Utility of Dermoscopic Evaluation in Predicting Clinical Response to Diphencyprone in a Cohort of Patients with Alopecia Areata

BACKGROUND: Alopecia areata (AA) is a chronic and inflammatory disease of hair follicles, causing nonscarring alopecia. While the various types of treatment have been investigated, the definite cure for AA has not been established yet. OBJECTIVES: The objective of this study is to evaluate the clinical and dermoscopic features of patients with AA to identify the factors with prognostic values in diphenylcyclopropenone (DPCP) response rate. METHODS: Eighty patients with AA were included, and baseline hair loss was calculated based on the severity alopecia tool (SALT) score. The characteristic dermoscopic features of AA were evaluated by two skilled dermatologists separately at baseline, 12 and 24 weeks afterward. RESULTS: The mean SALT score in the 1(st), 12(th), and 24(th) week was 77 ± 24.7, 80 ± 27, and 71 ± 35.6, respectively, which were not significantly different over this time period (P = 0.085). SALT score correlated negatively with the short vellus hair/field (ρ = −0.361, P = 0.02), broken hair/field (ρ = −0.317, P = 0.044), and tapering hair/field (ρ = −0.388, P = 0.012) in the 1(st) week. Forty-one patients continued treatment courses over 24 weeks. Six patients had good response, 11 achieved partial response, and 24 had no hair regrowth. Statistically significant correlation was observed between treatment response and duration of disease (P = 0.04), frequency of relapses (P = 0.033), type of alopecia, and number of black dots (P = 0.028). The mean for all dermoscopic findings showed descending process during our three follow-up sessions which was statistically significant for black dot (P = 0.015) and broken hair (P = 0.006). CONCLUSION: The number of black dot per field initially was negatively correlated to DPCP therapy and the frequency of dermoscopic findings reduced during the treatment process.