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Dec, 2003
Histopathologic features of alopecia areata:
a new look.
Whiting DA.
Baylor Hair Research and Treatment Center, Dallas, TX 75246, USA. daddoc@dallasassocderm@com
BACKGROUND: A peribulbar lymphocytic infiltrate is the expected histologic
feature of alopecia areata, but it is absent in many scalp biopsy specimens.
Other diagnostic criteria are needed. OBJECTIVE: To establish the histologic
features of alopecia areata in scalp biopsy specimens taken from different types
of alopecia areata, using follicular counts to relate biopsy findings to stages
of the disease. METHODS: Fifty consecutive new patients with alopecia areata
were studied. Four-millimeter punch biopsy specimens were taken from the scalp
in areas of recent, active hair loss; old, inactive hair loss; or recent hair
regrowth. Specimens were sectioned horizontally. Terminal and vellus-like hairs
were counted. Inflammation and fibrosis around lower and upper follicles were
rated. RESULTS: The histopathologic features of alopecia areata were not
significantly affected by the sex, age, and race of the patient or by the type,
percentage of hair loss, total duration, or regression of alopecia areata. The
major factor affecting the histopathologic features was the duration of the
current episode of alopecia areata. In the acute stage, bulbar lymphocytes
surrounded terminal hairs in early episodes and miniaturized hairs in repeated
episodes. In the subacute stage, decreased anagen and increased catagen and
telogen hairs were characteristic. In the chronic stage, decreased terminal and
increased miniaturized hairs were found, with variable inflammation. During
recovery, increasing numbers of terminal anagen hairs from regrowth of
miniaturized hairs and a lack of inflammation were noted. CONCLUSIONS: The
histopathologic features of alopecia areata depend on the stage of the current
episode. Alopecia areata should be suspected when high percentages of telogen
hairs or miniaturized hairs are present, even in the absence of a peribulbar
lymphocytic infiltrate.
PMID: 14676070 [PubMed - in process]
 
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