A recent study conducted at the Universidad Autónoma de Nuevo León in Mexico has revealed significant insights into the relationship between trichoscopic findings and scalp psoriasis severity. The research, led by Mayra A. Reyes Soto, MD, indicates that specific trichoscopic features, such as twisted red loops and hemorrhagic dots, may serve as valuable indicators of disease severity and patient quality of life.
The study, which took place from March 2023 to August 2024, involved a cohort of 81 adult participants diagnosed with scalp psoriasis. This research addresses an important gap in existing knowledge, as prior studies had not systematically analyzed trichoscopic characteristics within Hispanic populations. According to Dr. Reyes Soto and her colleagues, the findings could pave the way for more personalized management strategies for patients.
Study Design and Methodology
The researchers conducted a descriptive, cross-sectional observational study at the University Hospital, focusing on adult patients aged 18 and older with a dermatologist-confirmed diagnosis of scalp psoriasis. The team calculated a necessary sample size of at least 75 participants to achieve sufficient statistical power based on previously reported prevalence rates of trichoscopic features in scalp psoriasis.
Each participant underwent a comprehensive clinical evaluation, which included assessments using the Dermatology Life Quality Index (DLQI), the Psoriasis Scalp Severity Index (PSSI), and the Scalp-Specific Dermatology Life Quality Index (SCALPDEX). The investigators utilized a Fotofinder system to capture standardized trichoscopic images of five distinct scalp areas under controlled conditions. The images were taken at magnifications of 20×, 40×, and 70×, using both dry and wet techniques to enhance visualization of vascular patterns.
Key Findings and Implications
Among the 81 participants, the mean age was 40 ± 13.65 years, with approximately 50.6% female representation. The study found that twisted red loops were the most prevalent vascular feature, observed in 64–84% of the scalp regions. These loops correlated significantly with higher scores on the PSSI, Videodermoscopy Scalp Psoriasis Severity Index (VSCAPSI), and DLQI (P < .05). Conversely, the presence of hemorrhagic dots, particularly in parietal areas, was associated with worse quality-of-life outcomes. Specifically, this feature corresponded to increases of 5 points in DLQI and 17.1 points in SCALPDEX (P < .01). The researchers noted an interesting trend: while female participants reported lower objective severity scores than their male counterparts, they indicated a greater scalp-specific symptom burden. Dr. Reyes Soto's team concluded that while twisted red loops may serve as indicators of clinical severity, hemorrhagic dots could better reflect patient distress, which is often overlooked by standard severity indices. This suggests a potential need for integrating both clinical and patient-reported measures in evaluations of scalp psoriasis. In their closing remarks, the researchers emphasized the exploratory nature of their findings, stating, “These findings position trichoscopy as a potential tool beyond diagnosis, aiding in a more holistic, patient-centered evaluation.” They called for future longitudinal studies to validate these trichoscopic features as biomarkers for monitoring disease progression and guiding therapeutic decisions across diverse populations. This research not only contributes to a deeper understanding of scalp psoriasis but also highlights the importance of considering patient-reported outcomes alongside traditional clinical assessments. As the field of dermatology evolves, such studies may ultimately lead to improved care strategies tailored to individual patient needs.
