Dermatoscopic features of central centrifugal cicatricial alopecia

Background: No data exist on the dermatoscopic findings in central centrifugal cicatricial alopecia (CCCA). Objective: We sought to establish the spectrum of dermatoscopic features and their frequency in CCCA. Methods: We retrospectively evaluated 153 nonpolarized dermatoscopic images obtained from 51 women with histologically proven CCCA and established a list of 12 dermatoscopic features that were independently scored for each image. Controls included 30 dermatoscopic images from histologically proven cases of scarring traction alopecia and discoid lupus erythematosus. The receiver operating characteristic curve analysis assessed the specificity and sensitivity; Cohen kappa statistics assessed the agreement. Dermatoscopic pathologic correlations were performed on the horizontal sections of 41 of the 51 specimens, which were obtained with dermatoscopy-guided biopsy procedures. Results: Peripilar white gray halo around the emergence of hairs was observed in 94% of patients and was highly specific and sensitive for CCCA in all clinical stages. It corresponds on pathology to the lamellar fibrosis surrounding the outer root sheath. Limitations: This was a retrospective study. Conclusion: The presence of a peripilar white halo is a dermatoscopic feature that suggests the diagnosis of CCCA in African American patients with mild central thinning, and it is an optimal site from which to obtain a biopsy specimen.