Recent research has unveiled significant insights into the relationship between trichoscopic findings and scalp psoriasis severity. A study led by Mayra A. Reyes Soto, MD, from the Universidad Autónoma de Nuevo León in Mexico, reveals that twisted red loops observed during trichoscopy correlate with increased severity scores for scalp psoriasis. In contrast, the presence of hemorrhagic dots appears to be a strong indicator of diminished quality of life for patients.
This work addresses a notable gap in existing research, which has largely overlooked the correlation between trichoscopic patterns and both disease severity and patient-centered outcomes. The study, conducted between March 2023 and August 2024, involved a systematic analysis of trichoscopic features specifically within a Hispanic population affected by scalp psoriasis.
Study Design and Methodology
The observational study included adult participants aged 18 and older, all of whom had a dermatologist-confirmed diagnosis of scalp psoriasis. To ensure adequate statistical power, the research team calculated a required sample size of at least 75 participants, ultimately enrolling 81 individuals with a mean age of 40 ± 13.65 years, of which 50.6% were female.
Each participant underwent thorough clinical evaluations, utilizing tools such as the Dermatology Life Quality Index (DLQI), Psoriasis Scalp Severity Index (PSSI), and the Scalp-Specific Dermatology Life Quality Index (SCALPDEX). The investigators collected standardized trichoscopic images from five distinct scalp areas, ensuring consistent conditions through controlled lighting and camera positioning.
Trichoscopic assessments were performed using a Fotofinder system at magnifications of 20×, 40×, and 70×. Initially, a dry technique documented the distribution and degree of scaling, followed by a wet method involving an alcohol-based solution to enhance vascular pattern visibility. The analysis covered the frontal, right parietal, left parietal, occipital, and vertex regions, as well as an unaffected control area.
Key Findings and Implications
The investigators discovered that twisted red loops were the most prevalent vascular feature, appearing in 64–84% of the examined scalp regions. This feature was significantly linked to higher scores on the Psoriasis Scalp Severity Index, Videodermoscopy Scalp Psoriasis Severity Index (VSCAPSI), and the Dermatology Life Quality Index (P < .05). Conversely, the presence of hemorrhagic dots in the parietal areas was associated with substantial declines in quality of life, correlating with increases of 5 points in DLQI and 17.1 points in SCALPDEX (P < .01). Notably, female participants reported a greater scalp-specific symptom burden despite lower objective severity scores compared to their male counterparts. These findings suggest that while twisted red loops may indicate higher clinical severity in scalp psoriasis, hemorrhagic dots could serve as more reliable markers of patient distress and quality of life impairment. The study emphasizes the importance of integrating clinical measures with patient-reported outcomes in evaluating scalp psoriasis, especially given the psychosocial impacts observed among female patients. “This study positions trichoscopy as a potential tool beyond diagnosis, aiding in a more holistic, patient-centered evaluation,” Dr. Reyes Soto and colleagues concluded. They also cautioned that these results are preliminary and underscored the need for future longitudinal research to validate trichoscopic features as biomarkers for monitoring disease progression and guiding therapeutic decisions across diverse populations.
The research findings were published in the International Journal of Dermatology, propelling forward the conversation about personalized management strategies for individuals suffering from scalp psoriasis.
