Objective: To explore the characteristics of diffuse type of alopecia areata (AA) by analyzing data from clinical observations, histopathological and serological tests, as well as to assess the response to treatment modules.
Methods: Clinical data, including pathological findings of 9 patients with clinical features of diffuse AA, were analyzed retrospectively.
Results: 7 female and 2 male patients, first presenting in Spring and Summer time with a history of acute diffuse hair loss for a few months without obvious patches of hair loss. Three patients developed their scalp hair loss within 4 months but regrowth started before shedding of scalp hair completed and recovered fully within 6 months. One patient had a history of atopic dermatitis, and elevated serum IgE levels were found in the other 2 patients. Histopathology of scalp biopsies from all 9 patients showed increased frequency of catagen and telogen hair follicles, and peri-follicular inflammatory infiltration at the bulb area. Prominent eosinophilic infiltration around hair follicles was found in 3 patients. Immunohistochemistry showed moderate to intense lymphocytic infiltration around hair follicles and vessels. Both CD4+ and CD8+ cells were equally present in lymphocytic infiltrates. All of 9 cases were given Compound Glycyrrhizin Tablets and topical minoxidil, 5 cases were given systemic corticosteroids. All of them responded well, but two patients relapsed and presented as multiple AA patches and alopecia universalis respectively.
Conclusion: We reported 9 Chinese patients with diffuse AA who had acute hair loss in the Spring and Summer time. Histopathology showed changes typical of an acute or subacute phase of AA. This subtype of AA presents a comparatively benign clinical process with a possible involvement of hypersensitivity in the onset of the disease. An early and exact diagnosis with proper treatment using systemic corticosteroids and immunomodulators assures a quick recovery and may prevent further relapse.