The histopathologic diagnosis of traction alopecia: An evidence-based model.

J Am Acad Dermatol

HCT Dermatopathology Services, Baltimore, Maryland; Department of Dermatology, Uniformed Services University, Bethesda, Maryland.

Published: October 2023

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Article Abstract

Background: Traction alopecia (TA) is common, but histopathologic criteria for TA have not been objectively defined.

Objective: Determine whether the pauci-follicular unit (PFU) can be used as a diagnostic criterion for TA. Compared to a normal follicular unit (NFU), the PFU is a noninflamed follicular unit with an intact sebaceous gland but fewer than 2 follicles.

Methods: A retrospective review of 25 cases of TA and 25 cases of "normal scalp" was performed. Data included all follicles (by size and phase), sebaceous glands, and total follicular units.

Results: Comparing data (traction vs normal), we found a significantly higher number of PFUs in cases of TA (median 6 vs 0, P < .001), which can be used as a helpful and easily recognizable diagnostic tool in diagnosing cases of TA.

Limitations: Comparison to other forms of alopecia was not performed.

Conclusions: The number of PFUs in an alopecia biopsy can be used to establish the diagnosis of TA.

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http://dx.doi.org/10.1016/j.jaad.2023.05.094DOI Listing

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