Alopecia Areata Workup

  • Author: Chantal Bolduc, MD, FRCP(C); Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 3, 2012
 

Procedures

Diagnosis usually can be made on clinical grounds; a scalp biopsy seldom is needed, but it can be helpful when the clinical diagnosis is less certain.

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Histologic Findings

A histologic diagnosis of alopecia areata can be made when characteristic features are present. Horizontal sections usually are preferred to vertical sections because they allow examination of multiple hair follicles at different levels.

The most characteristic feature is a peribulbar lymphocytic infiltrate, which is described as appearing similar to a swarm of bees. The infiltrate often is sparse and usually involves only a few of the affected hairs in a biopsy specimen. Occasionally, no inflammation is found, which can result in diagnostic difficulties. A significant decrease in terminal hairs is associated with an increase in vellus hairs, with a ratio of 1.1:1 (normal is 7:1). Other helpful findings include pigment incontinence in the hair bulb and follicular stellae.

A shift occurs in the anagen-to-telogen ratio, which is not specific. The normal ratio is approximately 90% anagen phase to 10% telogen phase hair follicles; in alopecia areata, 73% of hairs are found to be in the anagen phase and 27% in the telogen phase. In long-standing cases of alopecia areata, the percentage of telogen-phase hairs can approach 100%. Degenerative changes of the hair matrix can be found but are uncommon. Eosinophils may be present in fibrous tracts and near hair bulbs.

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Contributor Information and Disclosures
Author

Chantal Bolduc, MD, FRCP(C)  Assistant Professor, Department of Dermatology, University of Montreal Faculty of Medicine; Physician, Innovaderm Research, Inc

Chantal Bolduc, MD, FRCP(C) is a member of the following medical societies: Canadian Dermatology Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Harvey Lui, MD, FRCPC  Professor and Head, Department of Dermatology and Skin Science, Vancouver General Hospital, University of British Columbia; Medical Director, The Skin Centre, Lions Laser Skin Centre and Psoriasis and Phototherapy Clinic, Vancouver General Hospital

Harvey Lui, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Society for Laser Medicine and Surgery, American Society for Photobiology, Canadian Dermatology Association, Canadian Dermatology Foundation, Canadian Medical Association, College of Physicians and Surgeons of British Columbia, European Academy of Dermatology and Venereology, National Psoriasis Foundation, North American Hair Research Society, and Photomedicine Society

Disclosure: Astellas Consulting fee Review panel membership; Amgen/Wyeth Consulting fee Speaking and teaching; LEO Pharma Honoraria Speaking and teaching; LEO Pharma Grant/research funds Investigator; Galderma Grant/research funds Other

Jerry Shapiro, MD, FRCP(C)  Clinical Associate Professor, Department of Medicine, Division of Dermatology, University of British Columbia, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Sperling, MD  Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Alopecia areata affecting the beard.
Alopecia areata affecting the arms.
Patchy alopecia areata.
Ophiasis pattern of alopecia areata.
Sisaipho pattern of alopecia areata.
Alopecia totalis.
Diffuse alopecia areata.
Corticosteroid injection.
Treatment algorithm for alopecia areata.
 
 
 
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