Macular Alopecia: A Single-Center Retrospective Cohort Study to Describe an Underrecognized Pattern of Alopecia

The prototypical non-scarring alopecia is alopecia areata (AA), which can present in multiple forms on the scalp, including patchy, ophiasis, sisaipho, diffuse, and totalis. Not included within current alopecia classification systems is a variant characterized by macules < 1 cm in diameter. Our objective was to identify and describe this variant of alopecia not previously recognized.

We conducted an institutional review board-approved, single-center retrospective chart review of patients presenting with hair loss to a pediatric dermatology clinic. Potential subjects were identified through a search using ICD9 and ICD10 codes for AA, alopecia unspecified, or other non-scarring alopecia from ambulatory dermatology visits from 2/1/2011 to 2/01/2024. After review, 392 patients with a diagnosis other than patchy AA or macular alopecia were excluded.

Of the 471 patients included in this study, 397 patients were categorized as patchy AA and 74 patients as macular alopecia. Compared to those with patchy AA, patients with macular alopecia had a female (57/74, 77%) and Hispanic/Latinx (46/74, 62%) predominance, with a younger median age of onset (5.9 years). Macular alopecia was located mainly near the parietal scalp. Patchy AA was located mainly on the occipital scalp. When follow-up data was available, resolution of hair loss without recurrence occurred in 63% of macular alopecia (median 5.0 months) and 20% of patchy AA patients (median 8.0 months), p < 0.001.

We propose the term "macular alopecia" for this entity characterized by small macules and spontaneous resolution within months.