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Research Letter |

Dirty Dots as a Normal Trichoscopic Finding in the Elderly Scalp

Mariya Miteva, MD1; Mariana Lima, MD2; Antonella Tosti, MD1
[+] Author Affiliations
1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
2Department of Dermatology, Santa Casa de Misericórdia do Recife, Recife, Brazil
JAMA Dermatol. 2016;152(4):474-476. doi:10.1001/jamadermatol.2015.5545.
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This study reviews the trichoscopic images in the scalps of elderly women and assesses them for dirty dots.

Trichoscopy is a helpful tool in the diagnosis and management of hair and scalp disorders.1 Dirty dots have been described as a normal trichoscopic finding in the scalps of 10 of 19 healthy children (53%) between 5 months and 14 years of age.2 None of the children had a preceding hair or scalp disorder. The dirty dots presented as clumped and haphazardly arrayed particulate debris and loose fibers of various colors. They are absent in adults2 and, to our knowledge, have not been reported in people of other ages.

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Figure 1.
Trichoscopic Images of Dirty Dots in the Scalp of 2 Women in Their 70s With Androgenetic Alopecia

A, Black 0.4-mm particle and 2 other smaller red and yellow particles seen via Handyscope (FotoFinder Systems; original magnification ×20) (arrowheads). B, Fine black particles on a background of significant thinning and sun damage seen via Handyscope (original magnification ×20) (arrowheads).

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Figure 2.
Scalp Biopsy Specimens From 2 Women With Androgenetic Alopecia

A, Mantle structures (immature sebaceous glands) extending from and surrounding a miniaturized follicle at the level of the isthmus on horizontal sections in a woman in her 70s (arrowheads). Only individual lobules of hypoplastic sebaceous glands are present (hematoxylin-eosin, original magnification ×10). B, Normal mature, multilobulated sebaceous glands in the follicular units of this scalp biopsy specimen in a woman in her 30s (hematoxylin-eosin, original magnification ×10) (arrowheads).

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