Background: Cicatricial alopecias represent a diverse group of diseases characterized by permanent destruction of the hair follicle and irreversible hair loss. The varied clinical features and differences in terminology have led to difficulties in defining consistent clinicopathologic correlation.
Objective: The aim of this study was to review the epidemiology, clinical characteristics, pathology and treatment of inflammatory cicatricial alopecias in Asian population referred to a university hair clinic.
Methods: Case records and histopathology slides of 25 patients with primary cicatricial alopecias, seen at the Asan Medical Center, Korea, were studied from 2006 to 2009. We classified each case into lymphocytic and neutrophilic cicatricial alopecias by histopathology and clinical charactereristics.
Results: The mean patient age was 38 years (range, 18-66 years), and the male to female ratio was 1.8:1. Lymphocytic cicatricial alopecias, including cutaneous lupus erythematosus, classic pseudopelade, and lichen planopilaris - were 6/25 cases. Neutrophilic and mixed cicatricial alopecias, such as folliculitis decalvans, dissecting folliculitis, and acne keloidalis - were 19/25 cases. Folliculitis decalvans was most common in this study. There was no distinct difference of clinical course between both groups.
Conclusions: An accurate diagnosis of cicatricial alopecia is achieved through careful clinicopathologic evaluation. We suggest that a scalp biopsy is mandatory in all cases. Multiple biopsies may be necessary for some affected individuals to achieve a definitive diagnosis as a result of a highly variable clinical course. An aggressive multiple modality for therapeutic approach is often necessary to prevent further irreversible follicular destruction. Current therapeutic options for lymphocytic cicatricial alopecia include corticosteroids, antimalarials, and isotretinoin versus antibiotics, corticosteroids, and isotretinoin for neutrophilic cicatricial alopecias.