LETTER TO EDITOR
Year: 2020 • Volume: 3 • Issue: 1 • Page: 14
POHL PINKUS LIKE CONSTRICTIONS IN LICHEN PLANO ILARIS ON DERMOSCOPY
Sandip Agrawal1, Rachita Dhurat1,Ravina Surve1, Sanober Daruwalla1, Aseem Sharma1
1 Dept. of Dermatology, Lokmanya Tilak Medical College and General Hospital
Dr Rachita Dhurat
OPD 16, 2nd floor, New OPD building, Sion Hospital, Mumbai-400022
How to cite this article:
Agarwal S, Dhurat R, Surve R, Daruwalla S, Sharma A. Pohl pinkus like constrictions in Lichen Plano Pilaris on dermoscopy. JDA Indian Journal of Clinical Dermatology 2020;3: 14
A 32 year old female presented with complete loss of hair over the scalp since 5 years (Figure 1). Treatment taken in the past was not effective and she still complained of new lesions with loss of hair. Skin of the alopecic patch involving almost the entire scalp sparing only the peripheral rim of hair line throughout, appeared shiny and atrophic and hair pull test from the periphery of the alopecic patch was positive.
Figure 1: Loss of hair involving 85% scalp area
Dermoscopic examination (Heine dermatoscope) revealed diminished follicular ostia, tubular perifollicular scaling and peripilar casts. Perifollicular blue-grey dots- target sign, suggestive of melanin incontinence were present1. White areas indicating fibrosis in the interfollicular area were seen. Interestingly, all hair in the affected area demonstrated varying thickness throughout the length of the hair shaft (Figure 2).
Figure 2: Dermoscopic picture-(Heine dermatoscope under 50x magnification polarized mode) Yellow arrow-peripilar cast, Red arrow- blue gray dots, Green arrow-white areas, Blue arrow- Pohl Pinkus like constrictions
Multiple pohlpinkus like constrictions were seen throughout the hair shaft probably suggestive of the multiple episodes of trauma that the hair experienced each time there was a flare of the disease. Integrin expression has a role in cell cell adhesion , epidermal differentiation and migration , its altered expression is seen in active lesions of lichen planus pilaris and probably the reason for pohlpinkus like constrictions here. Trichogram revelaed floppy sock appearance due to roughened cuticle. To conclude, lichen planopilaris is the most common cause of
cicatricial alopecia. It frequently affects middle-aged females with irregular areas of atrophic alopecia on the scalp. Dermoscopy can act as a useful non-invasive aid in diagnosing lichen planopilaris .
1. Ankad B., Beergouder, S., &Moodalgiri, V. (2013). Lichen planopilaris versus discoid lupus erythematosus: A trichoscopic perspective.
International Journal of Trichology, 2013,5(4), 204-207. doi:10.4103/0974-7753.130409