Trichoscopy of Cicatricial Alopecia in Fair and Dark Skin: A Multicenter International Study of the EADV Task Force on Hair Diseases and the IDS Task Force on Trichoscopy

BACKGROUND: Trichoscopy enhances diagnostic accuracy in primary cicatricial alopecias (PCA), yet comparative data on its application across diverse skin phototypes remain limited. OBJECTIVES: The aim of this study was to characterize trichoscopic features across various forms of PCAs and compare findings between fair and dark phototypes. METHODS: This is a descriptive, multicenter international study analyzing trichoscopic patterns in 1102 patients with PCAs across a range of ethnic backgrounds and skin phototypes. RESULTS: The absence of follicular openings was the most consistent trichoscopic finding across all phototypes. Notable variations in trichoscopic patterns were observed based on skin color. In both fair and dark phototypes, signs of clinical and trichoscopic activity were predominantly observed within the first five years of disease duration, when inflammation is typically more pronounced. CONCLUSIONS: Clinicians should be aware of trichoscopic variations both between and within the same PCA according to the phototype. Such awareness enhances the recognition and interpretation of trichoscopic features, particularly during the early and active stages of the disease, and helps guide the selection of optimal biopsy sites across PCA subtypes in both fair and dark skin. This approach can ultimately facilitate histopathological confirmation and support clinical decision-making.