Alopecia Areata in Skin of Color: Trichoscopic Analysis in Black/African American Patients

Alopecia areata (AA) has a higher prevalence in populations with skin of color, yet the trichoscopic features in this population remain underexplored.

To identify trichoscopic findings present in a cohort of Black patients with a diagnosis of alopecia areata.

The electronic medical records system was used to retrospectively analyze the trichoscopic images and medical records of 10 Black patients with a clinical diagnosis of AA who were seen and treated at an academic hair loss clinic between 2019 and 2024. Clinical and trichoscopic images of the scalp were reviewed independently by two board-certified dermatologists. Statistical analysis using the Mann-Whitney U Test highlighted significant trends in the occurrence of these features across varying severity levels as per the Severity of Alopecia Tool (SALT) scores.

Commonly reported features such as vellus hairs, black dots, and tapering hairs, alongside novel features including peripilar hyperpigmentation, follicular hypopigmentation, diffuse erythema, uninterrupted honeycomb patterns, and perifollicular scale were observed. No statistical significance was noted between the presence of trichoscopic features and the correlated SALT score.

This study underscores the need for improved understanding and documentation of AA in Black individuals. Identification of trichoscopic features in AA will aid physicians with diagnosis and decrease the threshold for diagnosis of co-existing alopecias.