Diseases on Hair Follicles Leading to Hair Loss Part II: Scarring Alopecias

Katharina Wiedemeyer; Wolf-Berhard Schill, MD; Christoph Löser, MD


Skinmed. 2004;3(5) 

In This Article


The most important differential diagnosis to the mentioned granulocyte-associated alopecias is the deep trichomycosis. Trichomycosis may also present with follicular pustules, nodules, and hair loss. It should always be excluded before the beginning of treatment. Culture of hair material (pulling out an affected hair is not painful) detects trichophyton species in most cases. Compared with trichophyton infections, infections with microsporum species miss the strong inflammatory reaction as long as there is no bacterial superinfection. Typically, hair breaks off above the follicle openings and the scalp is covered by fine scaly material resembling flour. Use of a Wood's lamp is an easy method to diagnose an infection with microsporum species (green fluorescence). Mycotic infections are mainly observed in children. The favus is an exception, which affects adults and occurs under poor hygienic circumstances. Treatment consists of systemic antimycotics such as itraconazole or other azole derivatives or griseofulvin.

The most common causes for scarring alopecia are discoid lupus erythematosus and lichen planopilaris.[8] To distinguish lichen planus from lupus, one has to strive toward a good correlation of clinical and histopathologic findings, because either clinic or histology alone may not offer enough specific information to make the correct diagnosis.


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