I absolutely agree that dirty dots are due to dirt that deposits on the scalp. However, I believe that the reason we do not see this dirt in adults is not just because adults know how to shampoo but because of the sebaceous activity that washes the dirt from the scalp surface. In fact, in adult scalps, we do not see dirty particles even if the scalp has not been washed for several days, and we also do not see this feature in adolescents who are strongly involved in sports activities with exposure to “environmental dirt.”
Tosti A. A New Dermoscopic Finding in Healthy Children: Dirt!—Reply. Arch Dermatol. 2009;145(10):1198. doi:10.1001/archdermatol.2009.244
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