Skip to main content

Abstract

A large number of scalp disorders may destroy the hair follicles and result in cicatricial alopecia. These include diseases that primarily affect the hair follicles as well as diseases that affect the dermis and secondarily cause follicular destruction. Once established, cicatricial alopecia is a permanent condition that cannot be reversed by treatment. The differential diagnosis between the diseases that cause cicatricial alopecia requires a pathological examination. The site of biopsy is crucial for pathological diagnosis and can be better selected using dermoscopy. Current treatment options of primary cicatricial alopecia are limited as the precise mechanisms that trigger the diseases are still unknown.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abeck D, Korting HC, Braun-Falco O. Folliculitis decalvans. Long lasting response to combined therapy with fusidic acid and zinc. Acta Derm Venereol (Stockh). 1992;72:143–5.

    CAS  Google Scholar 

  • Bellet JS, Kaplan AL, Selim MA, Olsen EA. Keratosis follicularis spinulosa decalvans in a family. J Am Acad Dermatol. 2008;58(3):499–502.

    Article  PubMed  Google Scholar 

  • Etoh M, Jinnin M, Makino K, Yamane K, Nakayama W, Aoi J, Honda N, Kajihara I, Makino T, Fukushima S, Ihn H. microRNA-7 down-regulation mediates excessive collagen expression in localized scleroderma. Arch Dermatol Res. 2013;305(1):9–15.

    Article  CAS  PubMed  Google Scholar 

  • Kittridge A, Haught JM, English JC. Alopecia areata mimicking pseudopelade of Brocq. Cutis. 2010;86(4):187–9.

    PubMed  Google Scholar 

  • Makino K, Jinnin M, Hirano A, Yamane K, Eto M, Kusano T, Honda N, Kajihara I, Makino T, Sakai K, Masuguchi S, Fukushima S, Ihn H. The downregulation of microRNA let-7a contributes to the excessive expression of type I collagen in systemic and localized scleroderma. J Immunol. 2013;190(8):3905–15.

    Article  CAS  PubMed  Google Scholar 

  • Powell JJ, Dawber RPR. Successful treatment regime for folliculitis decalvans despite uncertainty of all aetiological factors. Br J Dermatol. 2001;144:428–9.

    Article  CAS  PubMed  Google Scholar 

  • Powell JJ, Dawber RPR, Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. Br J Dermatol. 1999;140:328–33.

    Article  CAS  PubMed  Google Scholar 

  • Yu M, Bell RH, Ross EK, Lo BK, Isaac-Renton M, Martinka M, Haegert A, Shapiro J, McElwee KJ. Lichen planopilaris and pseudopelade of Brocq involve distinct disease associated gene expression patterns by microarray. J Dermatol Sci. 2010;57(1):27–36.

    Article  CAS  PubMed  Google Scholar 

Further Reading

  • Alcántara González J, Boixeda P, Truchuelo Díez MT, Fleta Asín B. Keratosis pilaris rubra and keratosis pilaris atrophicans faciei treated with pulsed dye laser: report of 10 cases. J Eur Acad Dermatol Venereol. 2011;25(6):710–4.

    Article  PubMed  Google Scholar 

  • Alecu M, Geleriu L, Coman G, Galatescu L. The interleukin-1, interleukin-2, interleukin-6 and tumour necrosis factor alpha serological levels in localised and systemic sclerosis. Rom J Intern Med. 1998;36(3–4):251–9.

    CAS  PubMed  Google Scholar 

  • Al-Mutairi N, El-Khalawany M. Clinicopathological characteristics of lichen planus pigmentosus and its response to tacrolimus ointment: an open label, non-randomized, prospective study. J Eur Acad Dermatol Venereol. 2010;24(5):535–40.

    Article  CAS  PubMed  Google Scholar 

  • Aten E, Brasz LC, Bornholdt D, Hooijkaas IB, Porteous ME, Sybert VP, Vermeer MH, Vossen RH, van der Wielen MJ, Bakker E, Breuning MH, Grzeschik KH, Oosterwijk JC, den Dunnen JT. Keratosis follicularis spinulosa decalvans is caused by mutations in MBTPS2. Hum Mutat. 2010;31(10):1125–33.

    Article  CAS  PubMed  Google Scholar 

  • Baibergenova A, Walsh S. Use of pioglitazone in patients with lichen planopilaris. J Cutan Med Surg. 2012;16(2):97–100.

