Alopecia areata

Case 532   June 2012 (R. Carr/S. Taibjee)  Female 47 years, scalp. Rule out scarring alopecia.

F 47 two occipital bald patches 

Sub-acute stage.  Only 2 of many views visible.  Apparently ↑ catagen and telogen follicles and fibrous stellar tracts.  Mild lymphocytic infiltrate in residual hair bulb.  

DD: trichotillomania shows excess miniaturised hairs.  

Case 1138  3.11.14 (IH Chaudhry)  The Patient is 18 years old Female hair loss, ? androgenetic alopecia ? telogen effluvium

F 18 hair loss (*teaching)  

Nice series of horizontal sections at different levels.  Increased number of follicles in catagen and telogen.  Little inflammation higher up and no scarring.  Light “buzz of bees” around bulbs in fat. 

Case 1279  19.5.15 (U. Sundram)  23 year old female graduate student with 2 cm oval patch on the right occipital scalp.

F 23 bald patch scalp (*teaching)  

Nice swarm of bees. 

Case 1644  13.10.16 (A. Bakshi)  2 year old girl with area of reduced hair growth in  parietal scalp, 2 biopsies from scalp’. Images 1,2, 3- vertical sections. Images 4,5,6,7- horizontal section at level of isthmus. Images 8, 9, 10- horizontal sections at dermo-subcutaneous junction

F 2 reduced hair in parietal scalp 

Chronic phase which no longer shows the peribulbar swarm of bees.

Nice series of vertical and horizontal sections.  Marked shift into telogen with miniaturistaion of follicles.  Termal:vellus 1:1 (normal 7:1 of course).   

Vellus follicle bulbs found high in dermis.   

DD: High telogen counts seen in T. effluvium and traction alopecia – neither shows  

        miniaturisation. 

        Androgenetic alopecia shows high miniaturisation but low telogen count 

Case 2696  5.11.20 (S. Taibjee) 45M, Hair loss – patchy. Scalp feels hot. No pruritus or pain.  

M 45 patchy hair loss 

Extensive series of transverse sections showing semi-acute stage of AA, combining many of the textbook features in one biopsy: miniaturisation with hair cycle shift (with increased number of catagen and telogen follicles); subtle peri-bulbar lymphocytic infiltrate, nicely highlighted by CD3; pigment casts (not entirely specific for AA). 

Case 2946  21 10.21 (S. Taibjee)  F 68 hairloss for months 

This example shows most of the classical features, but especially a peculiar, pink, cornified centre.  These have been called “nanogen” hairs - found in the middle or upper dermis, are minute and cycle rapidly, showing mixed features of anagen, catagen, and telogen. They may contain central pinkish remnants of inner root sheath, but they lack hair shafts, perhaps accounting for the empty infundibula often seen in alopecia areata. 

Ref: Whiting DA. Histopathologic features of alopecia areata.  

Arch Dermatol. 2003;139:1555-1559 

Case 4569 19.12.24 (I H Chaudhry) F 60 Year old female with frontal scalp - Incisional Biopsy for vertical sectioning Few months history of hair loss Bald patches with short hairs frontal and temporal hairline with areas of scanty