Scarring (cicatricial) alopecias
Definition & Classification
- Scarring (cicatricial) alopecia = irreversible hair follicle loss due to inflammatory destruction of the stem cell region (bulge) → follicular ostia effaced, hair does not regrow.
- NAHRS Classification 2003:
- Lymphocytic dominant: LPP, FFA, classic Pseudopelade of Brocq, CDLE, Lichen planopilaris subgroups
- Neutrophilic dominant: Folliculitis decalvans, Folliculitis Hoffmann (perifolliculitis abscedens et suffodiens)
- Mixed: CCCA (Central Centrifugal Cicatricial Alopecia), Acne keloidalis nuchae
Diagnostics of Scarring Alopecias
- Trichoscopy + punch biopsy obligatory before starting therapy (ideally 4-mm biopsy from active border, possibly longitudinal biopsy).
- Histology + DIF (differentiation between Lichen planopilaris vs. CDLE important).
- Consider differential diagnoses: Secondary scarring alopecia after trauma, burn, congenital aplasia cutis, sarcoidosis of the scalp, cutaneous metastases, Kerion Celsi (suppurative tinea capitis), Pseudopelade of Brocq as an end stage.
Practise Scarring (cicatricial) alopecias in the app
Flashcards with spaced repetition, exam questions and spot-the-diagnosis on this topic – in DermaFuchs, free of charge.
In the DermaFuchs app: 5 flashcards · 1 clinical images
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More diseases of the skin appendages
- Acne fulminans
- Hidradenitis suppurativa (acne inversa)
- Acne vulgaris
- Alopecia areata
- Androgenetic alopecia
- Folliculitis (infectious)
- Lichen planopilaris
- Milia (milium)
Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.