Alopecia areata. A pathological study of nonresponder patients

Fourteen patients, four male and 10 female and ranging in age from 11 to 57 years, affected by longstanding alopecia areata that had not responded to sensitizing treatments, were submitted to scalp biopsy. Five patients had alopecia totalis and nine had alopecia universalis. The biopsy was performed on a scalp area that had been bald for > or = 1 year. We distinguished four distinct pathological patterns, which we termed "established bald patch," "early regrowth," "telogen," and "scarring," in four, seven, one, and two patients, respectively. Our study shows that, from a pathological point of view, nonresponder patients constitute a heterogeneous population. The pathological study of the scalp helps predict therapeutic failure only in the small proportion of nonresponder patients that shows a scarring pathological pattern.