Skip to main content

Cicatricial Alopecias

  • Chapter
  • First Online:
Book cover Skin of Color

Abstract

This chapter provides a practical approach to the diagnosis and management of the most common types of primary cicatricial alopecias. In primary scarring alopecias, the target of the inflammation is the hair follicle. In secondary scarring alopecias, the hair follicle is an innocent bystander in the disease process and is destroyed in a nonspecific manner. Examples of secondary scarring alopecias include deep burns, radiation dermatitis, cutaneous malignancies, cutaneous sarcoidosis, morphea, necrobiosis lipoidica, and certain chronic infections such as cutaneous tuberculosis. Secondary forms of scarring hair loss are quite common and must be considered in the differential diagnosis of late-stage primary scarring hair loss when inflammatory clues are no longer available to help with diagnosis. The diagnostic hallmark of all forms of cicatricial alopecia (primary and secondary) is visible loss of follicular ostia. In this chapter, we will focus on helpful clinical clues that help distinguish the various primary scarring alopecias and allow distinction from potentially similar non-scarring alopecias. Treatments will be discussed based on the inflammatory level of typical pathologic examination of each entity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sperling L, et al. Alopecias. In: Bolognia J, Jorizzo JL, Rapini RP, editors. Dermatology. St. Louis, MO: Elsevier; 2008. p. 996.

    Google Scholar 

  2. Finner AM, Otberg N, Shapiro J. Secondary cicatricial and other permanent alopecias. Dermatol Ther. 2008;21(4):279–94.

    Article  PubMed  Google Scholar 

  3. Olsen EA, Bergfeld WF, Cotsarelis G, et al. Summary of North American hair research society (NAHRS)-sponsored Workshop on Cicatricial Alopecia, Duke University Medical Center, February 10 and 11, 2001. J Am Acad Dermatol. 2003;48(1):103–10.

    Article  PubMed  Google Scholar 

  4. Sperling LC. Scarring alopecia and the dermatopathologist. J Cutan Pathol. 2001;28(7): 333–42.

    Article  PubMed  CAS  Google Scholar 

  5. Sperling LC, Skelton 3rd HG, Smith KJ, Sau P, Friedman K. Follicular degeneration syndrome in men. Arch Dermatol. 1994;130(6):763–9.

    Article  PubMed  CAS  Google Scholar 

  6. Sperling LC, Sau P. The follicular degeneration syndrome in black patients. “Hot comb alopecia” revisited and revised. Arch Dermatol. 1992;128(1):68–74.

    Article  PubMed  CAS  Google Scholar 

  7. LoPresti P, Papa CM, Kligman AM. Hot comb alopecia. Arch Dermatol. 1968;98(3):234–8.

    Article  PubMed  CAS  Google Scholar 

  8. McMichael AJ. Ethnic hair update: past and present. J Am Acad Dermatol. 2003;48(6 Suppl):S127–33.

    Article  PubMed  Google Scholar 

  9. Nnoruka EN. Hair loss: is there a relationship with hair care practices in Nigeria? Int J Dermatol. 2005;44 Suppl 1:13–7.

    Article  PubMed  Google Scholar 

  10. McMichael AJ. Hair and scalp disorders in ethnic populations. Dermatol Clin. 2003;21(4): 629–44.

    Article  PubMed  Google Scholar 

  11. Bulengo-Ransby SM, Bergfeld WF. Chemical and traumatic alopecia from thioglycolate in a black woman: a case report with unusual clinical and histologic findings. Cutis. 1992;49(2): 99–103.

    PubMed  CAS  Google Scholar 

  12. Gathers RC, Jankowski M, Eide M, Lim HW. Hair grooming practices and central centrifugal cicatricial alopecia. J Am Acad Dermatol. 2009;60(4):574–8.

    Article  PubMed  Google Scholar 

  13. Martin ES, Elewski BE. Tinea capitis in adult women masquerading as bacterial pyoderma. J Am Acad Dermatol. 2003;49(2 Suppl Case Reports):S177–9.

