Pre-/Postbiopsy Diagnosis Concordance in Women from an Afro-Caribbean Population: Response to Douglas et al

The document is a response to a study by Douglas et al. on the role of biopsy in managing alopecia in black women. The authors, practicing in Jamaica, evaluated 286 biopsy reports from Jamaican females with alopecia submitted to their dermatopathology service from January 2018 to December 2022. They found that pre-/postbiopsy diagnostic concordance was present in 76.6% of biopsies, with 65.3% having identical pre-/postbiopsy congruence and 34.7% having pathologic diagnoses compatible with a suspected clinical differential diagnosis. New diagnoses were made in 17.5% of cases, and biopsies were nondiagnostic in 5.9% of cases. The most common clinical impression was central centrifugal cicatricial alopecia (26.9%), which also mirrored the top pathologic diagnosis (25.2%). The authors found a 41% postbiopsy diagnosis discordance with clinically suspected traction alopecia. Despite some differences in findings, the authors agree with Douglas et al. on the importance of biopsy in managing alopecia in black women. They found potential postbiopsy adjustments to treatment in 44% (126) of cases.