Alopecia Areata Incognita: True or False?

In a letter to the editor, the authors challenge the conclusions of Tosti et al. regarding alopecia areata incognita, specifically disputing the specificity of yellow dots in scalp videodermoscopy as an indicator of alopecia areata. The authors conducted trichoscopy on 332 female patients with various types of alopecia and found that yellow dots were more indicative of female androgenic alopecia (FAGA), especially in the frontal area, and were also present in other diseases. They observed a condition in 24 women with rapid effluvium and diffuse hair thinning that did not fit existing classifications of hair loss, which they propose to call "acute hair miniaturization" or "Tosti alopecia." This condition was characterized by yellow dots across the scalp, thin pigmented hairs among thick terminal hairs, and histopathologic findings not indicative of alopecia areata. They conclude that there is a new disease entity that does not fit within the current classification of hair loss, but it is not a form of alopecia areata.