Predominantly Neutrophilic Group

Abstract

The predominantly neutrophilic group of primary cicatricial alopecias includes folliculitis decalvans and tufted folliculitis. Clinically, the affected areas are much more inflamed than the lymphocytic cicatricial alopecias with crusting, pustules, draining, and erythema. There is usually considerable pain, tenderness, and itching. Histologically in the early stages, the inflammatory infiltrate consists predominantly of neutrophils. However, the infiltrate does not remain neutrophilic but rather becomes plasma-cell rich. What other histologic features can be used as clues to a neutrophilic cicatricial alopecia that is no longer predominantly neutrophilic? Scan the scalp biopsy with low-power light microscopy: the presence of four or more fused follicles, and dense interfollicular inflammation and fibrosis are diagnostically useful (see Chap. 3)