International Journal of Trichology International Journal of Trichology
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Year : 2012  |  Volume : 4  |  Issue : 3  |  Page : 172-173

Acantholytic hair casts: A dermoscopic sign of pemphigus vulgaris of the scalp

Department of Dermatology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Brazil

Correspondence Address:
Rodrigo Pirmez
Rua Professor Rodolpho Paulo Rocco, 255, Departamento de Dermatologia, Rio de Janeiro, RJ 21941-913
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-7753.100087

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We report the dermoscopic features of pemphigus vulgaris (PV) involving the scalp of a 57-year-old African-American female. Among our findings, there were hair casts - movable tubular structures that envelop the hair shafts. We suggest that the development of those casts occurs through acantholysis within the outer root sheath, a mechanism not yet considered in the literature. This report also highlights how dermoscopy may contribute to the evaluation of disease activity, especially in those cases of PV in which scalp involvement is recalcitrant to treatment. Finally, we recommend that the presence of hair casts should herald the need of therapy adjustment for better disease control.

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