Dermatopathological Spectrum of Alopecias in Lagos Nigeria Dermatopathology of hair loss

Abstract

Background: Dermatopathological evaluation is the gold standard in hair loss management. It allows for specific diagnosis, precise therapies and prognosis. However, reports of dermatopathology based diagnoses of scalp hair loss are few in Nigeria. A study of the dermatopathological spectrum of scalp hair loss will reveal the commonly encountered types of hair loss and this will in addition aid in health care planning. Objectives: The study aimed to document and to correlate with clinical diagnoses, the dermatopathology diagnoses of hair loss. Methodology: This was a retrospective case review of 331 scalp biopsies evaluated for hair loss from 2015-2022 in Lagos, Nigeria. Standard laboratory processing, hematoxylin and eosin staining with relevant special stains and clinicopathologic correlation when necessary were done. Data was analyzed using SPSS version 23. Results: Three hundred and thirty one scalp biopsy samples from 251 patients were evaluated. The commonest dermatopathological diagnoses were central centrifugal cicatricial alopecia in 14.7%, folliculitis decalvans in 13.5%, alopecia areata in 13.5%, psoriasis in 12.8%, discoid lupus in 12.7%, lupus non-scarring alopecia in 4.2%, lichen planopilaris in 4% and androgenetic alopecia in 4%. The correlation between dermatopathological diagnosis with provisional clinical diagnosis was concordant in 75.7% of cases. Conclusion: Central centrifugal cicatricial alopecia and folliculitis decalvans are the commonest reasons for scalp biopsies. Clinicopathologic correlation is high for scalp hair loss. Dermatopathological evaluation is important in the definitive evaluation and management of hair loss. Age and gender influence the types of hair loss.