    Article  CAS  PubMed  Google Scholar 

  • Castaño-Suárez E, Romero-Maté A, Arias-Palomo D, Borbujo J. Photodynamic therapy for the treatment of folliculitis decalvans. Photodermatol Photoimmunol Photomed. 2012;28(2):102–4.

    Article  PubMed  Google Scholar 

  • Cavazzana I, Sala R, Bazzani C, Ceribelli A, Zane C, Cattaneo R, Tincani A, Calzavara-Pinton PG, Franceschini F. Treatment of lupus skin involvement with quinacrine and hydroxychloroquine. Lupus. 2009;18(8):735–9.

    Article  CAS  PubMed  Google Scholar 

  • Cevasco NC, Bergfeld WF, Remzi BK, de Knott HR. A case-series of 29 patients with lichen planopilaris: the Cleveland Clinic Foundation experience on evaluation, diagnosis, and treatment. J Am Acad Dermatol. 2007;57(1):47–53.

    Article  PubMed  Google Scholar 

  • Chiang C, Sah D, Cho BK, Ochoa BE, Price VH. Hydroxychloroquine and lichen planopilaris: efficacy and introduction of Lichen Planopilaris Activity Index scoring system. J Am Acad Dermatol. 2010;62(3):387–92.

    Article  CAS  PubMed  Google Scholar 

  • Consorti G, Tieghi R, Clauser LC. Frontal linear scleroderma: long-term result in volumetric restoration of the fronto-orbital area by structural fat grafting. J Craniofac Surg. 2012;23(3):e263–5.

    Article  PubMed  Google Scholar 

  • Dubost-Brama A, Delaporte E, Alfandari S, Piette F, Bergoend H. Folliculite disséquante du cuir chevelu: efficacité de l’isotrétinoïne. Ann Dermatol Venereol. 1994;121:328–30.

    CAS  PubMed  Google Scholar 

  • Duteille F, Le Fourn B, Hepner Lavergne D, Pannier M. The limitation of primary excision of cicatricial alopecia: a report of 63 patients. Ann Plast Surg. 2000;45:145–9.

    Article  CAS  PubMed  Google Scholar 

  • Edwards KR, Burke WA. Treatment of localized discoid lupus erythematosus with tazarotene. J Am Acad Dermatol. 1999;41(6):1049–50.

    Article  CAS  PubMed  Google Scholar 

  • Farkas L, Beiske K, Lund-Johansen F, Brandtzaeg P, Jahnsen FL. Plasmacytoid dendritic cells (natural interferon-alpha/beta-producing cells) accumulate in cutaneous lupus erythematosus lesions. Am J Pathol. 2001;159:237–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Georgala S, Katoulis AC, Befon A, Danopoulou I, Georgala C. Treatment of postmenopausal frontal fibrosing alopecia with oral dutasteride. J Am Acad Dermatol. 2009;61(1):157–8.

    Article  PubMed  Google Scholar 

  • González-Sixto B, García-Doval I, Oliveira R, Posada C, García-Cruz MA, Cruces M. Quinacrine in the treatment of cutaneous lupus erythematosus: practical aspects and a case series. Actas Dermosifiliogr. 2010;101(1):54–8.

    Article  PubMed  Google Scholar 

  • Hasegawa M, Fujimoto M, Kikuchi K, Takehara K. Elevated serum levels of interleukin-4 (IL-4), IL-10, and IL-13 in patients with systemic sclerosis. J Rheumatol. 1997;24(2):328–32.

    CAS  PubMed  Google Scholar 

  • Hasegawa M, Sato S, Nagaoka T, Fujimoto M, Takehara K. Serum levels of tumor necrosis factor and interleukin-13 are elevated in patients with localized scleroderma. Dermatology. 2003;207(2):141–7.

    Article  CAS  PubMed  Google Scholar 

  • Hemmati I, Otberg N, Martinka M, Alzolibani A, Restrepo I, Shapiro J. Discoid lupus erythematosus presenting with cysts, comedones, and cicatricial alopecia on the scalp. J Am Acad Dermatol. 2009;60(6):1070–2.

    Article  PubMed  Google Scholar 

  • Inamo Y, Ochiai T. Successful combination treatment of a patient with progressive juvenile localized scleroderma (Morphea) using imatinib, corticosteroids, and methotrexate. Pediatr Dermatol. 2013;30:e191–3.

    Article  PubMed  Google Scholar 

  • Järvinen TM, Hellquist A, Koskenmies S, Einarsdottir E, Panelius J, Hasan T, Julkunen H, Padyukov L, Kvarnström M, Wahren-Herlenius M, Nyberg F, D’Amato M, Kere J, Saarialho-Kere U. Polymorphisms of the ITGAM gene confer higher risk of discoid cutaneous than of systemic lupus erythematosus. PLoS One. 2010;5(12):e14212.

