Abstract

Objectives: The primary objective of this study is to categorize iatrogenic alopecia induced by non-surgical aesthetic procedures based on advanced trichoscopic findings. By delineating specific trichoscopic features, such as variation in follicular ostia, perifollicular discoloration, hair shaft caliber changes, and the presence of dystrophic hairs or cadaverized hairs, we aim to correlate these features with tailored therapeutic strategies. This categorization will aid in precise diagnosis and optimization of treatment approaches, addressing the pathophysiological nuances of each alopecia subtype. Introduction: Iatrogenic alopecia following non-surgical aesthetic procedures represents a complex and often underappreciated clinical challenge. This study aims to establish a novel categorization system for iatrogenic alopecia, utilizing detailed trichoscopic analysis. Trichoscopy, with its ability to reveal subtle changes in follicular structure, perifollicular patterns, and hair shaft integrity, offers a precise diagnostic tool for differentiating types of alopecia. This categorization not only enhances diagnostic precision but also guides the implementation of targeted therapeutic protocols. Materials / method: In this retrospective study, we analyzed 28 cases of iatrogenic alopecia subsequent to non-surgical aesthetic interventions. Trichoscopic evaluations were conducted with a focus on identifying distinct features such as: (1) Follicular Miniaturization with decreased hair shaft diameter and reduced terminal hair ratio, (2) Perifollicular Hyperpigmentation or the presence of Peripilar Signs, indicative of inflammatory processes, (3) Ruptured Hair Shafts with trichorrhexis nodosa-like appearances and flame hairs, and (4) Yellow Dots with perifollicular fibrosis suggestive of chemical panniculitis Results: four distinct: (1) Reduced Follicular Density and Absence of Terminal Anagen Follicles (21%), often caused by vascular compromise leading to ischemia and increased telogen effluvium; (2) Brittle and Miniaturized Hair with Peripilar Sign (11%), primarily due to chronic inflammation and chemical irritation from mesotherapy or other injectable treatments; (3) Ruptured Hair Shafts with Perifollicular Inflammation (25%), resulting from structural damage due to physical or chemical trauma; and (4) Yellow Dots with Perifollicular Fibrosis (14%), typically following panniculitis from fat-dissolving. Conclusion: This study presents a novel trichoscopic categorization of iatrogenic alopecia resulting from non-surgical aesthetic procedures, linking each category to its underlying cause and appropriate therapeutic strategy. By using advanced trichoscopic criteria and understanding the etiological mechanisms, clinicians can more accurately diagnose and treat iatrogenic alopecia, resulting in better patient outcomes. This approach represents a significant advancement in the management of alopecia, offering a precision medicine framework tailored to the unique needs of each patient.