Alopecia Areata Incognita and Diffuse Alopecia Areata: Clinical, Trichoscopic, Histopathological, and Therapeutic Features of a 5-Year Study

Alopecia Areata Incognita and Diffuse Alopecia Areata: Clinical, Trichoscopic, Histopathological, and Therapeutic Features of a 5-Year Study

Authors

  • Aurora Alessandrini Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
  • Michela Starace Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
  • Francesca Bruni Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
  • Nicolò Brandi Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
  • Carlotta Baraldi Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
  • Cosimo Misciali Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
  • Pier Alessandro Fanti Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
  • Bianca Maria Piraccini Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy

Keywords:

alopecia areata incognita, diffuse alopecia areata, yellow dots, histopathology, therapy

Abstract

Background: Alopecia areata is a nonscarring hair loss that usually causes round patches of baldness, but alopecia areata incognita (AAI) and diffuse alopecia areata (DAA) can cause a diffuse and acute pattern of hair loss.

Objective: To analyze the clinical, trichoscopic, histological, and therapeutic features of AAI and DAA.

Methods: The study was designed to include data of patients with histological diagnosis of AAI and DAA enrolled in our Hair Disease Outpatient Consultations.

Results: DAA had a greater involvement of the parietal and anterior-temporal regions, while AAI manifested itself mainly in the occipital-parietal regions. The most frequent pattern was empty yellow dots, yellow dots with vellus hairs, and small hair in regrowth, but the presence of pigtail hair was found almost exclusively in those with AAI. In cases of DDA, the finding of dystrophic hair and black dots was more frequent. The most frequent trichoscopic sign in both diseases was the presence of empty yellow dots, which, however, were described in a higher percentage in cases of DAA. The diseases have a benign course and are responsive to topical steroid therapy.

Conclusions: Trichoscopy is very important for the differential diagnosis between the 2 diseases and to select the best site for biopsy. In the presence of diffuse hair thinning, these entities must be considered.

References

Rebora A. Alopecia areata incognita: a hypothesis. Dermatologica. 1987;174(5):214-218.

Molina L, Donati A, Valente NS, et al. Alopecia areata incognita. Clinics (Sao Paulo). 2011;66(3):513-515.

Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977;97(3):247-254.

Park J, Song KH, Nam KH. Circumscribed alopecia areata incognita. Australas J Dermatol. 2013;54(1):52-54.

Tosti A, Whiting D, Iorizzo M, et al. The role of scalp dermoscopy in the diagnosis of alopecia areata incognita. J Am Acad Dermatol. 2008;59(1):64-67.

Inui S, Nakajima T, Itami S. Significance of dermoscopy in acute diffuse and total alopecia of the female scalp: review of twenty cases. Dermatology. 2008;217(4):333-336.

Müller CSL, El Shabrawi-Caelen L. “Follicular Swiss cheese” pattern—another histopathologic clue to alopecia areata. J Cutan Pathol. 2011;38(2):185-189.

Strazzulla LC, Wang EHC, Avila L, et al. Alopecia areata: an appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15-24.

Miteva M, Misciali C, Fanti PA, et al. Histopathologic features of alopecia areata incognito: a review of 46 cases. J Cutan Pathol. 2012;39(6):596-602.

Downloads

Published

2019-10-31

Issue

Section

Research

How to Cite

1.
Alopecia Areata Incognita and Diffuse Alopecia Areata: Clinical, Trichoscopic, Histopathological, and Therapeutic Features of a 5-Year Study. Dermatol Pract Concept [Internet]. 2019 Oct. 31 [cited 2024 Mar. 29];9(4):272-7. Available from: https://dpcj.org/index.php/dpc/article/view/dermatol-pract-concept-articleid-dp0904a05