Correlation of clinical and pathologic evaluation of scarring alopecia

John G. Zampella, Shawn Kwatra, Jihad Alhariri

Research output: Contribution to journalArticle

Abstract

Background: Differentiating scarring and nonscarring alopecia poses a diagnostic dilemma for clinicians, with histopathology used to distinguish. The extent to which dermatologists are able to clinically classify alopecia has not been evaluated. Methods: A retrospective study of pathology reports on 458 patients was used to calculate a kappa coefficient to correlate clinical presence of scarring or nonscarring alopecia to histopathologic presence of scarring or nonscarring. A multivariate analysis was performed to assess for associations with scarring. Results: The kappa correlation coefficient was 0.59 (P < 0.0001), indicating moderate agreement and varied by race and sex. There were 15 times higher odds of making the clinical diagnosis of scarring alopecia (OR 14.64 95% CI [8.64–24.18]; P < 0.001), and this increased with age. Conclusions: These results suggest that clinical exam is moderately reliable in distinguishing between scarring and nonscarring alopecia. Our results highlight the need for education and diagnostic schemata for evaluation of alopecia based on gender and in skin of color.

Original languageEnglish (US)
JournalInternational Journal of Dermatology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Alopecia
Cicatrix
Skin Pigmentation
Multivariate Analysis
Retrospective Studies
Pathology
Education

ASJC Scopus subject areas

  • Dermatology

Cite this

@article{52c68f53be78401393b9b2f678d11d16,
title = "Correlation of clinical and pathologic evaluation of scarring alopecia",
abstract = "Background: Differentiating scarring and nonscarring alopecia poses a diagnostic dilemma for clinicians, with histopathology used to distinguish. The extent to which dermatologists are able to clinically classify alopecia has not been evaluated. Methods: A retrospective study of pathology reports on 458 patients was used to calculate a kappa coefficient to correlate clinical presence of scarring or nonscarring alopecia to histopathologic presence of scarring or nonscarring. A multivariate analysis was performed to assess for associations with scarring. Results: The kappa correlation coefficient was 0.59 (P < 0.0001), indicating moderate agreement and varied by race and sex. There were 15 times higher odds of making the clinical diagnosis of scarring alopecia (OR 14.64 95{\%} CI [8.64–24.18]; P < 0.001), and this increased with age. Conclusions: These results suggest that clinical exam is moderately reliable in distinguishing between scarring and nonscarring alopecia. Our results highlight the need for education and diagnostic schemata for evaluation of alopecia based on gender and in skin of color.",
author = "Zampella, {John G.} and Shawn Kwatra and Jihad Alhariri",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/ijd.14221",
language = "English (US)",
journal = "International Journal of Dermatology",
issn = "0011-9059",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Correlation of clinical and pathologic evaluation of scarring alopecia

AU - Zampella, John G.

AU - Kwatra, Shawn

AU - Alhariri, Jihad

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Differentiating scarring and nonscarring alopecia poses a diagnostic dilemma for clinicians, with histopathology used to distinguish. The extent to which dermatologists are able to clinically classify alopecia has not been evaluated. Methods: A retrospective study of pathology reports on 458 patients was used to calculate a kappa coefficient to correlate clinical presence of scarring or nonscarring alopecia to histopathologic presence of scarring or nonscarring. A multivariate analysis was performed to assess for associations with scarring. Results: The kappa correlation coefficient was 0.59 (P < 0.0001), indicating moderate agreement and varied by race and sex. There were 15 times higher odds of making the clinical diagnosis of scarring alopecia (OR 14.64 95% CI [8.64–24.18]; P < 0.001), and this increased with age. Conclusions: These results suggest that clinical exam is moderately reliable in distinguishing between scarring and nonscarring alopecia. Our results highlight the need for education and diagnostic schemata for evaluation of alopecia based on gender and in skin of color.

AB - Background: Differentiating scarring and nonscarring alopecia poses a diagnostic dilemma for clinicians, with histopathology used to distinguish. The extent to which dermatologists are able to clinically classify alopecia has not been evaluated. Methods: A retrospective study of pathology reports on 458 patients was used to calculate a kappa coefficient to correlate clinical presence of scarring or nonscarring alopecia to histopathologic presence of scarring or nonscarring. A multivariate analysis was performed to assess for associations with scarring. Results: The kappa correlation coefficient was 0.59 (P < 0.0001), indicating moderate agreement and varied by race and sex. There were 15 times higher odds of making the clinical diagnosis of scarring alopecia (OR 14.64 95% CI [8.64–24.18]; P < 0.001), and this increased with age. Conclusions: These results suggest that clinical exam is moderately reliable in distinguishing between scarring and nonscarring alopecia. Our results highlight the need for education and diagnostic schemata for evaluation of alopecia based on gender and in skin of color.

UR - http://www.scopus.com/inward/record.url?scp=85053260740&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053260740&partnerID=8YFLogxK

U2 - 10.1111/ijd.14221

DO - 10.1111/ijd.14221

M3 - Article

JO - International Journal of Dermatology

JF - International Journal of Dermatology

SN - 0011-9059

ER -