Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(1):4742 1 Epidemiological, Clinical, Dermoscopic Findings, and Management of Perinevoid Alopecia Cintia Medeiros Martins1, Daniel Fernandes Melo1, Hugo Monteiro Faver2, Michela Starace3,4, José Leonardo Rodrigues Machado5, Carla Jorge Machado6, Rita Fernanda Cortez de Almeida1 1 Department of Dermatology, State University of Rio de Janeiro, Rio de Janeiro, Brazil 2 Dermatology Department, Central Army Hospital, Rio de Janeiro, Brazil 3 Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy 4 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy 5 Dermatology Department, Faculdade IPEMED de Ciências Médicas (AFYA), Rio de Janeiro, Brazil 6 Preventive and Social Medicine Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Key words: Perinevoid Alopecia, Alopecia Areata, Dermoscopy, Trichoscopy, Alopecia Citation: Medeiros Martins C, Fernandes Melo D, Monteiro Faver H, et al. Epidemiological, Clinical, Dermoscopic Findings, and Management of Perinevoid Alopecia. Dermatol Pract Concept. 2025;15(1):4742. DOI: https://doi.org/10.5826/dpc.1501a4742 Accepted: November 4, 2024; Published: January 2025 Copyright: ©2024 Medeiros Martins et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Cintia Medeiros Martins, Department of Dermatology, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77, Rio de Janeiro, 20551-030, Brazil. Phone.: +55 21 28688478. E-mail: martinscintiam@gmail.com Introduction Perinevoid alopecia (PA) is a particularly rare variant of alo- pecia areata (AA) associated with a central pigmented nevus [1,2]. It appears to be a nevocentric phenomenon, similar to halo nevus, and caused by an inflammatory response against hair follicles, nevic cells, and melanocytic structures [2,3]. Research on PA is limited, particularly concerning dermos- copy and therapy. In this article, we aimed to describe the ep- idemiological, clinical, and dermoscopic findings of PA and analyze its management in a multicenter retrospective study. Case Presentation We included five patients - most were male (4/5), with a median age of 24 years (range: 9–72). Fitzpatrick skin phototypes ranged from II to IV. The average duration of the disease was 4 months (range: 3–26). Two patients had data on the nevus duration (3 and 9 years), and one pa- tient had a positive family history of AA. Oval-shaped hair loss occurred in three patients (3/5), with an average size of 3 cm (range: 1.6–3.5). The occipital area was the most commonly affected (3/5), and the predominant trichoscopy finding was vellus hair (5/5), followed by short regrowing hairs, black dots, and broken hairs (4/5). Two patients had a positive pull test. The median nevus size was 0.3 cm (range: 0.1–0.5), and the most prevalent dermoscopic pattern was homogeneous-globular (2/5). Regarding treatment, topi- cal and intralesional corticosteroids were administered to three of the five subjects. The same three patients experi- enced complete hair regrowth after topical or intralesional corticosteroids. vijayakumars Sticky Note Marked set by vijayakumars 2 Research Letter | Dermatol Pract Concept. 2025;15(1):4742 Figure 1. (A) Alopecia patch centered by a melanocytic nevus, clinically consistent with perinevoid alopecia. (B,C) Trichoscopy of a perinevoid alopecia patch showing yellow dots and vellus hair, in addition to a mela- nocytic lesion with a homogeneous-globular pattern. (D) A round area of hair loss with a central pigmented nevus in the mildscalp. (E) Trichoscopy of a perinevoid alopecia patch showing typical findings of alopecia areata such as yellow and black dots, vellus hairs, short regrowing hairs, broken hairs, and circular hairs. (F) Trichoscopy after treatment with infiltrative and topical corticosteroids showing complete hair regrowth. Conclusions PA etiopathogenesis is attributable to an autoimmune re- sponse against hair follicles and nevic cells mediated by T cell epitopes–melanocyte complexes [4]. Although the au- toimmune process resembles AA, the exact antigen remains unclear [1]. The most common findings on trichoscopy in our sample were vellus hairs, short regrowing hairs, black dots, and bro- ken hairs, which is in agreement with previous case reports [2]. Since those features are also prevalent in AA, PA seems to be a subtype of that condition, highlighting the value of trichos- copy in the physician diagnostic tools. Some publications on PA describe complete hair re- growth after surgical excision of the nevus [1,2,5]. In con- trast, our patients underwent topical therapy with 0.05% clobetasol propionate cream, with or without intralesional betamethasone at monthly intervals (betamethasone 0.05 mL + saline 0.95 mL - 0.05 mL per site spaced 1 cm apart) [6]. Intralesional corticosteroids were also effective [5]. Our research underlines the efficacy of such a non-invasive approach, considering how similar PA and AA are. Limita- tions of this study include the lack of standardization of der- moscopy imaging and the small sample