Scarring Alopecias: Not always Classic in Appearance

The Scarring Alopecias: Not always classic

Scarring alopecias are a type of hair loss associated with the development of permanent hair loss. Not every scarring alopecia looks “classic” or “textbook.” One needs to always consider a scarring alopecia in patients with many symptoms (especially scalp tenderness and burning). Rapid loss, shedding, and redness in the scalp may also cause one to at least consider the possibility.

This patient has lichen planopilaris despite the lack of more classic dermatoscopic features. There is not much in the way of perifollicular redness. There is no real perifollicular scale (and the little bit of scale that is present can be seen in the normal scalp and in seborrheic dermatitis). There is no pili torti (twisting of hair) and no loss of follicular ostia. There is so degree of ansotrichosis (variation in diameter of hairs) which is consistent with the underlying androgenetic alopecia that the patient has had for years prior to the new development of scarring alopecia. The patient presented with hair shedding, scalp burning, scalp itching, tenderness and redness. A black dot marks the spot that a biopsy was taken to prove the diagnosis of lichen planopilaris.