Report
The role of scalp dermoscopy in the diagnosis of alopecia areata incognita

https://doi.org/10.1016/j.jaad.2008.03.031Get rights and content

Background

Alopecia areata incognita is a variety of alopecia areata characterized by acute diffuse shedding of telogen hairs without typical patches.

Objective

We sought to report the clinical, pathological, and dermoscopic features of alopecia areata incognita.

Methods

Seventy patients with alopecia areata incognita were evaluated clinically and with videodermoscopy during the period of 2002 to 2006. Pathology was performed in 50 patients.

Results

The presence of numerous, diffuse, round or polycyclic yellow dots, different in size and uniform in color and distribution, was a typical dermoscopic feature in all patients. Short regrowing hairs were also present. The dermoscopic findings were correlated and supported by the histologic features of the scalp specimens.

Limitations

Scalp biopsy was performed only in 50 patients.

Conclusion

Videodermoscopy is a first step before performing a biopsy. It can help the clinician to find the right place to take the sample, but can also avoid unnecessary biopsies.

Section snippets

Case reports

All patients, 58 female and 12 male (mean age 33.37 years), presented with severe and diffuse hair loss, lasting from 2 weeks to 2 months before our examination. The patients were seen at the Department of Dermatology of the Universities of Bologna (50 patients) and Catania (20 patients), Italy, during the period of 2002 to 2006. All patients had severe hair thinning, often with a sudden loss of more than 60% of their scalp hairs. Clinical examination revealed diffuse hair thinning in all cases

Results

The dermoscopic features of the scalp were similar in all patients. Using the epiluminescent mode of operation, the scalp showed many diffuse, round or polycyclic yellow dots, which varied in size and were uniform in color and distribution. The yellow dots were evident within the follicular ostium of both empty and hair-bearing follicles and affected about 70% of the follicles. A large number of regrowing, tapered, terminal hairs (2-4 mm long) was also evident in the entire scalp (Fig 3).

Discussion

AAI is a variety of alopecia areata that mimics telogen effluvium. AAI has an acute onset and produces diffuse and severe hair thinning in a few months. Women are most commonly affected. Clinical history is negative for events known as possible causes of telogen effluvium.

From a pathological point of view, AAI should be suspected when high percentages of telogen hairs and/or miniaturized hairs are present even in the absence of a peribulbar lymphocytic infiltrate. The presence of a subtle

References (5)

There are more references available in the full text version of this article.

Cited by (134)

  • Alopecia areata incognito: an elusive disease

    2024, International Journal of Dermatology
View all citing articles on Scopus

Funding sources: None.

Conflicts of interest: None declared.

Reprints not available from the authors.

View full text