    Article  PubMed  Google Scholar 

  14. Sperling LC, Solomon AR, Whiting DA. A new look at scarring alopecia. Arch Dermatol. 2000;136(2):235–42.

    Article  PubMed  CAS  Google Scholar 

  15. Ackerman AB, Walton NW, Jones RE, Charissi C. “Hot comb alopecia”/ “Follicular degeneration syndrome” in African American women is traction alopecia. Dermatopath: Practical Conceptual. 2000;6:6–21.

    Google Scholar 

  16. Olsen EA. Female pattern hair loss and its relationship to permanent/cicatricial alopecia: a new perspective. j investig dermatol Symp proc. 2005;10(3):217–21.

    Article  PubMed  Google Scholar 

  17. Scott DA. Disorders of the hair and scalp in blacks. Dermatol Clin. 1988;6(3):387–95.

    PubMed  CAS  Google Scholar 

  18. Price VH. The medical treatment of cicatricial alopecia. Semin Cutan Med Surg. 2006;25(1):56–9.

    Article  PubMed  CAS  Google Scholar 

  19. Taylor S. Practical tips for managing hair disorders in African-American females. Pract Dermatol. 2006;3(7):25–7.

    Google Scholar 

  20. Callender VD, McMichael AJ, Cohen GF. Medical and surgical therapies for alopecias in black women. Dermatol Ther. 2004;17(2):164–76.

    Article  PubMed  Google Scholar 

  21. Brown MD, Johnson T, Swanson NA. Extensive keloids following hair transplantation. J Dermatol Surg Oncol. 1990;16(9):867–9.

    PubMed  CAS  Google Scholar 

  22. Chieregato C, Zini A, Barba A, Magnanini M, Rosina P. Lichen planopilaris: report of 30 cases and review of the literature. Int J Dermatol. 2003;42(5):342–5.

    Article  PubMed  CAS  Google Scholar 

  23. Mehregan DA, Van Hale HM, Muller SA. Lichen planopilaris: clinical and pathologic study of forty-five patients. J Am Acad Dermatol. 1992;27(6 Pt 1):935–42.

    Article  PubMed  CAS  Google Scholar 

  24. Mirmirani P. Cicatricial Alopecia. In: healthcare I, editor. Hair and scalp diseases: medical, surgical and cosmetic treatments. New York: Informa Healthcare; 2008. p. 137–48.

    Google Scholar 

  25. Kossard S, Lee MS, Wilkinson B. Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris. J Am Acad Dermatol. 1997;36(1):59–66.

    Article  PubMed  CAS  Google Scholar 

  26. Zinkernagel MS, Trueb RM. Fibrosing alopecia in a pattern distribution: patterned lichen planopilaris or androgenetic alopecia with a lichenoid tissue reaction pattern? Arch Dermatol. 2000;136(2):205–11.

    Article  PubMed  CAS  Google Scholar 

  27. Bianchi L, Paro Vidolin A, Piemonte P, Carboni I, Chimenti S. Graham Little-Piccardi-Lassueur syndrome: effective treatment with cyclosporin A. Clin Exp Dermatol. 2001;26(6).

    Google Scholar 

  28. Amato L, Mei S, Massi D, Gallerani I, Fabbri P. Cicatricial alopecia; a dermatopathologic and immunopathologic study of 33 patients (pseudopelade of Brocq is not a specific clinico-pathologic entity). Int J Dermatol. 2002;41(1):8–15.

    Article  PubMed  CAS  Google Scholar 

  29. Silvers DN, Katz BE, Young AW. Pseudopelade of Brocq is lichen planopilaris: report of four cases that support this nosology. Cutis. 1993;51(2):99–105.

    PubMed  CAS  Google Scholar 

  30. Ronchese F. Pseudopelade. Arch dermat. 1960;82:336–43.

    Article  CAS  Google Scholar 

  31. Karnik P, Tekeste Z, McCormick TS, et al. Hair follicle stem cell-specific PPARgamma deletion causes scarring alopecia. J Invest Dermatol. 2009;129(5):1243–57.

