizing red lines were detected to be significantly more frequent in FAGA patients with mild and/or early disease while brown dots were significantly more frequent in FAGA patients in severe and/or latestages. Perifollicular discoloration (hyperpigmentation) and increased number of hairs in one pilosebaceous unit were significant trichoscopic findings in MAGA patients with mild and/or early disease while patients with severe and/or late stages of MAGA revealed honeycomb-type hyperpigmentation pattern, white and brown dots.The incidence of each dermoscopic finding in MAGA and FAGA were compared using the ratio test and perifollicular hyperpigmentation in FAGA and yellow, brown and white dots in MAGA were found to be significantly common. When the same estimation were calculated between trichoscopic findings of psoriasis and seborrheic dermatitis, red globule and dots, atypical red vessels, structureless red areas, signet ring vessels and white-grey veil appearance in proximal part of hair were detected to be more frequent psoriasis and twisted red loops and comma vessels in seborrheic dermatitis.New trichoscopic findings detected for the first time in AA patients in our study included clustered white dots, increased number of hairs in one pilosebaceous unit, black dotted pigmentation, white-grey veil appearance in proximal part of hair and arborizing red lines. Honeycomb-type hyperpigmentation pattern, clustered white dots and black dotted pigmentation correlated with the severity of AA and exclamation mark hairs correlated with AA activity while exclamation mark hairs correlated negatively with the severity of AA and atypical red vessels and white dots correlated negatively with disease activity. The risk for severe disease for AA were 36.2 times higher for honeycomb-type hyperpigmentation, seven times for white and clustered white dots, 17 times for black dotted pigmentation and 4.6 times less for exclamation-mark hair.There was no correlation between skin type with white dots, perifollicular hyperpigmentation and honeycomb-type hyperpigmentation.When trichoscopic findings were compared within the control group, perifollicular hyperpigmentation and increased number of hairs in one pilosebaceous unit were significantly more frequent in patients under age 25 then patients over age 50.Accordingly six new distinguishing trichoscopic structures including increased number of hairs in one pilosebaceous unit, white-grey veil appearance in proximal part of hair, brown dots, dotted black dots, clustered white dots and signet ring vessels were defined in our study which were not mentioned before in other dermatoscopic studies in alopecia patients. In addition, correlation between trichoscopic findings and disease severity in AGA are described for the first time in this report. 142