Trichoscopic Data on Scalp Psoriasis Suggest Technique Provides Holistic Assessment

In trichoscopic findings, new data suggest that twisted red loops are correlated with increased scalp psoriasis severity scores, but hemorrhagic dots could be strong predictors of decreased quality of life.1,2

These findings suggest that hemorrhagic dots could function as objective markers for patient distress that are often not reported with the standard clinical indices. Such data were the result of a recent analysis by Mayra A. Reyes Soto, MD—from the Department of Dermatology at the Universidad Autónoma de Nuevo Leon in México—and a team of other investigators.

Soto et al highlighted that while there is current research describing trichoscopic patterns, data regarding their correlation with disease severity or patient-centered outcomes is lacking. The team also noted that no dedicated analysis has systematically characterized trichoscopic features within a Hispanic population with scalp psoriasis.

“Here, we investigated the trichoscopic findings of scalp psoriasis and evaluated their relationship with objective severity indices and patient-reported outcomes,” Soto and colleagues wrote.1 “By addressing this gap, our study aims to explore these potential associations, generating preliminary insights that could guide future research toward more personalized management strategies and ultimately improve patient care.”

Trial Design Details

The investigative team conducted a descriptive, cross-sectional observational study at the University Hospital of the Universidad Autónoma de Nuevo León between March 2023 - August 2024. Eligible participants were adult patients of both sexes who were ≥18 years of age and reported having a dermatologist-confirmed diagnosis of scalp psoriasis. The study's required sample size was calculated based on previously reported trichoscopic feature prevalence rates in scalp psoriasis, indicating that at least 75 participants would be needed to ensure adequate statistical power.

This particular patient cohort was Hispanic adults with scalp psoriasis. Each of the trial subjects were given a detailed clinical evaluation by Soto and coauthors that included the 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 5 distinct scalp areas, and all photographs were taken in a controlled environment with uniform background, lighting, and camera positioning.

Trichoscopy was carried out by Soto and colleagues via a Fotofinder system at 20×, 40×, and 70× magnifications. A dry technique was first applied by the investigative team to document the distribution and degree of scaling, and this was followed by a wet method using an alcohol-based solution to enhance visualization of vascular patterns. The team gathered images from the frontal, right parietal, left parietal, occipital, and vertex regions, as well as from one unaffected control area. All of these image data were securely stored within a restricted-access database. Any associations between trichoscopic findings and clinical outcomes were assessed by the team through multiple linear regression models.

Findings on Trichoscopy

There were 81 individuals included in total, with a mean age 40 ± 13.65 years and 50.6% being listed as female. Twisted red loops were found by the investigators to represent the most common vascular feature, observed in 64–84% of scalp regions, and they were significantly correlated with higher PSSI, Videodermoscopy Scalp Psoriasis Severity Index (VSCAPSI), and DLQI scores among patients (P < .05).1 Hemorrhagic dots' presence in the parietal areas was linked by Soto and coauthors to worse quality-of-life outcomes, and there were corresponding to increases of 5 points in DLQI and 17.1 points in SCALPDEX (P < .01). Interestingly, while women presented with lower objective severity scores compared to men, they also reported greater scalp-specific symptom burden.

Such findings, Soto et al highlighted, would suggest that while twisted red loops may function as indicators of increased clinical severity in scalp psoriasis, hemorrhagic dots could function as more reliable predictors of impaired quality of life. This is given that they reflect aspects of patient distress not captured by conventional severity indices. The team's observation that female patients reported a disproportionate psychosocial impact despite milder clinical involvement would also suggest the potential value of integrating both clinical and patient-reported measures in scalp psoriasis evaluations.

“These findings position trichoscopy as a potential tool beyond diagnosis, aiding in a more holistic, patient-centered evaluation,” they concluded.1 “However, given the study's exploratory, cross-sectional nature, these results are preliminary. Future longitudinal research is essential to validate these trichoscopic features as biomarkers for monitoring disease progression and guiding therapeutic decisions in diverse populations.”

References

1. MA Reyes Soto, D López-Quintero, J Ocampo-Candiani, et al. Trichoscopic Features of Scalp Psoriasis: Their Association With Disease Severity and Quality of Life in a Hispanic Population. International Journal of Dermatology (2025): 1–7, https://doi.org/10.1111/ijd.70038.

2. P Rosina, MR Zamperetti, A Giovannini, et al. Videocapillaroscopy in the Differential Diagnosis Between Psoriasis and Seborrheic Dermatitis of the Scalp. Dermatology 214, no. 1 (2007): 21–24.