Cicatrising Alopecias

Abstract

An attempt was made to study the distinguishing clinical features, histopathological findings especially the elastic tissue stain and examination of the plucked hairs in 30 cases of cicatrical alopecia. Clinically, pseudopelade had irregular areas of atrophy with tufts of normal hairs arising from the bald scarred areas. Folliculitis decalvans had a history or presence of inflammatory papules and pustules with atrophy extending to the temporal areas. DLE showed features of cutaneous DLE at least in some places. A smooth, slightly violaceous atrophic patch with spinous lesions in other areas suggested lichen planopilaris. Morphoea presented with a sclerosed plaque which was linear in some cases. Most of the plucked hairs in cicatrising alopecias showed anagen hairs which were easily plucked, in contrast to the telogen hairs of alopecia areata. Histopathologically accumulation of elastic fibres around the vertical fibrous column and loss of elastic tissue in the papillary dermis were diaagnostic of pseudopelade. In folliculitis decalvans, fibrosis was irregular with many dilated blood vessels even in the late state of the disease. Appearances suggestive of solar elastosis were characteristic of advanced lesions of DLE. Irregular atrophy with scanty fragmented elastic fibres were found in the scarring stage of lichen planopilaris. Morphoea showed thickened and closely packed collagen bundles and fragmented elastic fibres. On the basis of its characteristic clinical and histopathological features, not found even in the late stages of other scarring alopecias, it is suggested that pseudopelade is an autonomous disease.