CLINICAL
PEARL
Hair dye: A trichoscopy pitfall Kunal Angra, BA,a Charlotte E. LaSenna, BS,b Anna J. Nichols, MD, PhD,c and Antonella Tosti, MDc Washington, DC, and Miami, Florida
CLINICAL CHALLENGE Hair and scalp disorders account for a large proportion of the presenting complaints to dermatologists. Trichoscopy (dermoscopy of the hair and scalp) serves as a very important diagnostic tool.1 However, evaluation of the hair and scalp may be additionally challenging if the patient has a history of hair dye use. Permanent and semipermanent hair dyes can mimic distinct pathologies. Permanent hair dye may penetrate hair follicles, giving a ‘‘black dot’’ appearance that is characteristic of active alopecia areata (Fig 1). Semipermanent hair dye can deposit on the scalp and resemble excoriated lesions (Fig 2) or sun damage to the unsuspecting eye. Long-term contact of dyes with the scalp may lead to contact dermatitis, which has been shown to cause telogen effluvium.2
Fig 1. Patient with stable alopecia areata with permanent hair dye infiltrating follicles to appear as the black dots of active disease.
Howard University College of Medicine,a Washington, DC; Miller School of Medicineb and Department of Dermatology and Cutaneous Surgery,c University of Miami, Florida. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Kunal Angra, BA, Department of Dermatology, Miller School of Medicine, University of Miami, 1600 NW
10th Ave, RMSB Building, Room 2023C, Miami, Fl 33136. E-mail: [email protected]. J Am Acad Dermatol 2015;72:e101-2. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.10.009
e101
e102 Angra et al
J AM ACAD DERMATOL
APRIL 2015
Fig 2. Patient with semipermanent hair dye appearing as excoriated lesions on the scalp. The surrounding dyed hairs of similar color suggest the correct diagnosis.
SOLUTION In order to reach the correct diagnosis, it is important to inquire about hair dye use. Understanding the different types of hair dye and the way they may deposit on the scalp is particularly useful in order to distinguish hair dye deposits from scalp disorders. Patients who use hair dye should also be instructed to ensure that their scalp is washed well immediately after coloring to prevent staining of the scalp from interfering with the true diagnosis and its consequences. REFERENCES 1. Miteva M, Tosti A. Hair and scalp dermoscopy. J Am Acad Dermatol. 2012;67:1040-1048. 2. Tosti A, Piraccini BM, van Neste DJ. Telogen effluvium after allergic contact dermatitis of the scalp. Arch Dermatol. 2001;137:187-190.
PEARL
Hair dye: A trichoscopy pitfall Kunal Angra, BA,a Charlotte E. LaSenna, BS,b Anna J. Nichols, MD, PhD,c and Antonella Tosti, MDc Washington, DC, and Miami, Florida
CLINICAL CHALLENGE Hair and scalp disorders account for a large proportion of the presenting complaints to dermatologists. Trichoscopy (dermoscopy of the hair and scalp) serves as a very important diagnostic tool.1 However, evaluation of the hair and scalp may be additionally challenging if the patient has a history of hair dye use. Permanent and semipermanent hair dyes can mimic distinct pathologies. Permanent hair dye may penetrate hair follicles, giving a ‘‘black dot’’ appearance that is characteristic of active alopecia areata (Fig 1). Semipermanent hair dye can deposit on the scalp and resemble excoriated lesions (Fig 2) or sun damage to the unsuspecting eye. Long-term contact of dyes with the scalp may lead to contact dermatitis, which has been shown to cause telogen effluvium.2
Fig 1. Patient with stable alopecia areata with permanent hair dye infiltrating follicles to appear as the black dots of active disease.
Howard University College of Medicine,a Washington, DC; Miller School of Medicineb and Department of Dermatology and Cutaneous Surgery,c University of Miami, Florida. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Kunal Angra, BA, Department of Dermatology, Miller School of Medicine, University of Miami, 1600 NW
10th Ave, RMSB Building, Room 2023C, Miami, Fl 33136. E-mail: [email protected]. J Am Acad Dermatol 2015;72:e101-2. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.10.009
e101
e102 Angra et al
J AM ACAD DERMATOL
APRIL 2015
Fig 2. Patient with semipermanent hair dye appearing as excoriated lesions on the scalp. The surrounding dyed hairs of similar color suggest the correct diagnosis.
SOLUTION In order to reach the correct diagnosis, it is important to inquire about hair dye use. Understanding the different types of hair dye and the way they may deposit on the scalp is particularly useful in order to distinguish hair dye deposits from scalp disorders. Patients who use hair dye should also be instructed to ensure that their scalp is washed well immediately after coloring to prevent staining of the scalp from interfering with the true diagnosis and its consequences. REFERENCES 1. Miteva M, Tosti A. Hair and scalp dermoscopy. J Am Acad Dermatol. 2012;67:1040-1048. 2. Tosti A, Piraccini BM, van Neste DJ. Telogen effluvium after allergic contact dermatitis of the scalp. Arch Dermatol. 2001;137:187-190.
