Clinical, trichoscopic, and histopathological features of primary cicatricial alopecias: A retrospective observational study at a tertiary care centre of North East India

Abstract

Background:The primary cicatricial alopecias (PCAs) are a rare group of diseases where hair follicle is the primary target of destruction. There are a few studies on histopathological and trichoscopic features of PCA.Aims:To study the clinical, trichoscopic, and histopathological characteristics of PCAs of the scalp and to find out the concordance between trichoscopic and histopathological diagnosis.Materials and Methods:We retrospectively analyzed the clinical, trichoscopic, and histopathological features of 24 PCA patients. Fisher's Chi-square exact test was done to find the significant trichoscopic and histopathological features. Cohen's kappa coefficient was used to determine the agreement between histopathological and trichoscopic diagnosis.Results:A total of 24 patients of PCA were seen with a male: female ratio of 2:1. There were 10 (41.7%) patients of discoid lupus erythematosus (DLE), 5 (20.8%) of lichen planopilaris (LPP), 3 (12.5%) of dissecting cellulitis of scalp, and 2 (8.3%) each of pseudopelade of brocq, folliculitis decalvans, and frontal fibrosing alopecia. The important histopathological findings of DLE were follicular plugging, vacuolar changes in the basal layer, necrotic keratinocytes, and superficial and deep perifollicular and perivascular lymphocytic infiltrate. Histopathology of LPP showed vacuolar changes in the basal layer and lichenoid infiltrate involving the infundibulum and isthmus. Trichoscopy of DLE showed follicular plugging, yellow dots, and thick arborizing blood vessels. The peripilar cast was important finding in LPP. The characteristic yellow dot with three-dimensional structure was noted in dissecting cellulitis of the scalp. The Cohen's kappa agreement was 0.89 between histopathological and trichoscopic diagnosis.Conclusion:The diagnosis of PCA is challenging because of overlapping features clinically and histopathologically. Trichoscopy may provide quick and reliable diagnosis and obviate the necessity of scalp biopsy in busy clinics.

Trichoscopy of Dark Scalp

“…Other dermoscopic features of DLE are the presence of follicular red dots (erythematous polycyclic, concentric structures which correspond to dilated follicular openings surrounded by dilated vessels), white patches, and variable scaling [82]. Enlarged branching vessels are also common, and their presence strongly suggests a diagnosis of DLE [65,82,83]. Abedini et al [84] reported that the presence of both tortuous branching vessels and hyperkeratotic follicular scales was 100% specific for the diagnosis of DLE in Iranian patients (phototypes III-V).…”

Trichoscopy of primary cicatricial alopecias: an updated review

“…Pathologically, this corresponds to the accumulation of melanophages around the follicles while sparing the interfollicular area . Presence of elongated blood vessels or arborizing red lines in LPP has been reported in a few studies and correspond to the subpapillary vascular plexus . These are different from the vessels seen in DLE which are tortuous and thicker .…”

“…Thick arborizing vessels or tortuous enlarged branching vessels have been described as a characteristic trichoscopic feature of DLE of the scalp . A combination of tortuous enlarged branching vessels and follicular keratotic plugging was reported as 100% specific for the diagnosis of DLE …”

“…25,26 Thick arborizing vessels or tortuous enlarged branching vessels have been described as a characteristic trichoscopic feature of DLE of the scalp. 3,15,27 A combination of tortuous enlarged branching vessels and follicular keratotic plugging was reported as 100% specific for the diagnosis of DLE. 3 Large, twisted, arborizing vessels in the area of porcelain white skin signify old and inactive lesions and correlate with scarring and vascular hyperplasia in histology.…”

Correlation between clinical, histopathological and direct immunoflourescence findings in cases of cicatricial alopecias

“…A study was undertaken by Thakur et al to study the clinical, trichoscopic, and histopathological characteristics of cicatricial alopecias of the scalp and to find out the concordance between trichoscopic and histopathological diagnosis. 12 They concluded that there was 89% concordance between trichoscopic and histopathological diagnosis in their study.…”