Clinical, Dermoscopic and Histopathologic Features of Cicatricial Alopecia- A Prospective Cohort Study

Abstract

Introduction: Cicatricial Alopecia (CA) is a scarring form that arises due to permanent hair follicle destruction. It can either primarily affect the follicles or by an external process leads to secondary alopecia causing scarring and considerable disfigurement of the scalp. Hence initial diagnosis, aetiology of the contributing factors and earlier intervention are vital. Aim: To identify the diagnostic features of CA based on clinical, dermoscopic and histopathological (HP) findings and the underlying aetiological causes. Materials and Methods: This prospective cohort study was conducted in a tertiary care centre of Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India from November 2016 to September 2017. Total 50 clinically diagnosed CA cases were randomly selected and case history, related skin findings, predisposing factors and other findings associated with scarring were documented. Dermatological examination and Hair pull test was done. Trichoscopic examination was done using a non polarised dermoscopy with specific emphasis on the follicular ostia and morphological patterns. Scalp biopsy was done. The collected data were analysed in terms of frequency and percentage and Chi-square test was also performed with p-value <0.05 as statistically significant. Results: Out of total 50 patients, 22 (44%) were males, and 28 (56%) females with the mean age of 35.46±15.03 years. Total 29 (58%) patients had multiple lesions and 21 (42%) had localised involvement of alopecia in the scalp. Focal type was noted in 86%, and diffuse type in 14%. In this study, 80% of CA were of primary causes with only 20% secondary causes. Lichen Plano Pilaris (LPP) and trauma were the most common primary and secondary causes. The dermoscopic features of absent follicular orifice, arborising thicker blood vessel and pustule formation were statistically significant (p-value <0.001) for the diagnosis of CA. The most common histopathological feature was basal cell vacuolization (54%), followed by hyperkeratosis (52%), and follicular plugging (46%). Conclusion: The clinical, dermoscopic and histopathological findings of this study were consistent for diagnosis and differentiating primary CA. Histopathology is the final confirmatory diagnostic tool when characteristic clinical and dermoscopic features are absent.

Keywords

• permanent hair follicle destruction
• primary scarring alopecia
• skin of colour
• trichoscope