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

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

Disclosures

Skinmed. 2004;3(5) 

In This Article

Lupus Erythematosus

Chronic cutaneous lupus erythematosus (CCLE) can affect the scalp and starts with coin-shaped, scaly, and erythematous lesions. Removal of the scales requires force because the scales are anchored by hyperkeratotic plaques within the follicle openings (Figure 3). CCLE leads to atrophic hypopigmented hairless patches in 30%-50% of cases. The diagnosis can be confirmed by serological findings like leucopenia, anemia, and antinuclear antibodies. However, serology may be completely normal. A biopsy shows vacuolar degeneration of the basal cell layer, compact hyperkeratosis, hyperkeratotic plugs of the hair follicles, and patchy inflammatory infiltrates around adnexum and vessels. Perivascular and perieccrine chronic inflammation helps to differentiate lupus erythematosus from lichen planopilaris.[7] Direct immunofluorescence detects granular deposits of IgG and C3 at the dermal-epidermal junction and follicular epithelium.

Chronic cutaneous lupus erythematosus of the scalp showing hyperkeratotic, erythematous plaques leading to scarring alopecia.

Treatment comprises topical, intralesional or systemic steroids, retinoids, and antimalarials. Thalidomide as an anti-inflammatory agent and immunomodulator (by inhibition of tumor necrosis factor ) showed promising results in small clinical studies of patients with refractory CCLE.[12]

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