Scarring alopecia

The absence of hair follicles is an important physical sign as it indicates:

(1) The presence of an inflammatory process that requires further investigation.

(2) That there is unlikely to be any substantial recovery of hair growth.

The presence of inflammation does not necessarily produce marked erythema—in lichen planus and lupus erythematosus, the inflammatory changes are often chronic. Systemic lupus erythematosus produces areas of inflammation that extend, leaving residual scarring. In discoid lupus erythematosus there is more scaling with keratotic plugs in the follicle. Localised scleroderma (morphoea) also causes alopecia, often with a linear atrophic lesion—the en coup de sabre pattern.

More acute inflammatory changes are seen as a result of pyogenic infection or kerion in which there is a marked inflammatory reaction to fungal infection from cattle. In "folliculitis decalvans" there is florid folliculitis with deep seated pustules and scarring. Treatment is with prolonged antibiotics.

Tinea capitis can be associated with alopecia.

Trauma can also cause scarring with alopecia.

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