Scalp Biopsy Useful in Clarifying Alopecia Diagnosis Among Black Women

Black women who have alopecia without a clear diagnosis or multiple diagnoses should be offered a scalp biopsy, according to a research letter published in Journal of the American Academy of Dermatology.

Researchers retrospectively reviewed patient records collected between 2015 and 2020. They evaluated the prevalence of using scalp biopsy among Black women suspected of alopecia.

The study cohort comprised 420 women, of whom 34.5% were diagnosed with multiple types of alopecia and 18.3% were not diagnosed with a specific type of alopecia. Among the cohort with multiple diagnoses, the most common was traction alopecia (30.7%), followed by central centrifugal cicatricial alopecia (24.1%), and androgenetic alopecia (14.8%).

Among women with a single diagnosis, most were diagnosed with alopecia areata (n=76), followed by traction alopecia (n=51), central centrifugal cicatricial alopecia (n=41), androgenetic alopecia (n=13), lichen planopilaris or discoid lupus erythematosus (n=9), and telogen effluvium (n=8).

Few women (9.5%) underwent diagnostic biopsy.

Among the biopsy recipients, most were diagnosed with more than 1 alopecia conditions (50%), followed by central centrifugal cicatricial alopecia (15.0%), and no specific diagnosis (12.5%) prior to the biopsy. After biopsy, the diagnoses changed to central centrifugal cicatricial alopecia (27.5%), lichen planopilaris or discoid lupus erythematosus (27.5%), androgenetic alopecia (15.0%), androgenetic (5.0%), or telogen effluvium (5.0%). There were also more than 1 diagnoses (5.0%), and other diagnoses (15.0%) given to participants following biopsy.

Among women whose biopsy results led to a change in diagnosis (n=28), 75% had their treatment plan amended. The most common additions to treatment included topical steroids, topical minoxidil, and intralesional triamcinolone acetonide injections.

The limitations of this study include the absence of trichoscopy data and the lack of expert-reviewed biopsied tissues.

Study authors conclude, “Our data suggest that multi-subtype alopecia may be overdiagnosed, and traction alopecia may be overcalled in patients with presumed multi-subtype alopecia. […] Given the usefulness of biopsy for diagnosis and management of alopecia in our population, we recommend offering scalp biopsies to Black women with alopecia when the diagnosis is not clear-cut.”