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Cicatricial Alopecia (Scarring)

Whenever the hair follicle is seriously damaged, it is permanently lost and replaced by scar tissue. The resulting alopecias are grouped as Scarring or Cicatricial Alopecias.

 

The Scarring alopecias are differentiated from the non-scarring by

absence of follicular openings, increased wrinkling thin, shiny, dry, depressed skin covered with telangiectasia Towards the periphery of the hairless area the hair may be twisted and standing on end due to fibrosis in the dermis.

 

Causes and Development

  • Traumatic
  • Mechanical injury
  • Thermal injury
  • Chemical injury
  • Combined injury (Hot comb alopecia)
  • Electrical burns
  • Traction alopecia
  • Trichotillomania

Developmental/Hereditary

 

Epidermal nevus

 

Lamellar ichthyosis

NEOPLASTIC

Marie-unna syndrome

Basal cell carcinoma

Hair follicle hamartoma syndrome

Squamous cell carcinoma

Polyostotic fibrous dysplasia

Metastasis

Hallerman-streiff syndrome

Lymphomas

 

Follicular Inflammation

WITH PUSTULES WITHOUT PUSTULES
Tinea capitis Follicular lichen planus
Folliculitis decalvans Discoid lupus erythematous  
Bacterial folliculitis Lichen sclerosus et atrophicus
Acne necrotica varioliformis Follicular mucinosis

 

Dermal Inflammation Leading To Secondery Follicular Damage

 

Cicatricial pemphigoid

Leishmaniasis

Morphea

Myiasis

Facial hemiatrophy

Herpes zoster

Dermatomyositis

Ecthyma and deep secondary ptodermas

Necrobiosis lipoidica

Temporal arteritis

Sarcoidosis

 

Pyoderma gangrenosum

 

Syphilis

 

     

Investigations And Treatment

Punch biopsy-punch driven parallel to hair direction.

Multiple punches preferable-allow study of different stages of disease.


Features of biopsy-dermal papillae represented by sclerotic whorls:

  • absence of sebaceous glands.
  • replacement of follicles by fibrotic tracts.
  • arector pili muscle preserved.

Microscopic examination for fungal elements.

Culture to rule out mycoses in doubtful cases

Relevant systemic examination to rule out lupus erythematosus, syphilis, lymphomas.

 

Treatment-

Small patches may be excised & closed primarily.

Larger patches- autografting and scalp expansion technique is useful.

Less motivated patients-cosmetic camouflage may be helpful- creative hair styling, altering the curling or colour of hair, scalp stains and a wig.

 





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