Taiba Trumboo, Yasmeen Jabeen Bhat, Obeid Shafi, Shafat Ahmad Tak, Saika Reyaz, Iffat Hassan Shah
Background: Pediatric hair and scalp disorders encompass a diverse array of conditions, requiring a systematic approach for accurate diagnosis. Incorporating trichoscopic and light microscopic examinations can enhance diagnostic accuracy. Objective: To evaluate the clinico-epidemiological, trichoscopic and light microscopic features of hair and scalp disorders in the pediatric population. Methods: A hospital-based cross-sectional study was conducted involving pediatric patients aged 0-12 years seeking medical attention for hair and scalp conditions. Trichoscopic and light microscopic examinations were used for diagnosis, and the agreement between these modalities was assessed with Cohen's Kappa coefficient. Results: A total of 220 children were examined, with a median age of 7 years and male-to-female ratio of 0.9:1. The median duration of illness was 4 months, and median age of disease onset was 5.75 years. The most prevalent conditions observed were scalp infections, followed by non-infectious scaly scalp dermatosis, and alopecia areata. Rare trichoscopic findings included "matchstick hair" in Netherton syndrome, trichoclasis in alopecia areata, trichoscopic features of transient neonatal hair loss, and new rare variants of tinea capitis, including alopecia areata-like, seborrheic dermatitis-like, and follicular pustular presentations. High agreement was found between trichoscopy and clinical diagnosis (Cohen's kappa = 0.917), as well as between trichoscopy and light microscopy (Cohen's kappa = 0.769). Conclusion: The findings underscore the significance of incorporating trichoscopic and light microscopy for diagnosing pediatric hair and scalp disorders, including rare genetic hair disorders. High agreement observed between trichoscopy, clinical diagnosis, and light microscopy emphasizes their utility as reliable non-invasive diagnostic tools in pediatric dermatology.