Utility of trichoscopy in comparison to the standard methods for assessing the disease activity, severity, and therapeutic response in alopecia areata

Objectives: Alopecia areata (AA) is a common autoimmune hair disorder with variable disease activity and severity. Conventionally, hair pull test (HPT) and off late trichoscopy are used to diagnose and monitor disease course in AA. The aim of the study was to evaluate the use of trichoscope in monitoring the disease activity, severity, and therapeutic response in AA. Material and Methods: This was a hospital-based and longitudinal study. Consecutive patients with AA between March 2018 and February 2019 were included in the study. Baseline clinical examination, HPT, and trichoscopy of patients was done at baseline and adequate treatment initiated. Monthly follow-up for next 3 months was done to study response to treatment. Results: Black dots (BDs) (100%) were commonest trichoscopic feature followed by yellow dots (YDs) (93.5%). BDs, broken hairs (BHs), and short vellus hairs (SVH) had significant correlation with disease activity while all trichoscopic markers significantly correlated with disease severity. With each follow-up, mean values for YDs, BDs, and BHs were declining, while SVH was increasing steadily. The abatement of trichoscopic activity markers preceded the disappearance of a positive HPT. Conclusion: The abatement of trichoscopic markers of disease activity in AA preceded a negative HPT, highlighting the role of trichoscopy as a useful tool in monitoring therapeutic response.