Starace Michela, De Carvalho Nathalie, Melo Daniel Fernandes, Cedirian Stephano, Mandel Victor Desmond, Machado Carla Jorge, Misciali Cosimo, Pellacani Giovanni, Piraccini Bianca Maria, Ardigò Marco
Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy.
Dermatol Pract Concept. 2024 Oct 30;14(4):e2024229. doi: 10.5826/dpc.1404a229.
Alopecia areata incognita is a non-scarring autoimmune hair loss condition primarily affecting women aged 20 to 40. It is often misdiagnosed due to its resemblance to other conditions. Diagnosis relies on clinical suspicion, trichoscopic findings, and histological features. Reflectance confocal microscopy (RCM) shows promise as a non-invasive diagnostic tool for alopecia areata incognita. In this study, we aimed to explore RCM's diagnostic potential by investigating its association with trichoscopic and histopathological findings.
We conducted a prospective study with 12 female patients affected by alopecia areata incognita. Patient data, trichoscopy, and RCM were used for diagnosis. Biopsies were taken based on trichoscopic and RCM criteria. Agreement between RCM, trichoscopy, and histopathology was assessed.
RCM showed substantial agreement with histopathology for fibrous tracts (92.9%). Other criteria, like infundibular ostia and inflammation, exhibited reasonable agreement (71.4% to 78.6%), with varying Kappa values. Miniaturized follicles had the lowest agreement (64.3%).
This study suggests that RCM holds promise as a diagnostic tool for alopecia areata incognita, offering advantages in non-invasiveness and real-time monitoring. It demonstrated substantial agreement with histopathology in identifying key features. While some discrepancies were noted, especially in detecting inflammatory infiltrates, further research may enhance RCM's sensitivity. The non-invasive nature of RCM could improve patient experiences and offer dynamic disease tracking for better treatment decisions. This technology's potential extends beyond alopecia areata incognita, presenting opportunities for more patient-friendly diagnostic procedures in trichology.
隐匿性斑秃是一种非瘢痕性自身免疫性脱发疾病，主要影响20至40岁的女性。由于其与其他病症相似，常被误诊。诊断依赖于临床怀疑、毛发镜检查结果和组织学特征。反射共聚焦显微镜（RCM）有望成为隐匿性斑秃的一种非侵入性诊断工具。在本研究中，我们旨在通过研究RCM与毛发镜及组织病理学检查结果之间的关联，探索其诊断潜力。
我们对12例隐匿性斑秃女性患者进行了一项前瞻性研究。使用患者数据、毛发镜检查和RCM进行诊断。根据毛发镜和RCM标准进行活检。评估RCM、毛发镜检查和组织病理学之间的一致性。
RCM与纤维束的组织病理学表现具有高度一致性（92.9%）。其他标准，如漏斗部开口和炎症，表现出合理的一致性（71.4%至78.6%），kappa值各不相同。小型化毛囊的一致性最低（64.3%）。
本研究表明，RCM有望成为隐匿性斑秃的诊断工具，在非侵入性和实时监测方面具有优势。它在识别关键特征方面与组织病理学表现出高度一致性。虽然存在一些差异，特别是在检测炎性浸润方面，但进一步的研究可能会提高RCM的敏感性。RCM的非侵入性可以改善患者体验，并为更好的治疗决策提供动态疾病跟踪。这项技术的潜力不仅限于隐匿性斑秃，还为毛发学中更利于患者的诊断程序提供了机会。
