Clinicopathological Features of Alopecia With an Emphasis on Etiology and Histopathological Characteristics of Scarring Alopecia

Abstract

IntroductionAlopecia is a common dermatological condition with varied etiologies based on age, gender and geographic location. Non-cicatricial (non-scarring) alopecia is more common but often not biopsied. Alternatively, primary cicatricial (scarring) alopecia is diagnostically more challenging and more commonly biopsied to determine the etiology. In this study, we evaluated the clinicopathological characteristics of alopecia in our population. MethodsWe conducted a retrospective study at the Department of Histopathology, Liaquat National Hospital and Medical College, Pakistan. A total of 104 patients were enrolled in the study who underwent scalp biopsy for alopecia over a period of 11 years. Clinical data were obtained from clinical referral forms, which included age, sex of the patients and duration of the lesions. Three hematoxylin and eosin-stained tissue sections, along with periodic acid-Schiff (PAS), PAS with diastase and collagen stains were examined, and histopathological diagnosis was rendered. ResultsOur study demonstrated that alopecia was more prevalent among females, accounting for 73.1% of cases. Most of the patients belonged to the age group of <35 years (53.8%). The type of alopecia in 88.5% of the cases was scarring, while there were 11.5% cases of non-scarring alopecia. The most common diagnoses were discoid lupus erythematosus (DLE) (23.1%) and pseudopelade of Brocq (PB) (23.1%), followed by lichen planopilaris (LPP) (15.4%). A significant association was noted between the histological features and the diagnosis, as epidermal atrophy was the most common histological feature in most cases of DLE, followed by periadnexal infiltrates, lymphocytic infiltrates, follicular plugging and basement membrane thickening. In LPP, the most common histological features were perifollicular infiltrates and fibrosis. In PB, the frequently recurring histological features in most cases were the loss of sebaceous glands, dermal fibrosis and epidermal thinning. ConclusionIn this study, we demonstrated the key role of skin punch biopsy and histology in determining the accurate etiology of scarring alopecia. We found discoid lupus erythematosus and pseudopelade of Brocq to be the most common causes of scarring alopecia, followed by lichen planopilaris.

Histopathologic Spectrum of Alopecias Seen in a Jamaican Setting

“…In other richly pigmented skin populations, DLE most commonly biopsied CA. 4–6,9,10,14,15 In our population, it is not. Again, this divergence may result from our Afro-Caribbean majority population where CCCA is evidently a relatively prevalent disease.…”

“…This mirrors findings in similar studies, although more exaggerated than in other populations (F:M = 1.7–2.7:1). 4–6,9,10 This increased ratio was maintained for all subsets of alopecias, except neutrophilic scarring (M:F ratio = 1.79:1), typically more common in males. 11 This female preponderance is likely multifactorial.…”

“…This contrasts with other non-Black but richly pigmented skin populations and White-predominant populations where DLE and LPP are the most commonly biopsied CAs, respectively. [4][5][6]9,10,14,15 FD and chronic TA (including MFA component diagnoses) were the second most common. Although chronic TA was unsurprising given common hairstyling practices in Afro-Caribbean populations, the high proportion of FD was unexpected.…”

“…Discoid lupus erythematosus (DLE), pseudopelade of Brocq, and LPP were most common. 5 Similarly, in Brazil, DLE followed by pseudopelade of Brocq and LPP were most frequently biopsied. 6 No data exist regarding the etiology of alopecia in the English-speaking Caribbean, a unique population composed primarily of persons of African descent.…”

An Update on Alopecia and its Association With Thyroid Autoimmune Diseases

“…Alopecia is a dermatological disorder characterized by hair loss from the scalp or body. [1][2][3] It is one of the most common dermatological disorders worldwide and has several aetiologies, such as hereditary background, hormonal imbalance, infection or idiopathic causes. 1,3,4 Alopecia can be classified into two main categories: scarring (or cicatricial) alopecia and non-scarring (noncicatricial) alopecia (Figure 1).…”