Evaluation of Difficult Alopecia Areata Cases Requiring Histopathological Confirmation

This study investigates when histopathological confirmation is necessary for diagnosing atypical cases of alopecia areata (AA). Out of 137 patients, 10 (7.3%) required histopathological examination. The study found that unexpected trichoscopy features, such as loss of follicle ostium and vellus hair, are more common in cases with a long disease duration, while typical features like exclamation mark hairs and black dots may not always be present. The findings suggest that in challenging cases, histopathological confirmation can be crucial for accurate diagnosis.