BH31 Dermoscopic analysis of patients with and without poor prognostic indicators in alopecia areata: a comparative study

Abstract Alopecia areata (AA) manifests as rapid and patchy loss of hair, which may involve any hair-bearing part of the body. We used dermoscopy to identify the key dermoscopic findings of AA in patients with and without poor prognostic indicators. This was a prospective observational study carried out at a tertiary care centre, which included patients with AA seen between July 2024 and October 2024. History, age, sex, symptoms, duration of disease and various prognostic factors were recorded. Patients who had only beard, moustache or eyebrow involvement were excluded. In total 85 patients with a clinical diagnosis of AA were included in this study. For each patient we carried out a thorough clinical history, examination and Severity of Alopecia Tool (SALT) score calculation for quantitative assessment of scalp hair loss. Dermlite DL3 was used to assess and record the dermoscopic findings. The patients had a male-to-female ratio of about 2 : 1. Their mean age was 26.6 years (SD 9.82) and the mean duration of disease was 5.98 months (SD 11.7). Patchy AA was the most common type. Patients with poor prognostic markers had a higher SALT score (mean 35.0, SD 37.2) than those without (mean 10.8, SD 14.1); with P = 0.002 (see the Table). There was a statistically significant higher SALT score in patients with disease duration > 3 months. Dermoscopic features that were significantly associated with patients having poor prognostic factors were yellow dots (P < 0.001), black dots (P = 0.02), broken hairs (P = 0.03) and coudability hair (P < 0.001), while in patients with a good prognosis, vellus hair (P = 0.005) was more commonly seen. In conclusion, ours is the first study to emphasize the comparison of dermoscopic features of AA in patients with and without poor prognostic indicators. Yellow dots, black dots, broken hairs and coudability hair are associated with poor prognosis, while vellus hair indicated a favourable outcome. Identifying these key dermoscopic markers can help in assessing the disease severity, to potentially refine prognostic assessments and guide treatment decisions.TableDermoscopic features and Severity of Alopecia Tool (SALT) scoreDermoscopic patternYellow dotsBlack dotsBroken hairTapering hairVellus hairCoudability hairSALT score, mean (SD)Total (n = 85)71445643431917.0 (24.6)Prognosis Not poor (n = 63)49303930351010.8 (14.1) Poor (n = 22)221417138935.0 (37.2) P-value< 0.0010.020.030.100.005< 0.0010.003Sex Male (n = 56)51323531241015.6 (24.2) Female (n = 29)2012211219919.7 (25.7) P-value< 0.0010.020.630.040.0010.020.48Duration < 3 months (n = 54)45303929271212.5 (21.9) > 3 months (n = 31)2614171416724.9 (27.4) P-value0.920.140.0090.230.810.950.03The data are presented as the number of patients.