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A comparative study of histopathologic features in alopecia areata and pattern hair loss.
J Cutan Pathol. 2023 Jun; 50(6):563-567.JC

Abstract

BACKGROUND

When peribulbar infiltrates are absent, other histopathologic findings are necessary to distinguish alopecia areata (AA) from pattern hair loss (PHL). The purpose of this study is to determine which histopathologic features are most useful for differentiation.

METHODS

A retrospective slide review was conducted of AA and PHL scalp biopsy specimens from 2014 to 2019 at a tertiary referral center.

RESULTS

Ninety-six cases were retrieved, of which 38 were AA. Peribulbar infiltrates were identified in 24 AA (63.2%) cases. A catagen/telogen shift was observed more frequently in AA than PHL (25 cases, 65.5% vs. 10 cases, 17.2%; p ≤ 0.0001). Lymphocytes (4 cases, 10.5% vs. 1 case, 1.7%; p = 0.058) and melanin (25 cases, 65.8% vs. 5 cases, 8.6%; p ≤ 0.0001) in fibrous tracts were more common in AA. Apoptotic bodies within vellus hairs were more frequently identified in AA (32 cases, 84.2% vs. 37 cases, 63.8%; p = 0.030). Small dystrophic follicles were also more common in AA (16 cases, 42.1% vs. 1 case, 1.7%; p < 0.0001).

CONCLUSIONS

Common features of AA other than peribulbar infiltrates include a catagen/telogen shift, melanin in fibrous tracts, and small dystrophic follicles. Practitioners should consider these features when distinguishing AA from PHL in specimens without peribulbar infiltrates. The retrospective design limits our ability to exclude multifactorial alopecia, such as telogen effluvium.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Plante J
Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA.
Valdebran M
Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA. Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.
Forcucci J
Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Bosland J
Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Elbendary A
Dermatology Department, Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Jaiswal R
Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Elston D
Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

MeSH

HumansAlopecia AreataRetrospective StudiesMelaninsAlopeciaHair Follicle

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36606876

Citation

Plante, John, et al. "A Comparative Study of Histopathologic Features in Alopecia Areata and Pattern Hair Loss." Journal of Cutaneous Pathology, vol. 50, no. 6, 2023, pp. 563-567.
Plante J, Valdebran M, Forcucci J, et al. A comparative study of histopathologic features in alopecia areata and pattern hair loss. J Cutan Pathol. 2023;50(6):563-567.
Plante, J., Valdebran, M., Forcucci, J., Bosland, J., Elbendary, A., Jaiswal, R., & Elston, D. (2023). A comparative study of histopathologic features in alopecia areata and pattern hair loss. Journal of Cutaneous Pathology, 50(6), 563-567. https://doi.org/10.1111/cup.14384
Plante J, et al. A Comparative Study of Histopathologic Features in Alopecia Areata and Pattern Hair Loss. J Cutan Pathol. 2023;50(6):563-567. PubMed PMID: 36606876.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative study of histopathologic features in alopecia areata and pattern hair loss. AU - Plante,John, AU - Valdebran,Manuel, AU - Forcucci,Jessica, AU - Bosland,John, AU - Elbendary,Amira, AU - Jaiswal,Richa, AU - Elston,Dirk, Y1 - 2023/01/19/ PY - 2022/12/03/revised PY - 2022/05/27/received PY - 2023/01/04/accepted PY - 2023/5/17/medline PY - 2023/1/7/pubmed PY - 2023/1/6/entrez KW - alopecia areata KW - androgenetic alopecia KW - histopathology KW - pattern hair loss SP - 563 EP - 567 JF - Journal of cutaneous pathology JO - J Cutan Pathol VL - 50 IS - 6 N2 - BACKGROUND: When peribulbar infiltrates are absent, other histopathologic findings are necessary to distinguish alopecia areata (AA) from pattern hair loss (PHL). The purpose of this study is to determine which histopathologic features are most useful for differentiation. METHODS: A retrospective slide review was conducted of AA and PHL scalp biopsy specimens from 2014 to 2019 at a tertiary referral center. RESULTS: Ninety-six cases were retrieved, of which 38 were AA. Peribulbar infiltrates were identified in 24 AA (63.2%) cases. A catagen/telogen shift was observed more frequently in AA than PHL (25 cases, 65.5% vs. 10 cases, 17.2%; p ≤ 0.0001). Lymphocytes (4 cases, 10.5% vs. 1 case, 1.7%; p = 0.058) and melanin (25 cases, 65.8% vs. 5 cases, 8.6%; p ≤ 0.0001) in fibrous tracts were more common in AA. Apoptotic bodies within vellus hairs were more frequently identified in AA (32 cases, 84.2% vs. 37 cases, 63.8%; p = 0.030). Small dystrophic follicles were also more common in AA (16 cases, 42.1% vs. 1 case, 1.7%; p < 0.0001). CONCLUSIONS: Common features of AA other than peribulbar infiltrates include a catagen/telogen shift, melanin in fibrous tracts, and small dystrophic follicles. Practitioners should consider these features when distinguishing AA from PHL in specimens without peribulbar infiltrates. The retrospective design limits our ability to exclude multifactorial alopecia, such as telogen effluvium. SN - 1600-0560 UR - https://www.unboundmedicine.com/medline/citation/36606876/A_comparative_study_of_histopathologic_features_in_alopecia_areata_and_pattern_hair_loss_ DB - PRIME DP - Unbound Medicine ER -