Abstract

Objectives: - Understand the role of trichoscopy in the diagnosis of alopecia areata (AA). - Recognize characteristic trichoscopic features of active, chronic, and regrowing AA. - Differentiate alopecia areata from other causes of non-scarring alopecia using trichoscopy. - Identify predictive and non-predictive trichoscopic markers for treatment response. - Apply trichoscopy in disease monitoring, follow-up, and biopsy guidance. Introduction: Alopecia areata is a chronic autoimmune disorder characterized by sudden, non-scarring hair loss in well-defined patches. It may affect the scalp, face, and other areas and presents with variable clinical severity, ranging from localized patchy alopecia to alopecia totalis and universalis. Nail involvement is frequent and reflects disease severity. Although the diagnosis is often clinical, atypical presentations such as diffuse alopecia, alopecia incognita, or early disease may be diagnostically challenging. Materials / method: Patients with clinically suspected alopecia areata underwent dermatologic and trichoscopic examination using a polarized dermatoscope. Lesional and perilesional scalp areas were systematically assessed. Trichoscopic features including hair shaft abnormalities, follicular openings, pigmentation, and regrowth signs were recorded. Trichoscopy was also used to guide biopsy in selected cases and to monitor therapeutic response during follow-up. Results: Active alopecia areata showed exclamation mark hairs, tapered hairs, black dots, and broken hairs. Chronic disease was characterized by yellow dots, monilethrix-like hairs, and reduced follicular openings. Regrowth was indicated by short vellus hairs, upright regrowing hairs, and pigtail hairs. Distinct trichoscopic patterns correlated with clinical subtypes and allowed differentiation from other non-scarring alopecias. Conclusion: Trichoscopy is a reliable, non-invasive tool for diagnosing alopecia areata, assessing disease activity, guiding biopsy, and monitoring treatment response. Its routine use improves diagnostic accuracy, supports prognostic evaluation, and enhances clinical management of patients with alopecia areata.