This case series highlights the diagnostic challenges in differentiating between scarring and nonscarring alopecia, as both patients presented with similar features yet had distinct underlying conditions.

The first patient (60 year old, female) was initially diagnosed with Frontal Fibrosing Alopecia due to the pattern of hair loss in the frontal area of the scalp. Trichoscopy shows perifollicular and interfollicular scaling, yellow crusts around the follicles, dotted vessels, yellow structureless areas with surrounding erythema. However, the patient responded well to Clobetasol Propionate 500mcg/mL Scalp Solution twice a day and Minoxidil 5% Solution twice a day for 30 days, which was not expected in patients with scarring alopecia. Further evaluation revealed that the hair loss was due to Telogen Effluvium and Seborrheic Dermatitis.

In contrast, the second patient (54 year old, female), which was managed as a case of Discoid Lupus Erythematosus of the scalp. Trichoscopy shows absence of follicular opening, white patches, perifollicular scale, white and brown dots. Despite receiving similar treatment, the patient did not experience any improvement, reinforcing the complexity of managing hair loss disorders.

A key aspect of this case series is the emphasis on Trichoscopy. It shows specific patterns associated with various types of alopecia, allowing for prompt diagnosis and treatment while reducing the need for unnecessary biopsies. It invites further discussion on the importance of accurate assessment, the role of Trichoscopy in diagnosis, and the potential for unexpected responses to treatment in Dermatology.