Sequential Cyclic Changes of Hair Roots Revealed by Dermoscopy Demonstrate a Progressive Mechanism of Diffuse Alopecia Areata Over Time

October 2018 in “ Experimental Dermatology ”

Xingqi Zhang, Yanting Ye, Zhen Zhu, Yuqing Yang, Hui Cao, Kevin J. McElwee, Yunxia Ling

diffuse alopecia areata patchy alopecia areata acute telogen effluvium anagen effluvium catagen telogen effluvium exogen dermoscopy histopathology hair follicle regression follicle miniaturization hair-cycle specific DAA PAA ATE

Studysummary This study suggests that diffuse alopecia areata initially involves an intense inflammatory attack during the anagen phase, progressing through different hair cycle stages with specific shedding patterns.

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The study analyzed the progression of diffuse alopecia areata (DAA) in 23 patients by observing hair roots and scalp changes through dermoscopy and histopathology, comparing them with 20 patchy AA (PAA) patients, 23 acute telogen effluvium (ATE) patients, and 10 normal controls. It found that DAA begins with anagen effluvium, characterized by intense inflammation and hair follicle regression, and progresses through catagen to telogen effluvium with premature exogen. Dermoscopic features varied with the disease stage, and histopathology in 9 patients revealed intense early inflammation and later follicle miniaturization. The study concluded that DAA's progression is hair-cycle specific and suggested that the changing hair root morphology over time should be considered in clinical analysis. The research was funded by the National Natural Science Foundation of China and the Natural Science Foundation of Guangdong Province.

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