Secondary cicatricial and other permanent alopecias

Abstract

Various nonfollicular scalp conditions can cause secondary scarring or permanent alopecia. Possible causes are congenital defects, trauma, inflammatory conditions, infections, and neoplasms (rarely drugs). Associated signs and symptoms and other diagnostic procedures such as histopathology may aid in the diagnosis. Detection of the underlying disorder may be difficult in end-stage lesions. Treatment is specific for active conditions. Surgery and hair transplantation are options for localized scars.

Histopathology of alopecia: a clinicopathological approach to diagnosis

“…Scarring (cicatricial) alopecia represents a complex group of hair disorders all characterized by having as a common final pathway the destruction of the hair follicle unit. This process may be secondary, and due to numerous aetiologies (Table 1), 13 or primary, where the cause and pathogenesis are largely unknown, but the target is the hair follicle itself 14–23 . Biphasic scarring alopecias comprise another subset of permanent alopecias; in these cases, early non‐scarring hair loss is followed by permanent follicle drop‐out.…”

Psychosocial impact of cicatricial alopecias

“…[3] Various non-follicular conditions of the scalp can lead to secondary cicatricial alopecias, which include traumatic, infectious, inflammatory, neoplastic, and genetic conditions. [4] Cicatricial alopecias can be particularly challenging clinically, as patients tend to present late due to non-recognition at an early stage, and treatment options are poorly defined and often limited in effect. [5]…”

Female Adolescent Hair Disorders

“…3 The outcome can be as severe as scarring alopecia with permanent hair loss. 6 In fact, in 2000 a national outbreak of alopecia and hair damage among patients, most of whom were African American women, was attributed to use of a hair-relaxing formulation. 7 Excessive heat and hair processing may cause splitting of hairs at the ends called trichoptilosis, which is characterized by longitudinal fraying of cortical fibers after loss of the hair cuticle (Fig.…”

“…Less common infections that can involve the scalp and cause secondary scarring alopecia include leprosy, syphilis, cutaneous tuberculosis, and varicella. 6 Scalp infections may present with increased severity or persistence in immunosuppressed patients. 19 …”