Alopecia areata is non-scarring alopecia that is characterized classically by rapid onset hair loss. It is a hair-specific autoimmune disease characterized by dense lymphocytic infiltrate around the hair follicle. The average lifetime risk of developing this disease is approximately 1.7%. The causative and triggering factors for alopecia areata are not clear yet. Notable variations in the clinical presentation of alopecia areata have been observed, ranging from well-demarcated hair loss patches to a complete absence of scalp hair or even total body hair. Alopecia areata incognito is an uncommon variant of alopecia areata. It is characterized by acute diffuse shedding of telogen hairs in the absence of typical alopecic patches. The prevalence of alopecia areata incognito is unknown, but the disease is more prevalent in females. Clinically it can resemble telogen effluvium or androgenetic alopecia, the presence of numerous yellow dots and short regrowing hairs are the main dermoscopic features of alopecia areata incognito. It requires high clinical suspicion and histopathological correlation is essential. The present case is a fifty-four years old Saudi female that has been diagnosed and treated as female pattern androgenetic alopecia for the past eight years with no improvement. Attended our clinic, a comprehensive medical history and physical examination were done, followed by scalp biopsy to diagnose her condition and exclude other causes of diffuse alopecia. The histopathological report revealed alopecia areata histopathology. A clinical correlation of alopecia areata incognito was made and treated accordingly.
Key words: Alopecia areata incognito, Saudi female with hair loss, Diffuse alopecia, Trichoscopy
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