Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan.
J Dermatol. 2020 Jun;47(6):583-591. doi: 10.1111/1346-8138.15306. Epub 2020 Mar 15.
The term "acute diffuse and total alopecia" (ADTA) has been often used as a synonym for self-regressing severe alopecia areata (AA). However, ADTA is originally defined as a rapidly-progressive subtype of AA (RP-AA) with short recovery time and favorable prognosis irrespective of interventions. Indeed, a subpopulation of ADTA recovers spontaneously. We focused on this unique subset of AA, which we coined as "self-healing ADTA" (sADTA). Prompt and accurate differentiation of sADTA from other RP-AA is important to avoid unnecessary treatments, which is still challenging due to the lack of predictive diagnostic hallmarks. In this study, 18 sADTA patients were retrospectively analyzed to delineate their demographics and clinical features, including gentle hair pull test and trichoscopic findings, followed by statistical comparison with those of RP-AA. All sADTA cases were female and the average age was 38.1 ± 15.9 years. The progression of hair loss areas peaked at 3.6 ± 1.5 months, and complete hair regrowth was achieved in 7.9 ± 1.7 months. The identified factors supporting the diagnosis of sADTA included being female; the absence of scalp pain and itch; the absence of extra-scalp hair loss; club hair predominance in hair pull test; predominant short vellus hairs; and increase in vacant follicular ostia on trichoscopy. Subsequently, a scoring system for early diagnosis of sADTA was developed by counting the number of six identified factors present in a tested case. When analyzed by the developed system, all sADTA cases, including an additional four cases, had scores of 4 or above, while all RP-AA cases had scores below 3 except one case. Therefore, the system successfully differentiated sADTA from RP-AA (P < 0.01). Despite some technical limitations, the current study suggested that sADTA is a distinctive entity with unique pathophysiology and that early diagnosis before intervention is feasible based on the characteristics.
术语“急性弥漫性全脱发”（ADTA）常被用作自限性严重斑秃（AA）的同义词。然而，ADTA 最初被定义为一种进展迅速的 AA 亚型（RP-AA），其具有较短的恢复期和良好的预后，无论干预与否。事实上，ADTA 存在一个亚群可自发缓解。我们关注的是 AA 这一独特的亚群，我们将其命名为“自愈性 ADTA”（sADTA）。准确区分 sADTA 与其他 RP-AA 对于避免不必要的治疗非常重要，由于缺乏预测性的诊断特征，这仍然具有挑战性。在这项研究中，回顾性分析了 18 例 sADTA 患者，以描绘其人口统计学和临床特征，包括轻柔的毛发牵拉试验和毛发镜检查结果，并与 RP-AA 进行了统计学比较。所有 sADTA 患者均为女性，平均年龄为 38.1±15.9 岁。脱发区的进展在 3.6±1.5 个月达到峰值，7.9±1.7 个月后完全再生。支持 sADTA 诊断的因素包括：女性；头皮无疼痛和瘙痒；无头皮外脱发；毛发牵拉试验中以 club 毛发为主；以短毳毛为主；毛发镜下毛囊口空泡增加。随后，通过计数在测试病例中存在的六个确定因素的数量，开发了用于早期诊断 sADTA 的评分系统。通过该系统进行分析时，所有 sADTA 病例，包括另外 4 例病例，评分均为 4 或以上，而所有 RP-AA 病例的评分均低于 3，除了 1 例外。因此，该系统成功地区分了 sADTA 和 RP-AA（P<0.01）。尽管存在一些技术限制，但本研究表明，sADTA 是一种具有独特病理生理学的独特实体，并且基于这些特征，在干预前进行早期诊断是可行的。
