Perifollicular redness in LPP

Redness around hairs

The normal and healthy scalp is not red. However a number of conditions cause the scalp to be red in areas. Redness occurring around the hair follicle itself is called “perifollicular redness” or “perifollicular erythema”. It usually indicates that there is inflammation somewhere in that hair follicle. Some causes of perifollicular erythema are not all that worrisome but may cause some degree of symptoms. Examples would include itching in patients with seborrheic dermatitis. However, one must always take note of perifollicular erythema and carefully evaluate whether the redness and associated inflammation is a sign of something more serious. Some examples here including perifollicular erythema associated with three scarring alopecias - 1) lichen planopilaris 2) central centrifugal cicatricial alopecia and 3) folliculitis decalvans.

The finding of perifollicular erythema should always prompt the clinician to commit to a diagnosis based on the patient’s history, blood tests and scalp examination findings. If the cause of the redness is not certain, a 4 mm punch biopsy should be done.