Alopecia areata predictive score: A new trichoscopy-based tool to predict treatment outcome in patients with patchy alopecia areata

Abstract

Introduction: There are no evidence-based data how to predict response to therapy in patients with alopecia areata.

Aim: The assessment of the predictive value of trichoscopy for the therapeutic outcome in patients with alopecia areata.

Methods: A total of 65 patients with patchy alopecia areata were included into the study. Trichoscopy was performed at baseline and 2 months after the treatment initiation. After 6 months, patients were classified as responders (27/65) and nonresponders (38/65).

Results: There were no differences between the groups in baseline trichoscopy. After 2 months, black dots, broken hairs, exclamation mark hairs, and tapered hairs occurred significantly more often in nonresponders compared to responders (19/38, 50% vs 3/27, 11%; 26/38, 68% vs 6/27, 22%; 23/38, 61% vs 5/27, 19% and 11/38, 29% vs 0/27, 0%, respectively). Upright regrowing hairs and pigtail hairs occurred significantly more often in responders compared to nonresponders (27/27, 100% vs 21/38, 55% and 9/27, 33% vs 3/38, 8%, respectively). A trichoscopy-based Alopecia Areata Predictive Score (min -4 to max 2) was developed. Probability of hair regrowth was 98.3%, 88.7%, 52.3%, 13.2%, 2.1%, 0.3%, and 0% in patients with score 2, 1, 0, -1, -2, -3, and -4, respectively.

Conclusions: In patchy alopecia areata, upright regrowing hairs and pigtail hairs are positive, while black dots, broken hairs, exclamation mark hairs, and tapered hairs negative predictive markers. Alopecia Areata Predictive Score is new trichoscopy-based tool to predict treatment outcome in patients with patchy alopecia areata.

Keywords: alopecia areata; dermatoscopy; dermoscopy; prognosis; trichoscopy.