**13. Alopecia Areata**

Alopecia areata (Fig 11) is one form of non-scarring alopecia characterize by patchy hair loss of autoimmune origin. It usually presents as a single or multiple confluent patches of nonscarring alopecia. Spontaneous regression of the disease is common in this disease and the hair may grow back if the affected region is small. Topical treatment is effective including cortico‐ steroids clobetasol or fluocinonide, corticosteroid injections, or cream, steroid injections, topical minoxidil, irritants (anthralin or topical coal tar), and topical immunotherapy. Oral corticosteroids decrease the hair loss, but only for the period during which they are taken.

Direct immunofluorescence highlights the presence of colloid bodies in the peri-infundibular

By immunohistochemistry staining [12], there is a significant alteration in the basement membrane structure in lesions of LPP which could differentiate it from active lesions of scalp

**Figure 10.** Anti-type IV collagen staining in LPP. Interrupted expression of type IV collagen in an affected hair follicle in an LPP lesion with projections into the underlying dermis, with the adjacent epidermis showing normal expression

The diagnosis of this type of alopecia is usually based on a thorough history and a focused physical examination. In some patients, punch biopsy may be necessary if the cause of hair loss is unclear as has been described previously. The focus in the following discussion will be on alopecia areata and androgenetic alopecia (the skin biopsies will be needed in some of

Alopecia areata (Fig 11) is one form of non-scarring alopecia characterize by patchy hair loss of autoimmune origin. It usually presents as a single or multiple confluent patches of nonscarring alopecia. Spontaneous regression of the disease is common in this disease and the hair may grow back if the affected region is small. Topical treatment is effective including cortico‐ steroids clobetasol or fluocinonide, corticosteroid injections, or cream, steroid injections,

area staining with IgM (less frequently with IgG, IgA and C3).

DLE lesions.

22 Skin Biopsy - Diagnosis and Treatment

of the collagen

cases).

**12. Non scarring alopecia**

**13. Alopecia Areata**

Diagnostic pathological findings (Fig 12) are more prominent in this type of alopecia which characterize by peribulbar lymphocytic inflammation which is usually considered to be an essential finding in establishing the diagnosis [13]. The lymphocytic

infiltrate is rich in helper T cells, which are considered to be evidence of an autoimmune process. Despite this, it may be absent in many scalp biopsy specimens. In the acute stage; a moderate to dense inflammatory cell infiltrate (mainly lymphocytes and langerhans cells) [14] develops around anagen hair and this leads finally to anagen arrest and inhibition which weakens the lowest portion of the

hair shaft. Using follicular counts [15] related to the stage of disease is a useful way to establish the histologic features of alopecia areata in scalp biopsy specimens taken from different types of alopecia areata; alopecia areata should be suspected when high percentages of telogen hairs are present, even in the absence of a peribulbar infiltrate [15].

**Figure 11.** Alopecia areata in a child presented with diffuse hair loss.

sity Medical Center, February 10 and 11, 2001. J. Am. Acad. Dermatol. 2003; 48; 103–

Scalp Biopsy and Diagnosis of Common Hair Loss Problems

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**Figure 12.** Skin biopsy from a patient with alopecia areata demonstrating perifollicular lymphocytic infiltrate.
