INTRODUCTION
Alopecia is one of the most common dermatologic conditions affecting Black patients, with a significantly negative impact on quality of life.1,2 Timely and accurate diagnosis is therefore critical in order to reverse or halt progression of disease.3 Unfortunately, lack of representation of skin of color (SOC) patients in the current literature may contribute to misdiagnosis as providers may be unfamiliar with the clinical spectrum of alopecia presenting in darker scalps.4 In particular, vertex alopecia in SOC patients can be subject to bias as certain scarring alopecias, such as central centrifugal cicatricial alopecia (CCCA), occur at a higher prevalence in patients of African descent5 and classically presents as hair loss in the vertex of the scalp.6 Other forms of alopecia may present with vertex involvement in patients of color, so clinicians should fight the urge to jump to a diagnosis of CCCA without performing a thorough examination. Trichoscopy, or scalp dermoscopy, allows dermatologists to evaluate alopecia based on visualization of morphologic patterns and can provide diagnostic clues to help clinicians avoid misdiagnosis of alopecia. Key studies have defined trichoscopic findings in SOC.7,8 While trichoscopy does not replace the need for biopsy, it is a critical tool in the initial evaluation of hair loss.
We aim to highlight the importance of challenging bias in the clinical diagnosis of alopecia in SOC. The diagnosis of alopecia based on gross clinical morphology alone can lead to misdiagnosis of alopecia type in Black patients. Barriers to early diagnosis must be reduced to ensure quality care is given to patients of all racial backgrounds. Herein, we present three cases of vertex alopecia in which the initial suspected clinical diagnosis did not correspond with trichoscopic and biopsy results. To distinguish alopecia findings in Black patients, a dedicated approach using a combination of clinical exam findings and patient history, along with trichoscopy and biopsy, may be essential to prevent misdiagnosis and improve clinical and diagnostic outcomes.
We aim to highlight the importance of challenging bias in the clinical diagnosis of alopecia in SOC. The diagnosis of alopecia based on gross clinical morphology alone can lead to misdiagnosis of alopecia type in Black patients. Barriers to early diagnosis must be reduced to ensure quality care is given to patients of all racial backgrounds. Herein, we present three cases of vertex alopecia in which the initial suspected clinical diagnosis did not correspond with trichoscopic and biopsy results. To distinguish alopecia findings in Black patients, a dedicated approach using a combination of clinical exam findings and patient history, along with trichoscopy and biopsy, may be essential to prevent misdiagnosis and improve clinical and diagnostic outcomes.
