Background: Scalp dermoscopy plays an important role in the diagnosis of hair and scalp disorders, and specific dermoscopic patterns have recently been associated with several disorders causing noncicatricial alopecia, such as androgenetic alopecia, alopecia areata, trichotilloma-nia, and tinea capitis. Observations:We describe the morphologic and patho-logic features of a new dermoscopic pattern, referred to as "follicular red dots," that was found in scalp lesions of 5 patients with active discoid lupus erythematosus (DLE). Follicular red dots appear as erythematous poly-cyclic, concentric structures, with a diameter ranging from 0.16 to 0.47 mm, regularly distributed in and around the follicular ostia. In the pathologic findings, red dots cor-respond to widened infundibula plugged by keratin and surrounded by dilated vessels and extravasated erythro-cytes. Retrospective blinded evaluation of the dermo-scopic images of 155 patients with cicatricial alopecia sug-gests that follicular red dots are a specific feature of DLE because the pattern was not identified in the images of cicatricial alopecia resulting from other diseases. Conclusions: The follicular red dot pattern is a specific feature of scalp lesions of active lupus erythematosus of the scalp. Recognition of this distinctive dermoscopic pat-tern may help the clinician to differentiate DLE from other diseases causing cicatricial alopecia.
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