    Article  PubMed  PubMed Central  Google Scholar 

  • Karnik P, Tekeste Z, McCormick TS, Gilliam AC, Price VH, Cooper KD, Mirmirani P. Hair follicle stem cell-specific PPARgamma deletion causes scarring alopecia. J Invest Dermatol. 2009;129(5):1243–57.

    Article  CAS  PubMed  Google Scholar 

  • Katoulis A, Georgala S, Bozi E, Papadavid E, Kalogeromitros D, Stavrianeas N. Frontal fibrosing alopecia: treatment with oral dutasteride and topical pimecrolimus. J Eur Acad Dermatol Venereol. 2009;23(5):580–2.

    Article  CAS  PubMed  Google Scholar 

  • Kossard S, Lee MS, Wilkinson B. Postmenopausal frontal fibrosing alopecia: a variant of lichen planopilaris. J Am Acad Dermatol. 1997;36:59–66.

    Article  CAS  PubMed  Google Scholar 

  • Kreuter A, Hyun J, Stücker M, Sommer A, Altmeyer P, Gambichler T. A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma. J Am Acad Dermatol. 2006;54(3):440–7.

    Article  PubMed  Google Scholar 

  • Kunte C, Loeser C, Wolff H. Folliculitis spinulosa decalvans: successful therapy with dapsone. J Am Acad Dermatol. 1998;39:891–993.

    Article  CAS  PubMed  Google Scholar 

  • Lencastre A, Tosti A. Images in clinical medicine. A receding hairline. N Engl J Med. 2013;369(2):e2.

    Article  PubMed  Google Scholar 

  • Madani S, Trotter MJ, Shapiro J. Pseudopelade of Brocq in beard area. J Am Acad Dermatol. 2000;42:895–6.

    Article  CAS  PubMed  Google Scholar 

  • Matard B, Meylheuc T, Briandet R, Casin I, Assouly P, Cavelier-Balloy B, Reygagne P. First evidence of bacterial biofilms in the anaerobe part of scalp hair follicles: a pilot comparative study in folliculitis decalvans. J Eur Acad Dermatol Venereol. 2013;27(7):853–60.

    Article  CAS  PubMed  Google Scholar 

  • Mihaljević N, van den Driesch P. Successful use of infliximab in a patient with recalcitrant folliculitis decalvans. J Dtsch Dermatol Ges. 2012;10(8):589–90.

    PubMed  Google Scholar 

  • Mirmirani P, Karnik P. Lichen planopilaris treated with a peroxisome proliferator-activated receptor gamma agonist. Arch Dermatol. 2009;145(12):1363–6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miteva M, Tosti A. Dermoscopy guided scalp biopsy in cicatricial alopecia. J Eur Acad Dermatol Venereol. 2012;26:1468–3083. 2012.

    Google Scholar 

  • Navarini AA, Kolios AG, Prinz-Vavricka BM, Haug S, Trüeb RM. Low-dose excimer 308-nm laser for treatment of lichen planopilaris. Arch Dermatol. 2011;147(11):1325–6.

    Article  PubMed  Google Scholar 

  • Pai VV, Kikkeri NN, Sori T, Dinesh U. Graham-little piccardi lassueur syndrome: an unusual variant of follicular lichen planus. Int J Trichology. 2011;3(1):28–30.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parikh N, Choi J, Li M, Sharma R, Fernandez-Peñas P. Squamous cell carcinoma arising in a recent plaque of discoid lupus erythematous, in a sun-protected area. Lupus. 2010;19(2):210–2.

    Article  CAS  PubMed  Google Scholar 

  • Piraccini BM, Vincenzi C, Lorenzi S, Jorizzo M, Tosti A. Oral calcitriol in the treatment of scleroderma “en coupe de sabre”. J Dermatol Treat. 2000;11:207–8.

    Article  Google Scholar 

  • Radstake TR, van Bon L, Broen J, Hussiani A, Hesselstrand R, Wuttge DM, Deng Y, Simms R, Lubberts E, Lafyatis R. The pronounced Th17 profile in systemic sclerosis (SSc) together with intracellular expression of TGFbeta and IFNgamma distinguishes SSc phenotypes. PLoS One. 2009;4(6):e5903.

