A case posted to the IDS forum by John Burns

age: 35 years

sex: f

location: total body;without any specification, side not specified

clinical history: The first and second photo from the diseased portion, the third photo is from the normal scalp. What are the clues and who am I?

Giuseppe Argenziano (8/29/2010 12:47:39 PM):

Alopecia areata???

Giuseppe Argenziano (8/29/2010 12:54:59 PM):
Yellow dots and small cadaverized hairs??

Fox Gary (8/30/2010 2:30:51 AM):
Ditto. On the first photo, one hair just a tad east of true central position that I can't tell where it originates but looks like an exclamation point hair to me, unless too long to qualify (or I'm guessing it's point of origination incorrectly).

Burns John (8/30/2010 4:38:26 AM):
Yep, yellow dots and cadaverized hairs. Also ! point hairs and a diverse population of hairs, big and small. Thanks for the comments, just for fun !

Dermoscopy of alopecia areata

Yellow dots are the typical dermoscopic finding of alopecia areata. They are defined by a distinctive array of yellow to yellow-pink, round or polycyclic dots that vary in size and are uniform in color. The dots are most apparent in areas of alopecia where there is devoid of hair, and they may contain hair shaft stigmata of alopecia areata, including exclamation-point hair, cadaverized hair, and other dystrophic hairs. The yellow dot likely represents distention of the affected follicular infundibulum with keratinous material and sebum. This is supported by findings on light microscopy and the observation that ''degreasing'' an affected area with acetone results in diminished dot size. In alopecia areata, degenerating follicular keratinocytes probably constitute the bulk of the yellow dot. However they were also seen in affected terminal hair-bearing scalp (eg, transitional zone in AGA, and alopecia areata incognita).Observation of yellow dots can be helpful in clinically puzzling cases. A common scenario is differentiation of alopecia areata incognita from trichotillomania or telogen effluvium, in which case observation of yellow dots makes the diagnosis of alopecia areata certain. Clinical distinction of alopecia areata from AGA, which can share the yellow dot feature, is not usually a problem. A careful history taking is often determinative. If the yellow dot pattern is diagnostic of alopecia areata when AGA can be excluded clinically, then the need for a scalp biopsy, the results of which can be inexact, may be diminished. This has particular relevance to care of children, who are commonly afflicted by two of these conditions, alopecia areata and trichotillomania, for whom a biopsy can be traumatic.

See also: Videodermoscopy in the evaluation of hair and scalp disorders.
Ross EK, Vincenzi C, Tosti A. J Am Acad Dermatol. 2006;55:799-806.