Dr. Victoria Barbosa, associate professor of medicine at the University of Chicago Pritzker School of Medicine, spoke with Next Steps in Derm, in partnership with Skin of Color Update, about the two categories of nonscarring alopecias. Hear why Dr. Barbosa says clinicians need to give ample time to counseling patients about behavioral changes to prevent progression of hair loss. Learn about recently approved treatments that are changing clinical practice in the treatment of alopecia areata. Find out how established medications are finding a new use in the treatment of female pattern hair loss and how combination therapies may be the future. Plus hear Dr. Barbosa’s approach to telogen effluvium from weight loss.
Further Reading
If you want to read more about nonscarring alopecias in patients with skin of color, check out the following articles published in the Journal of Drugs in Dermatology:
Alopecia Areata in Skin of Color: Trichoscopic Analysis in Black/African American Patients
ABSTRACT
Importance: Alopecia areata (AA) has a higher prevalence in populations with skin of color, yet the trichoscopic features in this population remain underexplored.
Objective: To identify trichoscopic findings present in a cohort of Black patients with a diagnosis of alopecia areata.
Evidence Review: 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.
Findings: 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.
Conclusions and Relevance: 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.
Minimizing Bias in Alopecia Diagnosis in Skin of Color Patients
ABSTRACT
Alopecia is one of the most common dermatologic conditions affecting black patients, with a significantly negative impact on quality of life.1,2 Timely and accurate diagnosis is therefore critical in order to reverse or halt progression of disease.3 Unfortunately, lack of representation of skin of color (SOC) patients in the current literature may contribute to misdiagnosis as providers may be unfamiliar with the clinical spectrum of alopecia presenting in darker scalps.4 Some scarring alopecia subtypes such as Central Centrifugal Cicatricial Alopecia (CCCA) are more prevalent in certain racial groups. However, focusing solely on patient demographics and gross clinical findings may obscure accurate diagnoses. To distinguish alopecia findings in Black patients, a dedicated approach using a combination of clinical exam findings and patient history, along with trichoscopy and biopsy, is essential to prevent misdiagnosis and improve clinical and diagnostic outcomes. We present three cases of alopecia in patients of color which the initial suspected clinical diagnosis did not correspond with trichoscopic and biopsy results. We challenge clinicians to reexamine their biases and fully evaluate patients of color with alopecia. An examination should include a thorough history, clinical examination, trichoscopy, and potentially a biopsy, particularly when findings do not correlate. Our cases highlight the challenges and disparities that exist in diagnosis of alopecia in Black patients. We emphasize the need for continued research regarding alopecia in skin of color and the importance of a complete workup for alopecia to improve diagnostic outcomes.
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