Trichoscopic clues of the scalp in moderate to severe atopic dermatitis: a monocentric analysis

Background: Atopic dermatitis (AD) stands as the prevailing chronic relapsing inflammatory dermatosis within the general population. Scalp involvement is a minor but frequent feature of AD, nevertheless it was relatively understudied up to now. This research aims to better describe the clinical and trichoscopic aspects of scalp involvement in moderate-to-severe AD, focusing on the vascular pattern of the vessels and scalp desquamation. Methods: A single-center retrospective and prospective study was conducted on 20 patients, collecting clinical and trichoscopic images at the Dermatology Unit of the University of Bologna, Italy. Results: Scalp lesions exhibited distinct morphological characteristics in both vascular and desquamation patterns. Three main trichoscopic patterns with a different grade of involvement were identified: erythematous pattern, erythematous desquamative pattern and exudative with crusts pattern. As for the limitations, the sample size was relatively small, and, being a single-centre study, the results may not be applicable to other populations or settings. In addition, no standardized criteria for trichoscopic analysis are available. Conclusions: This is the first study with the purpose to delineate the trichoscopic characteristics observed in patients with moderate-to-severe AD not in systemic therapy, thereby highlighting three distinct patterns of trichoscopy manifestations that define three distinct populations.