The histology of the lesions was indistinguishable from that of alopecia areata, except for a remarkable eosinophilic infiltrate. described 9 female cases of an acute and diffuse hair loss, which they termed “acute diffuse and total alopecia of the female scalp”. The time from the initial onset of the excessive hair loss to total hair loss was two months on average, which is similar to our patient. Choi and Ihm 3 classified a group of 13 patients (3 males and 10 females) who experienced acute diffuse hair loss over the entire scalp as having acute alopecia totalis. In all such cases, the dermoscopic findings were suggestive of AAI, showing diffuse, round or polycyclic yellow dots, which is a specific feature of alopecia areata, and regrowing, tapered, terminal hairs. 7 reported 70 patients with AAI, of whom 50 were histologically confirmed. 7 Follicular density is preserved in the acute and subacute stages, but it may decrease over time. 6 Additionally, a reversal in the anagen-telogen and terminal-vellus ratios is always observed and may be the only evidence suggesting the diagnosis in long-standing cases. ![]() This infiltrate gradually decreases with chronicity and concentrates around either only the miniaturized follicles or the follicular stelae (streamers). ![]() 5 The most consistent finding in acute AAI scalp biopsies is an inflammatory infiltrate around the terminal hair bulb. A strong female predominance (86.6%) is evident in the 112 cases that have been reported.Īlthough clinically different from other forms of alopecia areata, the histopathologic findings of AAI are similar to the classical forms of the disease and include its variation with disease stage. AAI is more common in patients under the age of 40, especially in those from 20 to 40 years of age. Similar cases have been described under different names, including “acute alopecia totalis” 3 and “acute diffuse and total alopecia of the female scalp”, 1,4 which are identical to AAI. The disorder has an extremely acute onset with subsequent diffuse hair loss that occurs within a few weeks. The patient was not taking any other medications.Īlopecia areata incognita (AAI) was first described by Rebora 2 in 1987. ![]() Her personal history included trichotillomania, which was diagnosed before age 20 and completely regressed after one year on antidepressive agents. The patient was otherwise healthy, but she noticed that her hair loss began after a stressful business trip. CASE REPORTĪ 23-year-old Brazilian woman was referred with rapidly progressing hair loss that became apparent over a period of two weeks ( Figure 1). 1 Prognosis is generally favorable, especially as compared to certain variants of alopecia areata, namely, alopecia areata totalis, universalis and ophiasic areata. While the clinical picture presented by this disease closely resembles that of telogen effluvium, specific clinical and dermoscopic findings of alopecia areata are invariably present along the disease course. ![]() In cases of alopecia areata incognita, the typical patchy distribution of hair loss in classical alopecia areata is absent, but abrupt and intense hair loss is characteristic. Alopecia areata incognita, also known as diffuse alopecia areata, is a rare form of alopecia areata described predominantly in young women.
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