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The aim of this study was to describe the trichoscopic features of mild FFA and try to find new trichoscopic patterns that could help in its prompt diagnosis. A cross-sectional observational and analytic study to assess trichoscopic features in patients with FFA approved by the local institutional review board was conducted. Patients with a frontal hairline recession less than 5 mm were included and fulfilled the diagnostic criteria of FFA.

To identify common trichoscopic patterns, a non-hierarchical k-medians cluster analysis was performed. A total of 56 patients were included and 112 trichoscopic images from the frontal hairline were analysed. The most commonly observed trichoscopic features were loss of vellus hairs (91.1%, partially in 25.0%), yellow dots (41.1%), black dots (40.2%) and white dots (40.2%). Statistical analysis found no significant differences of trichoscopic features in relation to other variables. Scarring trichoscopic signs in FFA have been deeply described.

In fact, the pseudo fringe sign can be present in some cases with remaining hairs on the hairline clinically visible. Interestingly, a significant number of patients showed signs of non-cicatricial alopecia, such as yellow dots and black dots, as it has been described in trichoscopy on the eyebrows in FFA.

There are three trichoscopic patterns in patients with mild FFA that clinicians should keep in mind. The cluster 1 is characterized by complete loss of vellus hair with white dots. It also presents a honeycomb pattern and pinpoint white dots. The cluster 2 includes partial to complete loss of vellus hair, multiple yellow dots and thin vascular pattern. Finally, the cluster 3 is associated with perifollicular erythema and possible loss of vellus hair.

In conclusion, the trichoscopic features of mild cases of FFA are described. Loss of vellus hair on the frontal hairline is the most frequent finding, although it may be preserved in some patients. The three trichoscopic patterns that are presented may help clinicians to suspect the diagnosis of this condition at very early stages and confirm the diagnosis through biopsy.