size, which might not be surprising considering the condition’s rarity. In summary, our study has addressed the epidemiology, clinical, and dermoscopic findings, as well as PA therapeutic approach. Topical or infiltrative corticosteroids have proven to be an effective and less invasive option compared to nevus surgical excision. Dermatologists should be vigilant regard- ing this unique presentation of AA for proper management. Further studies are warranted to validate our findings and detail additional characteristics of this atypical condition. Ethics Statement: The patients in this manuscript have given written informed consent to publication of their case details. Data Availability Statement: All data generated or analyzed during this study are included in this article.  Further enqui- ries can be directed to the corresponding author. S4C Sticky Note AQ: Figure 1 Callout missing. vijayakumars Sticky Note Marked set by vijayakumars vijayakumars Sticky Note Marked set by vijayakumars vijayakumars Sticky Note Marked set by vijayakumars Research Letter | Dermatol Pract Concept. 2025;15(1):4742 3 Table 1. Epidemiological, Clinical, Dermoscopic Findings, and Management of Perinevoid Alopecia. Characteristics  Statistics or Categories Obtained Values (N = 5; 100.0%) General information — Male gender: N (%) 4 (80.0) — Age (years) Mean//Median 34.4//24 Minimum; Maximum 9; 72 — Phototype (1-2-3-4-5-6): N (%) – 2 2 (40.0) – 3 1 (20.0) – 4 2 (40.0) — Duration of disease/alopecia (months)(1) Mean//Median 9.5// 4 Minimum; Maximum 3; 26 — Family history of alopecia areata: N (%) – Positive 1 (20.0) — Concomitant diseases: N (%) – Hypertension 1 (20.0) – Depression 1 (20.0) Clinical features of hair loss patch — Positive pull test: N (%) – 2 (40.0) — Shape of hair loss patch: N (%) – Oval 2 (40.0) – Round 3 (60.0) — Size of hair loss patch (cm) Mean//Median 2.7//3 Minimum; Maximum 1.6; 3.5 Clinical features of nevus — Size (cm) Mean//Median 0.4//0.3 Minimum; Maximum 0.1; 0.5 — Asymmetry: N (%) 1 (20.0) — Irregular borders: N (%) 1 (20.0) — More than one color: N (%)   1 (20.0) — Years since the nevus existed: N (%) – 3 1 (20.0) – 9 1 (20.0) – Unknown 3 (60.0) Scalp area affected: N (%) – Occipital 3 (60.0) – Midscalp 1 (20.0) – Temporal 1 (20.0) Trichoscopic findings: N (%) – Vellus hairs 5 (100.0) – Small hair in regrowth 4 (80.0) – Black dots 4 (80.0) – Broken hair 4 (80.0) – Yellow dots with vellus hair 3 (60.0) – Circular hairs 3 (60.0) – Empty yellow dots 2 (40.0) – Exclamation mark hairs 2 (40.0) – Pigtail hair 1 (20.0) – Pili torti 1 (20.0) – Branching tortuous vessels 1 (20.0) Table 1 continues S4C Sticky Note AQ: Table 1 Callout missing. vijayakumars Sticky Note Marked set by vijayakumars vijayakumars Sticky Note Marked set by vijayakumars vijayakumars Sticky Note Marked set by vijayakumars vijayakumars Sticky Note Marked set by vijayakumars vijayakumars Sticky Note Marked set by vijayakumars 4 Research Letter | Dermatol Pract Concept. 2025;15(1):4742 4. Kim SM, Sohng C, Kim JY, Jang YH, Lee SJ, Lee WJ. A Case of Perinevoid Alopecia on the Scalp. Ann Dermatol. 2019;31(2):244-246. DOI: 10.5021/ad.2019.31.2.244. PMID: 33911583; PMCID: PMC7992677.5. 5. Zhang Y, Zhang J, Zhou C. Perinevoid Alopecia: Report of Two Cases and Literature Review. Clin Cosmet Investig Dermatol. 2023 11;16:1003-1008. DOI: 10.2147/CCID.S400247. PMID: 37070000; PMCID: PMC10105572. 6. Melo DF, Dutra TBS, Baggieri VMAC, Tortelly VD. Intral- esional betamethasone as a therapeutic option for alope- cia areata. An Bras Dermatol. 2018;93(2):311-312. DOI: 10.1590/abd1806-4841.20187423. PMID: 29723356; PMCID: PMC5916422. References 1. Kimura H, Nagase K, Narisawa Y. Perinevoid alopecia: a case report and literature review. Br J Dermatol. 2018 Oct;179(4): 969-970. DOI: 10.1111/bjd.16709. PMID: 29704462. 2. Ruiz-Arriaga LF, López-García L, Vega-Memije ME. Perinevoid Alopecia: A Case Report. Skin Appendage Disord. 2019;5(2): 94-96. DOI: 10.1159/000490469. PMID: 30815441. PMCID: PMC6388562. 3. Machado JLR, Cortez de Almeida RF, Frattini SC, Melo DF. Perinevoid Alopecia: an Unusual Presentation of Alopecia Areata. Dermatol Pract Concept. 2022;12(3):e2022112. DOI: 10.5826 /dpc.1203a112. PMID: 36159147; PMCID: PMC9464527. Characteristics  Statistics or Categories Obtained Values (N = 5; 100.0%) Dermoscopic pattern of nevus: N (%) – Homogeneous-globular 2 (40.0) – Reticular 1 (20.0) – Homogeneous 1 (20.0) – Reticular-globular 1 (20.0) Treatment: N (%) — Topical steroid – Clobetasol cream once a day 3 months 3 (60.0) 24 months 1 (20.0) — Intralesional steroids – Betamethasone once a month per session 3 sessions 6 sessions 2 (40.0) 1 (20.0) — Topical minoxidil – Minoxidil 5% (twice daily) for 4 months 1 (20.0) — Systemic steroids – Prednisone (60mg twice/week) for 6 months 1 (20.0) Outcome: N (%) – Complete hair regrowth – Drop out 3 (60.0) 2 (40.0) Table 1. Epidemiological, Clinical, Dermoscopic Findings, and Management of Perinevoid Alopecia. 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