Histopathological Diagnosis of Alopecia Clinically Relevant to Alopecia Areata

Chinmanat  Lekhavat; Pinyo  Rattanaumpawan; Antonella  Tosti; Tarinee  Korviriyakamol; Suthep  Jerasutat; Poonnawis  Sudtikoonaseth; Penvadee  Pattanaprichakul

doi:10.33192/smj.v75i2.260753

Authors

Chinmanat Lekhavat Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Bangkok / Science in Dermatology and Dermatosurgery Curriculum, Rangsit University, Pathum Thani
Pinyo Rattanaumpawan Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Antonella Tosti Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Florida
Tarinee Korviriyakamol Asoke Skin Hospital, Bangkok
Suthep Jerasutat Lions Supannahong Clinic, Bangkok
Poonnawis Sudtikoonaseth Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Bangkok / Science in Dermatology and Dermatosurgery Curriculum, Rangsit University, Pathum Thani
Penvadee Pattanaprichakul Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok

DOI:

https://doi.org/10.33192/smj.v75i2.260753

Keywords:

Alopecia areata, scarring alopecia, lichen planopilaris, lupus erythematosus panniculitis, hair disorders, histopathology

Abstract

Objective: To study the histopathological diagnosis of alopecia clinically relevant to AA and to compare the histopathology between acute and chronic AA divided by time to onset at three and six months.

Materials & Methods: We conducted a cross-sectional study of 113 patients with typical manifestation of AA. Two scalp biopsies were done horizontally and vertically to confirm diagnosis. Histological findings of AA in the acute group were subsequently compared with the chronic group.

Results: Of the 113 eligible patients, 109 (96.5%) were pathologically diagnosed with AA. Other diagnoses included lichen planopilaris, lupus panniculitis, and unspecified scarring alopecia. The percentage of terminal telogen hairs in the acute group was significantly higher than the chronic group (mean % anagen: % telogen ratio = 21.2%:78.8% vs. 36.0%:64.0%; p = 0.016), while the chronic group had a significantly higher number of follicular streamers (mean ± SD; 2.5 ± 2.2 vs. 3.7 ± 2.6; p = 0.023). The number of vellus hairs significantly increased in the acute group at the six-month onset (p = 0.006). The number of nanogen hairs also increased significantly in the chronic group at both the three- and six-month onset (p = 0.020 and p = 0.007).

Conclusion: Typical manifestations of AA are not always diagnosed as AA. Acute AA has more terminal telogens and vellus hairs, while chronic AA has more follicular streamers and nanogen hairs.

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