34051 Scalp biopsy increases diagnostic accuracy and treatment outcomes in African American females with alopecia

Abstract

Background: Alopecia in African American (AA) women is prevalent and poses a significant burden on patient quality of life (QoL). Because certain subtypes of alopecia are common in this population, dermatologists may arrive at a diagnosis without a comprehensive workup. We investigated the extent of diagnostic workup, diagnostic accuracy, and patient satisfaction in a cohort of AA females with alopecia. Methods: We performed a retrospective chart review of AA female patients who received the diagnosis of alopecia from 2015 to 2020 in a single-center academic practice. Data were collected on demographics, subtype of alopecia diagnosed, and whether biopsy was performed. We then administered a survey to patients to assess symptom burden, QoL, and care satisfaction. Results: A total of 421 patients met inclusion criteria. Among these patients, 141 (33.5%) were diagnosed with multifactorial alopecia and 77 (18.3%) received no specific diagnosis. Forty patients (9.5%) underwent scalp biopsies. In cases where biopsy was performed, post-biopsy diagnoses differed from original diagnoses 67.5% of the time. A greater percentage of patients who underwent biopsy reported improved outcomes regarding symptoms, condition resolution, treatment plan satisfaction, and confidence in their dermatologist compared with nonbiopsied patients. Conclusions: In our cohort, most patients did not receive a unifying diagnosis of alopecia and did not undergo scalp biopsy. Of those who received biopsy, the pre- and post-biopsy diagnoses differed, and performance of scalp biopsy influenced management and patient satisfaction. We conclude that offering scalp biopsy to AA females with alopecia can improve treatment outcomes and patient satisfaction.