Scarring Alopecias

 

Scarring Alopecias

Acne Necrotica Miliaris & Varioliformis

Favus

Folliculitis Decalvans

Impetigo

Hyperkeratosis Cystica Follicularis

Herpes (Shingles) 

Lichen Planus (Planopilaris)

Lupus Erythematosus (discoid & systemic)

Pemphigus

Pseudo-pelade (Brocq)

Traction Alopecia

Tufted Folliculitis

This article is published for general information. It is not intended as an aid to self diagnosis. If you are suffering any of these conditions, medical advice should be sought. The Society lists practitioners in some countries.Please see Hair Consultants (titlebar)

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Acne Necrotica Miliaris - (superficial form of this disease)

Presenting as numerous small vesico-pustules on the scalp often at the central/posterior vertices. Pruritus may co-exist. The pustules rupture leaving a crust (often the only diagnostic feature). Patients are often adult males in middle age. Culture may indicate the presence of Corynebacterium (Propioni-bacterium) or Staphylococcus Aureus. Follicular necrosis usually results.
Acne necrotica varioliformis - (the deeper scarring form of the disease).
Presenting as inflammatory pruritic follicular papules which rupture leaving a crust and scarring.

 

Favus (Latin - honeycomb) 

A chronic inflammatory skin infection usually effecting the scalp, but may inculcate nails and glaborous skin. It is caused by one of the following dermatophytes : Trichophyton Schoenleinii, Trichophyton Violaceum, Trichophyton Mentagrophytes, Microsporum Gypseum. 
Symptoms: thick yellow cup-shaped crusts (scutula) grouped in patches like a honeycomb, each about the size of a split pea, with a hair projecting in the centre. may grow in the diseased state.
Favus may be spread by contagion usually from cats, dogs, mice. and is the only known rabbit ailment to be transmissible to man.

 

Folliculitis Decalvans 

A cicatrical alopecia characterised by erythematous scalp with folliculitis (pustules around the hair follicles). Follicle destruction, and scarring with permanent hair loss results. The disease which affects both men and women is inexorable. The onset can occur at any time after adolescence.

Aetiology is uncertain, but staphylococcus aureus has been implicated.

 

Impetigo

An infection of the skin caused primarily by the presence of Group A Beta-hemolytic Streptococci (GABS) sometimes named Streptococcus Pyogenes. Staphylococcus Aureus can also be isolated from impetigo lesions.
Impetigo presents as a group of small blisters which rapidly coalesce and rupture. The thin yellow exudate dries forming a crust. Sites: the scalp, the legs, the arms, face and trunk. Incubation period-up to 10 days. Hair losses and scarring may occur.

Causes: direct skin-to-skin contact with a carrier or someone suffering streptococcal pharyngitis.

Treatment: aural / topical antibiotic.

Hyperkeratosis Cystica Follicularis

A rare cicatrical alopecia which commences as greatly dilated follicles with horny plugs

 

Herpes Zoster (Shingles)

Scalp Shingles can be a very uncomfortable (sometimes painful) disease presenting as a localised rash with blistering (cause: Varicella the chickenpox virus). The blisters burst and crust over usually within a week often leaving pale scars.

Treatment is to relieve pain (analgesics), or a non-steroidal anti-inflammatory medicine. Calamine lotion may help.

Lichen Planus (Planopilaris)

 Lichen Planopilaris is the specific name given to lichen planus of the scalp.The disease presents as follicular and perifollicular violaceous, scaly, pruritic papules on the scalp which may coalesce into plaques. A scarring alopecia may result. The disease which is more common in women causes cicatrical alopecia with inflammation around affected hair follicles. In middle-aged patients distinct bald patches are exhibited. Pseudopelade may be the diagnosis.
Treatment: Oral / topical steroids may be helpful.

 

Lupus Erythematosus (discoid & systemic)

A chronic inflammatory condition caused by an autoimmune disease (when the body's tissues are attacked by its own immune system). 
The immune system is designed to fight infectious agents via the production of antibodies. Patients with Lupus produce abnormal antibodies in their blood which target own-body tissues rather than foreign infectious agents. Lupus can cause many and varied diseases. It exists in two forms:

i) Discoid Lupus Erythematosus- when only the skin is involved.
ii) Systemic Lupus Erythematosus - when internal organs are involved

Lupus is more frequently seen in Mongoloid and Negroid women. The disease can affect all age groups but more frequently commences in those aged 20 to 45 years. Its precise cause remain uncertain but genetics, viruses, exposure to ultraviolet light, and various drugs are suspected.
Discoid lupus is usually painless and non-pruritic but often results in cicatrical baldness which may become extensive.

 

Pemphigus 

A group of three rare, non-infectious, potentially recurring auto-immune diseases presenting as painful lesions/blisters on the skin and mucosal membranes. The scalp may be affected and usually results in a cicatrical alopecia.

 

Pseudo-pelade (Brocq)

A rare disease which initially resembles commencing alopecia areata. The scalp exhibits one or more small bald patches which are smooth and atrophic. Many more such patches may appear.

Sites: any scalp location but usually the vertices and parietal regions. The disease has given rise to the phrase 'footsteps in the snow'

 

Traction Alopecia

Hair loss (often permanent) in girls and adults (afroid and caucasoid)
Sites: may effect the anterior margin, auriculars and occipital hair line. This hairloss is often cicatrical, and is associated with scalp trauma produced by plaits, cornrows, long hair dressed and maintained firmly in chignons, ponytails, pleats etc. Similar damage may occur elsewhere on the scalp associated with hair extensions, tracks and the tight application of styling rollers.

 

Tufted Folliculitis

A rare form of scalp folliculitis presenting as uncomfortable erythematous skin with adherent crust and follicular hyperkeratosis. Locally, multiple hairshafts (possibly 5 +) may emerge from single dilated 'follicular orifice with inflammatory infiltrate. Hairshafts may depigment. Lesions may follow a symmetrical pattern of distribution. Current speculation is that Pemphigus may be inculcated. The pathogenesis is not currently understood. Staphylococcus aureus is not always present. Response to topical (intralesional) or systemic Antibiotic therapy alone is often insufficient.

The President 2016-2018

Dr Janet Palin

 

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