Alopecia Areata: Progressing Practice
Transcript: Alopecia areata diagnostics
Brett King, MD, PhD
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
So when we think about alopecia areata, this is usually a diagnosis that is clinical. We look at a patient almost without a history, and 9 times out of 10 we're going to know what the diagnosis is. But importantly, this is not always true, and there are many cases for which we will have some doubt or uncertainty related to diagnosis. In these cases, history is going to be key, and we want to know about waxing and waning nature. We want to know about abrupt onset versus a very slow onset over time. These are different features in the patient's history that will help us ascertain the correct diagnosis. Sometimes looking and hearing a story is not enough, and in those cases we should not hesitate, not for one minute, to do a biopsy. I think we too often insist that the diagnosis can be made clinically, can be made with a patient history, and we avoid doing a biopsy when it's really quite simple.
Too often, we do not do biopsies when we should. If there is any doubt, do a scalp biopsy. Remember that hair loss disorders includes scarring and non-scarring disorders. If we make an error and we give somebody a diagnosis of alopecia areata when indeed they have lichen planopilaris, when they have frontal fibrosing alopecia, or another scarring disorder, we go down a path of treatment that is not going to be effective. But meanwhile, they have scarring hair loss, and if that progresses too far, we've really done the patient a tremendous disservice. And so really just want to highlight before we get into recent advances, in particular advances highlighted at the AAD, just let's be really clear about how to make this diagnosis and the tools that we have to do it correctly.
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