Peripilar Sign in Androgenetic Alopecia: Does It Really Indicate Peripilar Infiltrate?

Dina Abdalla; Manal  Bosseila; Mona R.E. Abdel-Halim; Iman Sany

doi:10.5826/dpc.1401a96

Peripilar Sign in Androgenetic Alopecia: Does It Really Indicate Peripilar Infiltrate?

Authors

Dina Abdalla Dermatology Department, Faculty of Medicine, Cairo University, Egypt
Manal Bosseila Dermatology Department, Faculty of Medicine, Cairo University, Egypt
Mona R.E. Abdel-Halim Dermatology Department, Faculty of Medicine, Cairo University, Egypt
Iman Sany Dermatology Department, Faculty of Medicine, Cairo University, Egypt

Keywords:

androgenetic alopecia, trichoscopy, histopathology, peripilar sign, perifollicular infiltrate

Abstract

Introduction: Peripilar sign (PPS) is a trichoscopic sign that was first described in androgenetic alopecia (AGA) and is thought to reflect the presence of perifollicular infiltrate (PFI) in histopathology.

Objectives: To study PPS in a cohort of patients with AGA and to assess its validity as a sign indicative of PFI.

Methods: One hundred patients with AGA (confirmed by trichoscopic examination) were recruited in this cross-sectional study. From those patients, frontal scalp biopsy was done for two subgroups, 22 patients with PPS and 23 patients without PPS. Both groups were compared as regards the presence of PFI.

Results: Peripilar sign was present in 50% of the 100 studied cases. No significant difference existed between those with and those without PPS as regards PFI. Peripilar sign was significantly more encountered in patients with skin type III (p=0.001). Its absence was significantly associated with lower interpretability of yellow dots (p<0.001) and their scores were significantly positively correlated (r=0.498, p<0.001). Peripilar sign was significantly associated with absent melanophages histopathologically (p=0.011).

Conclusion: Peripilar sign as a trichoscopic sign in AGA does not reflect PFI. It represents a dark color more encountered in patients with lighter skin types. This can be explained by the increased contrast between the dark PPS and the lighter surrounding skin in lighter skin types. Further studies using melanocyte markers and Masson Fontana's stain are needed to further verify the cause of this peri-follicular dark color.

References

Kelly Y, Tosti A. Androgenetic Alopecia: Clinical Treatment. In: Tosti A, Asz-Sigall D, Pirmez R, eds. Hair and Scalp Treatments. Springer International Publishing; 2020:91-108.

Dhurat R. Utility of trichoscopy. Indian J Dermatopathol Diagn Dermatol. 2018;5(2):89.

Jain N, Doshi B, Khopkar U. Trichoscopy in alopecias: diagnosis simplified. Int J Trichology. 2013;5(4):170-178.

Tawfik SS, Sorour OA, Alariny AF, Elmorsy EH, Moneib H. White and yellow dots as new trichoscopic signs of severe female androgenetic alopecia in dark skin phototypes. Int J Dermatol. 2018;57(10):1221-1228.

Stefanato CM. Histopathology of alopecia: a clinicopathological approach to diagnosis. Histopathology. 2010;56(1):24-38.

Deloche C, de Lacharrière O, Misciali C, et al. Histological features of peripilar signs associated with androgenetic alopecia. Arch Dermatol Res. 2004;295(10):422-428.

Tosti A. Androgenetic Alopecia. In: Dermoscopy of Hair and Scalp Disorders: With Clinical and Pathological Correlations. 0 ed. CRC Press; 2007:15-25.

Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Rudnicka L. Dermoscopy in female androgenic alopecia: Method standardization and diagnostic criteria. Int J Trichology. 2009;1(2):123.

Norwood OT. Male Pattern Baldness: classification and Incidence: South Med J. 1975;68(11):1359-1365.

Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. J Am Acad Dermatol. 2004;51(2):189-199.

Restrepo R, Calonje E. Diseases of the Hair. In: Calonje E, Brenn T, Lazar AJ, MacKee PH, Billings SD, eds. McKee’s Pathology of the Skin: With Clinical Correlations. Fifth edition. Elsevier; 2018:1051-1128.

Chan YH. Biostatistics 102: quantitative data--parametric & non-parametric tests. Singapore Med J. 2003;44(8):391-396.

Chan YH. Biostatistics 103: qualitative data - tests of independence. Singapore Med J. 2003;44(10):498-503.

Chan YH. Biostatistics 104: correlational analysis. Singapore Med J. 2003;44(12):614-619.

Karadağ Köse Ö, Güleç AT. Clinical evaluation of alopecias using a handheld dermatoscope. J Am Acad Dermatol. 2012;67(2):206-214.

Park J, Kim JI, Kim HU, Yun SK, Kim SJ. Trichoscopic Findings of Hair Loss in Koreans. Ann Dermatol. 2015;27(5):539.

Varma K, Singh U, Kataria M. Trichoscopy in common scalp alopecia: an observational study. Int J Res Dermatol. 2020;6(3):361.

Mani S, Manickam N, Gopalan K. Role of dermoscopy in the diagnosis of alopecia. J Pak Assoc Dermatol. 2018;28(3):320-328.

Malakar S, Mehta P, Malakar S. Trichoscopy in anagen effluvium: Extensive peripilar sign. Our Dermatol Online. 2017;8(4):493-494.

Kibar M, Aktan Ş, Bilgin M. Scalp Dermatoscopic Findings in Androgenetic Alopecia and Their Relations with Disease Severity. Ann Dermatol. 2014;26(4):478.

Inui S, Nakajima T, Itami S. Scalp dermoscopy of androgenetic alopecia in Asian people. J Dermatol. 2009;36(2):82-85.

Chiramel M, Sharma V, Khandpur S, Sreenivas V. Relevance of trichoscopy in the differential diagnosis of alopecia: A cross-sectional study from North India. Indian J Dermatol Venereol Leprol. 2016;82(6):651.

Staricco RG, Miller-Milinska A. Activation of the Amelanotic Melanocytes in the Outer Root Sheath of the Hair Follicle Following Ultra Violet Rays Exposure. J Invest Dermatol. 1962;39(3):163-164.