Clinical, dermoscopic and histopathological assessment in patients of alopecia areata: A hospital based cross-sectional study

Abstract

Background Alopecia areata is a common, non-scarring, autoimmune, chronic inflammatory disease involving the hair follicles, characterized by hair loss on scalp and/ or body. Objective To study clinical, dermoscopic and histopathological findings in patients of alopecia areata. Materials and Methods Fifty consecutive patients attending dermatology outpatient department of a tertiary care hospital over a period of 2 years with clinical features suggestive of alopecia areata were selected. Detailed history, clinical examination followed by dermoscopy and skin biopsy taken from the margin of an active lesion. The data was analyzed, tabulated and mean, standard deviation and percentages wherever needed were calculated. Results The Commonest age group affected was 21-30 years (46%). Males 41 (82%) were affected more than females 9(18%). Scalp 41(82%) was the most common site involved, followed by beard area 8(16%). According to classification based on extent and pattern of hair loss, localized patchy alopecia 49(98%) was the most common type, followed by alopecia totalis 1(2%). However, no case of alopecia universalis was encountered during our study period. Patchy alopecia with multiple patches (more than 3), seen in 23 (46%) patients, was the most common type.  Nail pitting was the most common nail change noted in 13(26%) cases. The most common dermoscopic finding in our study was decreased anagen: telogen (A:T) ratio 43(86%), followed by yellow dots 42(84%), black dots 37(74%), short vellus hair 24(48%), broken hair 18(36%), dystrophic hair 16(32%), tapering hair 6(12%) etc. The most common histopathological finding in our study was decreased A:T ratio  seen in 43(86%), followed by peribulbar infiltrate 36(72%), follicular keratinous plugs 32(64%), dystrophic hairs 30(60%), miniaturized hair 22(44%) etc. Conclusion This study reaffirms the male predisposition, predominant scalp involvement and nail pitting as the most common findings. Dermoscopy can aid in the diagnosis of alopecia areata and may obviate its need in diagnosis.