Pemphigus is an autoimmune intraepidermal bullous disease that can affect the skin and∕or mucous membranes. Trichoscopy is a non‐invasive tool that can help in the clinical diagnosis, especially if the patient is presented with only scalp lesions. We conducted this study to investigate the trichoscopic features of pemphigus scalp lesions. A total of 100 patients with a confirmed diagnosis of pemphigus entered the study; Seventy‐nine patients were diagnosed as pemphigus Vulgaris (PV) and 21 as pemphigus foliaceus (PF). Trichoscopy of the scalp lesions was performed, and three dermatologists examined each patient’s trichoscopic images separately. The results were re‐checked simultaneously by the examiners. Association between variables was analyzed using different tests, including chi‐square test or Fischer’s exact test, independent T‐Test or Mann–Whitney nonparametric test, and logistic regression model when applicable.

The patients’ average age was 45.41 ± 11.13 years, and 58% of cases were male. The most common trichoscopic features observed among all cases were diffuse scaling, any vessels’ presence, and extravasation. The researchers more commonly saw positive anagen pull test, extravasation, yellow hemorrhagic crust, and polymorphic vessels in PV than PF cases. They can differentiate between PV and PF scalp lesions with 74% sensitivity and 91% specificity by having data of these variables.