Most forms of alopecia areata are easy to diagnose, however one form is not. Alopecia areata incognito (which some pair together with so called diffuse alopecia areata) is the most difficult type of alopecia areata to diagnose.
A number of dermatoscopic features support a diagnosis including yellow dots, regrowing hairs, dystrophic hairs, exclamation hair and black dots. Unfortunately, all these features are not always present.
In my opinion, most cases of diffuse alopecia areata I see have a unique feature that I have traditionally called "wimpy hairs". These hairs are short and fine and refuse to grow straight up. They are very different than the strong thick pointy "upright regrowing hairs" seen in telogen effluvium. Rather these wimpy hairs twist and turn and flop over on the scalp. Many such hairs are seen in the photo.
Treatment includes potent topical steroids and steroid injections.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299