Alopecia Areata on Vertex as a Potential Pitfall for Misdiagnosis of Central Centrifugal Cicatricial Alopecia in African-American Women

Trichoscopy is a noninvasive visualization tool used to more accurately diagnose hair and scalp disorders. Alopecia areata (AA) in the patient of African descent can mimic the early signs of central centrifugal cicatricial alopecia (CCCA), especially if the initial presentation of hair loss occurs on the central scalp. Two African-American women presented with singular round-ovoid patches of decreased hair loss on the central scalp. Given the clinical presentation, CCCA was the working diagnosis. However, using dermoscopy, the patients were found to have exclamation hairs and short broken hairs on a background of honeycomb-like pigmented network and regular pinpoint white dots consistent with AA. The diagnosis was confirmed on biopsy. We demonstrate the role of dermoscopy for diagnosing AA in the patient of African descent.