    Article  PubMed  CAS  Google Scholar 

  32. Harries MJ, Paus R. Scarring alopecia and the PPAR-gamma connection. J Invest Dermatol. 2009;129(5):1066–70.

    Article  PubMed  CAS  Google Scholar 

  33. Otberg N, Wu WY, McElwee KJ, Shapiro J. Diagnosis and management of primary cicatricial alopecia: part I. Skinmed. 2008;7(1):19–26.

    Article  PubMed  Google Scholar 

  34. Cevasco NC, Bergfeld WF, Remzi BK, de Knott HR. A case-series of 29 patients with lichen planopilaris: the Cleveland clinic foundation experience on evaluation, diagnosis, and treatment. J Am Acad Dermatol. 2007;57(1):47–53.

    Article  PubMed  Google Scholar 

  35. George YA RS, Gottlieb J, et al. Betamethasone valerate 0.12 % in foam vehicle scalp dermatitis in African Americans. Cosmet Dermatol. 2002;15:23–7.

    Google Scholar 

  36. Callen JP K-SC, Wolverton SE. Methotrexate. In: Comprehensive dermatologic drug therapy. Seconth ed. Philadelphia: Saunders; 2007.

    Google Scholar 

  37. Turan H, Baskan EB, Tunali S, Yazici S, Saricaoglu H. Methotrexate for the treatment of ­generalized lichen planus. J Am Acad Dermatol. 2009;60(1):164–6.

    Article  PubMed  Google Scholar 

  38. Nylander Lundqvist E, Wahlin YB, Hofer PA. Methotrexate supplemented with steroid ointments for the treatment of severe erosive lichen ruber. Acta Derm Venereol. 2002;82(1):63–4.

    Article  PubMed  Google Scholar 

  39. Mirmirani P, Willey A, Price VH. Short course of oral cyclosporine in lichen planopilaris. J Am Acad Dermatol. 2003;49(4):667–71.

    Article  PubMed  Google Scholar 

  40. Bohm M, Beissert S, Schwarz T, Metze D, Luger T. Bullous pemphigoid treated with mycophenolate mofetil. Lancet. 1997;349(9051):541.

    Article  PubMed  CAS  Google Scholar 

  41. Enk AH, Knop J. Treatment of pemphigus vulgaris with mycophenolate mofetil. Lancet. 1997;350(9076):494.

    Article  PubMed  CAS  Google Scholar 

  42. Frieling U, Bonsmann G, Schwarz T, Luger TA, Beissert S. Treatment of severe lichen planus with mycophenolate mofetil. J Am Acad Dermatol. 2003;49(6):1063–6.

    Article  PubMed  Google Scholar 

  43. Tosti A, Piraccini BM, Iorizzo M, Misciali C. Frontal fibrosing alopecia in postmenopausal women. J Am Acad Dermatol. 2005;52(1):55–60.

    Article  PubMed  Google Scholar 

  44. George SJ, Hsu S. Lichen planopilaris treated with thalidomide. J Am Acad Dermatol. 2001;45(6):965–6.

    Article  PubMed  CAS  Google Scholar 

  45. Callen JP. Chronic cutaneous lupus erythematosus. Clinical, laboratory, therapeutic, and prognostic examination of 62 patients. Arch Dermatol. 1982;118(6):412–6.

    Article  PubMed  CAS  Google Scholar 

  46. McCarty DJ, Manzi S, Medsger Jr TA, Ramsey-Goldman R, LaPorte RE, Kwoh CK. Incidence of systemic lupus erythematosus. Race and gender differences. Arthritis Rheum. 1995;38(9):1260–70.

    Article  PubMed  CAS  Google Scholar 

  47. Tebbe B, Mansmann U, Wollina U, et al. Markers in cutaneous lupus erythematosus indicating systemic involvement. A multicenter study on 296 patients. Acta Derm Venereol. 1997;77(4): 305–8.

    PubMed  CAS  Google Scholar 

  48. Werth VP, White WL, Sanchez MR, Franks AG. Incidence of alopecia areata in lupus erythematosus. Arch Dermatol. 1992;128(3):368–71.

