The Association between the Number of Follicular Stelae and Severity and Treatment Response of Alopecia Areata Cases: A Retrospective Study

BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by peribulbar lymphocytic infiltration, follicular miniaturization, catagen/telogen follicles, and increased follicular stelae (streamers) in skin biopsies. OBJECTIVES: Our aim was to assess the number of follicular stelae of patients with AA and to evaluate their association with clinical type and severity and treatment response of AA. MATERIALS AND METHODS: Histopathologic features including number of follicular stelae were recorded in skin biopsies taken from lesions of AA in 142 patients who attended our dermatology clinic from 2011 to 2017. RESULTS: There was a statistically significant correlation between the patient age and the number of follicular stelae (P = 0.001). There was a statistically significant correlation between the severity of disease and the number of follicular stelae (P = 0.005). AA subtypes (0%–25% scalp hair loss) had a significantly lower number of follicular stelae than 75%–100% scalp hair loss and alopecia universalis (7.92 ± 4.21 vs. 13.23 ± 7.28). There was no statistically significant correlation between the treatment response and the number of follicular stelae (P = 0.75). CONCLUSION: Our results showed that number of follicular stelae varied among AA clinical types and correlated with severity. This study was the first to evaluate the correlation between the number of follicular stelae and severity of AA.