Scarring alopecia and the dermatopathologist

Authors
Citation
Lc. Sperling, Scarring alopecia and the dermatopathologist, J CUT PATH, 28(7), 2001, pp. 333-342
Citations number
15
Categorie Soggetti
Dermatology
Journal title
JOURNAL OF CUTANEOUS PATHOLOGY
ISSN journal
03036987 → ACNP
Volume
28
Issue
7
Year of publication
2001
Pages
333 - 342
Database
ISI
SICI code
0303-6987(200108)28:7<333:SAATD>2.0.ZU;2-E
Abstract
Background: The evaluation of patients with cicatricial alopecia is particu larly challenging, and dermatopathologists receive little training in the i nterpretation of scalp biopsy specimens. Accurate interpretation of specime ns from patients with hair disease requires both qualitative (morphology of follicles, inflammation, fibrosis, etc.) and quantitative (size, number, f ollicular phase) information. Much of this data can only be obtained from t ransverse sections. In most cases, good clinical/pathologic correlation is required, and so clinicians should be expected to provide demographic infor mation as well as a brief description of the pattern of hair loss and a cli nical differential diagnosis. Results: The criteria used to classify the various forms of cicatricial alo pecia are relatively imprecise, and so classification is controversial and in a state of evolution. There are five fairly distinctive forms of cicatri cial alopecia: 1) chronic, cutaneous lupus erythematosus discoid LE); 2) li chen planopilaris; 3) dissecting cellulitis (perifolliculitis abscedens et suffodiens); 4) acne keloidalis; and 5) central, centrifugal scarring alope cia (follicular degeneration syndrome, folliculitis decalvans, pseudopelade ). Not all patients with cicatricial alopecia can be confidently assigned t o one of these five entities, and "cicatricial alopecia, unclassified" woul d be an appropriate label for such cases. Conclusion: The histologic features of five forms of cicatricial alopecia a re reviewed. Dermatopathologists can utilize a "checklist" to catalog the d iagnostic features of scalp biopsy specimens. In many, but not all, cases t he information thus acquired will "match" the clinical and histologic chara cteristics of a form of cicatricial alopecia. However, because of histologi c and clinical overlap between the forms of cicatricial alopecia, a definit ive diagnosis cannot always be rendered.