Histopathological pictures of the initial changes of the hair bulbs in alopecia areata

A biopsy of the seemingly normal scalp of a patient who had just begun to develop alopecia areata showed distinctive changes in bulbar morphology, in addition to peri-bulbar lymphocytic infiltrates. One of these changes was a loss of structural integrity of the centrally located supramatrical upper bulbar region. The other was the shrinkage of hair bulbs in the direction of club shape. Uninvolved intact anagen follicles were also present among these involved follicles.