How not to get scar(r)ed: pointers to the correct diagnosis in patients with suspected primary cicatricial alopecia

Abstract

Primary cicatricial alopecias (PCAs) are a rare, but important, group of disorders that cause irreversible damage to hair follicles resulting in scarring and permanent hair loss. They may also signify an underlying systemic disease. Thus, it is of paramount importance that clinicians who manage patients with hair loss are able to diagnose these disorders accurately. Unfortunately, PCAs are notoriously difficult conditions to diagnose and treat. The aim of this review is to present a rational and pragmatic guide to help clinicians in the professional assessment, investigation and diagnosis of patients with PCA. Illustrating typical clinical and histopathological presentations of key PCA entities we show how dermatoscopy can be profitably used for clinical diagnosis. Further, we advocate the search for loss of follicular ostia as a clinical hallmark of PCA, and suggest pragmatic strategies that allow rapid formulation of a working diagnosis.

Primary cicatricial alopecia: diagnosis and treatment

“…3 Hair regeneration is prevented because of destruction of epithelial stem cells in the bulge of the outer root sheath at the level where the arrector pili muscle inserts ( Figure 1). 4,5 Secondary cicatricial alopecia is also irreversible, though destruction of the hair follicle is incidental to a non-follicle-directed cause, such as thermal burns, metastatic cancer, trauma or radiation. 4 This article will focus on primary cicatricial alopecia.…”

Examination of Clinical and Demographic Characteristics of 14 Cases with Frontal Fibrosing Alopecia

“…Another opinion regarding FFA ethiopathogenesis is the effect of androgen hormonal factors. While the facts that it usually affects postmenopausal women, involves frontal scalp, and responds to antiandrogens such as finasteride or dutasteride in some patients suggest this, a significant relationship is yet to be revealed (4,9,24). Today, FFA is regarded as a clinical variant of LPP which has selectivity for frontotemporal hairline, primarily affects postmenopausal women and is characterized by lymphocytic cicatricial alopecia (2,3,17).…”

“…The incidence of the disease may be more. It may be due to ignoring and not seeking help in the early stages or the fact that these patients are diagnosed differently (24). Thereby, it causes delay in true diagnosis and treatment, and makes the alopecia permanent.…”

Expressions of CK15, CD34, Nestin and CD200 in Lichen Planopilaris

“…Liken planoplaris (LPP) primer skatrisyel alopesiler (PSA) arasında yer alan, histopatolojik olarak perifoliküler lenfohistiyositik inflamatuvar reaksiyon ile karakterize olan, saçlı derinin nispeten az görülen bir hastalığıdır (1)(2)(3). Folikülün sabit üst kısmında, arektör pili kasının foliküler kılıfa bağlanma yerine komşu epitelyal bölge, folikül tümsek bölgesi olarak bilinmektedir.…”

“…Bu bölgenin kıl folikülü kök hücreleri için bir niş oluşturduğu gösterilmiştir (4). PSA'larda inflamasyonun pilosebase ünitenin tümsek bölgesinde bulunan kök hücrelerine yöneldiği, kök hücrelerin hasarlanmasının kıl folikülünün kalıcı olarak yok olmasına neden olduğu düşünülmektedir (3,5).…”