    Article  PubMed  PubMed Central  Google Scholar 

  • Richard G, Harth W. Keratosis follicularis spinulosa decalvans. Hautarzt. 1993;44:529–34.

    CAS  PubMed  Google Scholar 

  • Rodríguez-Lojo R, Pozo JD, Barja JM, Piñeyro F, Pérez-Varela L. Keratosis pilaris atrophicans: treatment with intense pulsed light in four patients. J Cosmet Laser Ther. 2010;12(4):188–90.

    Article  PubMed  Google Scholar 

  • Samrao A, Chew AL, Price V. Frontal fibrosing alopecia: a clinical review of 36 patients. Br J Dermatol. 2010;163(6):1296–300.

    Article  CAS  PubMed  Google Scholar 

  • Spencer LA, Hawryluk EB, English 3rd JC. Lichen planopilaris: retrospective study and stepwise therapeutic approach. Arch Dermatol. 2009;145(3):333–4.

    Article  PubMed  Google Scholar 

  • Stefanaki C, Stefanaki K, Kontochristopoulos G, Antoniou C, Stratigos A, Nicolaidou E, Gregoriou S, Katsambas A. Topical tacrolimus 0.1 % ointment in the treatment of localized scleroderma. An open label clinical and histological study. J Dermatol. 2008;35(11):712–8.

    Article  PubMed  Google Scholar 

  • Su O, Onsun N, Onay HK, Erdemoglu Y, Ozkaya DB, Cebeci F, Somay A. Effectiveness of medium-dose ultraviolet A1 phototherapy in localized scleroderma. Int J Dermatol. 2011;50(8):1006–13.

    Article  PubMed  Google Scholar 

  • Sugano M, Shintani Y, Kobayashi K, Sakakibara N, Isomura I, Morita A. Successful treatment with topical tacrolimus in four cases of discoid lupus erythematosus. J Dermatol. 2006;33(12):887–91.

    Article  PubMed  Google Scholar 

  • Terao M, Matsui S, Katayama I. Two cases of refractory discoid lupus erythematosus successfully treated with topical tocoretinate. Dermatol Online J. 2011;17(4):15.

    PubMed  Google Scholar 

  • Torok KS, Arkachaisri T. Methotrexate and corticosteroids in the treatment of localized scleroderma: a standardized prospective longitudinal single-center study. J Rheumatol. 2012;39(2):286–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tosti A, Torres F, Misciali C, Vincenzi C, Starace M, Miteva M, Romanelli P. Follicular red dots: a novel dermoscopic pattern observed in scalp discoid lupus erythematosus. Arch Dermatol. 2009;145(12):1406–9.

    Article  PubMed  Google Scholar 

  • Walker JL, Smith HR, Lun K, Griffiths WA. Improvement of folliculitis decalvans following shaving of the scalp. Br J Dermatol. 2000;142:1245–6.

    Article  CAS  PubMed  Google Scholar 

  • Wenzel J, Wörenkämper E, Freutel S, Henze S, Haller O, Bieber T, Tüting T. Enhanced type I interferon signalling promotes Th1-biased inflammation in cutaneous lupus erythematosus. J Pathol. 2005;205(4):435–42.

    Article  CAS  PubMed  Google Scholar 

  • Wenzel J, Uerlich M, Wörrenkämper E, Freutel S, Bieber T, Tüting T. Scarring skin lesions of discoid lupus erythematosus are characterized by high numbers of skin-homing cytotoxic lymphocytes associated with strong expression of the type I interferon-induced protein MxA. Br J Dermatol. 2005;153(5):1011–5.

    Article  CAS  PubMed  Google Scholar 

  • Zinkernagel MS, Trueb RM. Fibrosing alopecia in a pattern distribution. Arch Dermatol. 2000;136:205–11.

    Article  CAS  PubMed  Google Scholar 

  • Zulian F, Vallongo C, Patrizi A, Belloni-Fortina A, Cutrone M, Alessio M, Martino S, Gerloni V, Vittadello F, Martini G, Zulian F, Vallongo C, Patrizi A, Belloni-Fortina A, Cutrone M, Alessio M, Martino S, Gerloni V, Vittadello F, Martini G. A long-term follow-up study of methotrexate in juvenile localized scleroderma (morphea). J Am Acad Dermatol. 2012;67(6):1151–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antonella Tosti .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Tosti, A., Maranda, E.L., Piraccini, B.M. (2015). Cicatricial Alopecia. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D’Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45139-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45139-7_15

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45138-0

  • Online ISBN: 978-3-662-45139-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics