Starace Michela, Hrvatin Stancic Bor, Cedirian Stephano, Quadrelli Federico, Pampaloni Francesca, Bruni Francesca, Alessandrini Aurora, Misciali Cosimo, Piraccini Bianca M
Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Ital J Dermatol Venerol. 2025 Aug;160(4):309-313. doi: 10.23736/S2784-8671.25.08170-8. Epub 2025 Jun 23.
Alopecia areata incognita (AAI) represents a variant of alopecia areata with an absence of well-defined alopecic patches but diffuse involvement of the scalp and even if usually affected females, it may also appear in male. Little is known about AAI in men. The aim of this study was to characterize the history, clinical, trichoscopic, and histopathologic features of AAI in male patients.
All histopathologically proven male patients with AAI between April 2011 and December 2023, were included in the study. The history, clinical, trichoscopic and histopathologic features of the male patients were evaluated.
Twenty-nine patients with AAI were included in the study, the mean age was 23.1. All patients had an underlying androgenetic alopecia (AGA) - Hamilton Scale: 17 (58.62%) grade IV, 9 (31.03%) grade V and 3 (10.34%) grade VI. The most common trichoscopic features included short regrowing hair (96.6%), yellow dots (89.7%) and pigtail hair (41.3%) especially seen in the occipital, parietal and frontal regions. A positive pull test with telogen roots was observed in 24.1% of the patients. Histopathological characteristics of AAI in male patients were indistinguishable from previously described features in female patients. All patients were treated with an ultra-potent topical corticosteroid under occlusion and topical 5% minoxidil twice/day or oral minoxidil, remission was established between 4-8 months after treatment initiation.
A thorough trichoscopic examination in cases of diffuse hair loss in male patients with AGA refractory to conventional therapy is warranted and trichoscopy-guided biopsy is necessary to confirm the diagnosis.
隐匿性斑秃（AAI）是斑秃的一种变体，不存在明确的脱发斑，而是头皮弥漫性受累，即使通常多见于女性，但也可能出现在男性身上。关于男性AAI的情况知之甚少。本研究的目的是描述男性AAI患者的病史、临床、毛发镜和组织病理学特征。
纳入2011年4月至2023年12月间所有经组织病理学证实的男性AAI患者。对男性患者的病史、临床、毛发镜和组织病理学特征进行评估。
29例AAI患者纳入研究，平均年龄23.1岁。所有患者均有雄激素性脱发（AGA）基础——汉密尔顿分级：17例（58.62%）为IV级，9例（31.03%）为V级，3例（10.34%）为VI级。最常见的毛发镜特征包括短再生发（96.6%）、黄点（89.7%）和辫子发（41.3%），尤其见于枕部、顶叶和额叶区域。24.1%的患者拔毛试验可见休止期毛囊根。男性患者AAI的组织病理学特征与先前描述的女性患者特征无明显差异。所有患者均接受超强效外用糖皮质激素封包治疗，外用5%米诺地尔每日两次或口服米诺地尔，治疗开始后4 - 8个月病情缓解。
对于常规治疗无效的AGA男性患者弥漫性脱发病例，有必要进行全面的毛发镜检查，且需毛发镜引导下活检以确诊。