    Article  PubMed  CAS  Google Scholar 

  49. Headington JT. Cicatricial alopecia. Dermatol Clin. 1996;14(4):773–82.

    Article  PubMed  CAS  Google Scholar 

  50. Koca R, Altinyazar HC, Ozen OI, Tekin NS. Dissecting cellulitis in a white male: response to isotretinoin. Int J Dermatol. 2002;41(8):509–13.

    Article  PubMed  Google Scholar 

  51. Sukhatme SV, Lenzy YM, Gottlieb AB. Refractory dissecting cellulitis of the scalp treated with adalimumab. J Drugs Dermatol. 2008;7(10):981–3.

    PubMed  Google Scholar 

  52. Scerri L, Williams HC, Allen BR. Dissecting cellulitis of the scalp: response to isotretinoin. Br J Dermatol. 1996;134(6):1105–8.

    Article  PubMed  CAS  Google Scholar 

  53. Williams CN, Cohen M, Ronan SG, Lewandowski CA. Dissecting cellulitis of the scalp. Plast Reconstr Surg. 1986;77(3):378–82.

    Article  PubMed  CAS  Google Scholar 

  54. Brandt HR, Malheiros AP, Teixeira MG, Machado MC. Perifolliculitis capitis abscedens et suffodiens successfully controlled with infliximab. Br J Dermatol. 2008;159(2):506–7.

    Article  PubMed  CAS  Google Scholar 

  55. Bolz S, Jappe U, Hartschuh W. Successful treatment of perifolliculitis capitis abscedens et suffodiens with combined isotretinoin and dapsone. J Dtsch Dermatol Ges. 2008;6(1):44–7.

    PubMed  Google Scholar 

  56. Georgala S, Korfitis C, Ioannidou D, Alestas T, Kylafis G, Georgala C. Dissecting cellulitis of the scalp treated with rifampicin and isotretinoin: case reports. Cutis. 2008;82(3):195–8.

    PubMed  Google Scholar 

  57. Glass LF, Berman B, Laub D. Treatment of perifolliculitis capitis abscedens et suffodiens with the carbon dioxide laser. J Dermatol Surg Oncol. 1989;15(6):673–6.

    PubMed  CAS  Google Scholar 

  58. Boyd AS, Binhlam JQ. Use of an 800-nm pulsed-diode laser in the treatment of recalcitrant dissecting cellulitis of the scalp. Arch Dermatol. 2002;138(10):1291–3.

    Article  PubMed  Google Scholar 

  59. Chui CT, Berger TG, Price VH, Zachary CB. Recalcitrant scarring follicular disorders treated by laser-assisted hair removal: a preliminary report. Dermatol Surg. 1999;25(1):34–7.

    Article  PubMed  CAS  Google Scholar 

  60. Krasner BD, Hamzavi FH, Murakawa GJ, Hamzavi IH. Dissecting cellulitis treated with the long-pulsed Nd:YAG laser. Dermatol Surg. 2006;32(8):1039–44.

    Article  PubMed  CAS  Google Scholar 

  61. Wu WY, Otberg N, McElwee KJ, Shapiro J. Diagnosis and management of primary cicatricial alopecia: part II. Skinmed. 2008;7(2):78–83.

    Article  PubMed  Google Scholar 

  62. Powell JJ, Dawber RP, Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. Br J Dermatol. 1999;140(2):328–33.

    Article  PubMed  CAS  Google Scholar 

  63. Powell J, Dawber RP. Folliculitis decalvans and tufted folliculitis are specific infective ­diseases that may lead to scarring, but are not a subset of central centrifugal scarring alopecia. Arch Dermatol. 2001;137(3):373–4.

    PubMed  CAS  Google Scholar 

  64. Abeck D, Korting HC, Braun-Falco O. Folliculitis decalvans. Long-lasting response to ­combined therapy with fusidic acid and zinc. Acta Derm Venereol. 1992;72(2):143–5.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amy J. McMichael M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Lenzy, Y.M., McMichael, A.J. (2013). Cicatricial Alopecias. In: Alexis, A., Barbosa, V. (eds) Skin of Color. Springer, New York, NY. https://doi.org/10.1007/978-0-387-84929-4_6

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-84929-4_6

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-84928-7

  • Online ISBN: 978-0-387-84929-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics