Diagnostic Challenges in Determining Alopecia Areata

The 2013 document outlines the difficulties in diagnosing alopecia areata (AA), a non-scarring autoimmune hair loss condition, and distinguishing it from other types of hair loss. It emphasizes the importance of a thorough history and examination, including all hair-bearing areas and nails, to identify clinical features and associated comorbidities. The paper also discusses the role of stress, medications, and genetic factors in triggering AA. Diagnostic tests such as the wash test, pull test, trichogram, scalp dermoscopy, and scalp biopsy are detailed for their utility in differentiating AA from conditions like androgenetic alopecia, telogen effluvium, and others. Dermatoscopic patterns like yellow dots and exclamation mark hairs are particularly noted for their diagnostic value. The document acknowledges the existence of drug-induced AA, particularly with anti-TNF-α biologic drugs and DMARDs, and the potential for hair regrowth upon drug withdrawal. Despite available treatments, none are curative or preventative, and the document anticipates future developments in diagnostic and therapeutic algorithms based on dermoscopy, while calling for further research into AA.