ABSTRACT
Normal dark scalp shows a homogeneous brown honeycomb pigment network (Figure 19.1) that correlates with an increased pigment density in the basal layer of epidermis. This trichoscopic feature of the normal dark scalp is very common, becomes accentuated over sun-exposed areas, and is responsible for most of the differences in trichoscopic characteristics of the scalp surface in skin of color compared to the white skin. Such a pigment network is more marked in the alopecic scalp because of increase in sun exposure, either in nonscarring alopecia (Figure 19.2) or scarring alopecia with interfollicular areas sparing (e.g., lichen planopilaris) (Figure 19.3), differently from fair-skinned patients, where honeycomb pigment network is usually observed mainly in androgenetic alopecia.1 Interestingly, in advanced stages of scarring alopecia, the honeycomb pigmentation may be lost, rendering the appreciation of the shiny atrophic areas more discernible from the adjoining pigmented areas.
