Scarring alopecia in discoid lupus erythematosus

Abstract

The clinicopathological features of the scarring alopecia of discoid lupus erythematosus (DLE) were studied. Scarring alopecia was present in 34% of 89 patients with DLE and was associated with a prolonged disease course. More than half these patients had scalp involvement at the onset of the disease. There was a significant reduction in size of sebaceous glands in affected scalp. Perifollicular lymphocytic inflammation was maximal around the mid-follicle at the level of the sebaceous gland, which seems to be an important functional level in the follicle. There are changes in the expression of the matrix molecules, the proteoglycans, in the connective tissue sheath and the keratin intermediate filaments in the outer root sheath cells at this level in normal scalp and in diseased scalp. Loss of a population of mid-follicular stem cells may be important in the pathogenesis of scarring alopecia in DLE.

A clinical and histopathological study of cicatricial alopecia

“…In our study, commonest histopathological feature of alopecia was perifollicular fibrosis seen in 65% patients,basal cell vacuolization was seen in 52.5% patients,perifollicular lymphocytic infiltrate were seen in 50% patients, epidermal atrophy seen in 35% patients and hyperkeratosis was seen in 20% patients. The combination of diffuse scaling, erythema, telangiectases, and mottled hyperpigmentation within areas of scarring alopecia was a distinctive feature of DLE [6,7]. In most patients with LP, the histologic changes involved only the follicles and the perifollicular dermis.…”

Primary cicatricial alopecias: clinicopathology of 112 cases

“…CCLE of the scalp may precede, coexist, or follow other skin lesions. 6 In an earlier study by Wilson et al,4 34% of patients with CCLE had scalp involvement and this may serve as a marker of chronicity and poor response to treatment. In a smaller study by Callen, 7 41% of patients with CCLE had cicatricial alopecia.…”

“…In accordance with previous studies, we observed a female predominance of lymphocytic cicatricial alopecias. [2][3][4] In our series, both LPP and CCLE affected predominately middle-aged adults, although LPP appears to have a later onset in life. In lupus erythematosus, the activity of the disease is primarily focused in the center of the plaque, whereas in LPP the activity predominately occurred at the periphery.…”

Histologic Features of Alopecias: Part II: Scarring Alopecias

“…4,6---9 Moreover, atrophy and destruction of the sebaceous glands are often observed from early stages. 7,9 In the late stages, CCLE lesions show striking lamellar fibrosis, surrounding the upper follicle, although these lesions can also be panfollicular, and as the condition progresses, the follicle may be completely destroyed ( Fig. 1).…”