Acute Diffuse and Total Alopecia of the Female Scalp: A New Subtype of Diffuse Alopecia Areata That Has a Favorable Prognosis – A Reply

In the document, Alfredo Rebora responds to a study by Sato-Kawamura et al. that identified 9 cases of a condition they named 'acute diffuse and total alopecia of the female scalp' (ADTAFS), suggesting it as a new subtype of diffuse alopecia areata with a favorable prognosis. Rebora argues that this condition, which is common in women and not rare in men, has already been recognized and named alopecia areata incognita (AAI). He points out that only 23% of patients with alopecia areata (AA) exhibit androgenetic alopecia (AGA) compared to 88% of controls, suggesting that AA may present differently in people with AGA. Rebora explains that the pathogenesis of AAI involves a cytostatic insult to the hair bulbs, leading to shedding of dystrophic hair and an increase in telogen hair shedding. He concludes that the condition described by Sato-Kawamura et al. is actually AAI and that understanding its pathogenetic mechanism negates the need for a new classification such as ADTAFS.