Scarring Alopecia Follow-up

  • Author: Basil M Hantash, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Oct 17, 2011
 

Deterrence/Prevention

Patients should discontinue any practices that exert traction on the hair, including the following:

  • Hairstyling practices such as braiding and chemical hair straightening
  • Use of tight curlers and nylon brushes
  • Wearing the hair in a chignon (bun)
Next

Prognosis

The natural history of scarring alopecia has not been extensively validated in the literature.

Previous
Next

Patient Education

Instruct patients to discontinue hairstyling practices that cause traction alopecia.

Evaluation and follow up should be emphasized, even if patient is disappointed that the physician does not have a quick fix for the problem or cannot reverse its course. At the very least, halting progression is often possible and a point to highlight.

Previous
 
Contributor Information and Disclosures
Author

Basil M Hantash, MD, PhD  Chairman, Elixir Institute of Regenerative Medicine

Basil M Hantash, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Rashid M Rashid, MD, PhD  Resident Physician, Department of Dermatology, University of Texas, Houston, MD Anderson Cancer Center, and Morzak Research Initiative

Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, Houston Dermatological Society, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

James W Patterson, MD  Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Chiu HY, Lin SJ. Fibrosing alopecia in a pattern distribution. J Eur Acad Dermatol Venereol. Feb 2 2010;[Medline].

  2. Olsen EA. Female pattern hair loss and its relationship to permanent/cicatricial alopecia: a new perspective. J Investig Dermatol Symp Proc. Dec 2005;10(3):217-21. [Medline].

  3. Ross EK, Tan E, Shapiro J. Update on primary cicatricial alopecias. J Am Acad Dermatol. Jul 2005;53(1):1-37; quiz 38-40. [Medline].

  4. Nusbaum BP, Nusbaum AG. Frontal fibrosing alopecia in a man: results of follicular unit test grafting. Dermatol Surg. Jun 2010;36(6):959-62. [Medline].

  5. Rashid RM, Thomas V. Androgenic pattern presentation of scarring and inflammatory alopecia. J Eur Acad Dermatol Venereol. Jan 6 2010;[Medline].

  6. Rakowska A, Slowinska M, Kowalska-Oledzka E, Olszewska M, Czuwara J, Rudnicka L. Alopecia areata incognita: true or false?. J Am Acad Dermatol. Jan 2009;60(1):162-3. [Medline].

  7. Abraham LS, Torres FN, Azulay-Abulafia L. Dermoscopic clues to distinguish trichotillomania from patchy alopecia areata. An Bras Dermatol. Oct 2010;85(5):723-6. [Medline].

  8. Iorizzo M, El Shabrawi Caelen L, Vincenzi C, Misciali C, Tosti A. Folliculotropic mycosis fungoides masquerading as alopecia areata. J Am Acad Dermatol. Aug 2010;63(2):e50-2. [Medline].

  9. Hutchens KA, Balfour EM, Smoller BR. Comparison between Langerhans cell concentration in lichen planopilaris and traction alopecia with possible immunologic implications. Am J Dermatopathol. May 2011;33(3):277-80. [Medline].

  10. Zinkernagel MS, Trüeb RM. Fibrosing alopecia in a pattern distribution: patterned lichen planopilaris or androgenetic alopecia with a lichenoid tissue reaction pattern?. Arch Dermatol. Feb 2000;136(2):205-11. [Medline].

  11. Aljabre SH. Trichotillomania: a trichotillosis, a trichotillotic, or a tic trichotillosis. Int J Dermatol. Nov 1993;32(11):823-4. [Medline].

  12. Lacarrubba F, Dall'oglio F, Micali G. Massive tufted hair folliculitis associated with chronic use of systemic corticosteroids. G Ital Dermatol Venereol. Apr 2011;146(2):164-5. [Medline].

  13. Kim KR, Lee JY, Kim MK, Yoon TY. Erosive pustular dermatosis of the scalp following herpes zoster: successful treatment with topical tacrolimus. Ann Dermatol. May 2010;22(2):232-4. [Medline].

  14. Hwang SM, Lee WS, Choi EH, Lee SH, Ahn SK. Nurse's cap alopecia. Int J Dermatol. Mar 1999;38(3):187-91. [Medline].

  15. Renna FS, Freedberg IM. Traction alopecia in nurses. Arch Dermatol. Nov 1973;108(5):694-5. [Medline].

  16. Whiting DA. How real is senescent alopecia? A histopathologic approach. Clin Dermatol. Jan-Feb 2011;29(1):49-53. [Medline].

  17. Kyei A, Bergfeld WF, Piliang M, Summers P. Medical and environmental risk factors for the development of central centrifugal cicatricial alopecia: a population study. Arch Dermatol. Aug 2011;147(8):909-14. [Medline].

  18. Mirmirani P, Karnik P. Lichen planopilaris treated with a peroxisome proliferator-activated receptor gamma agonist. Arch Dermatol. Dec 2009;145(12):1363-6. [Medline].

  19. Al-Zaid T, Vanderweil S, Zembowicz A, Lyle S. Sebaceous gland loss and inflammation in scarring alopecia: a potential role in pathogenesis. J Am Acad Dermatol. Sep 2011;65(3):597-603. [Medline].

  20. Hepper DM, Wu P, Anadkat MJ. Scarring alopecia associated with the epidermal growth factor receptor inhibitor erlotinib. J Am Acad Dermatol. May 2011;64(5):996-8. [Medline].

  21. Monselise A, Chan LJ, Shapiro J. Break dancing: a new risk factor for scarring hair loss. J Cutan Med Surg. May-Jun 2011;15(3):177-9. [Medline].

  22. Whiting DA. Cicatricial alopecia: clinico-pathological findings and treatment. Clin Dermatol. Mar-Apr 2001;19(2):211-25. [Medline].

  23. Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Determinants of marginal traction alopecia in African girls and women. J Am Acad Dermatol. Sep 2008;59(3):432-8. [Medline].

  24. Ochoa BE, King LE Jr, Price VH. Lichen planopilaris: Annual incidence in four hair referral centers in the United States. J Am Acad Dermatol. Feb 2008;58(2):352-3. [Medline].

  25. Rashid RM. Alopecia: the case for systemic care and evaluation. Accepted for publication. Skinmed. 2010;to be determined.

  26. Dorr VJ. A practitioner's guide to cancer-related alopecia. Semin Oncol. Oct 1998;25(5):562-70. [Medline].

  27. Matta M, Kibbi AG, Khattar J, Salman SM, Zaynoun ST. Lichen planopilaris: a clinicopathologic study. J Am Acad Dermatol. Apr 1990;22(4):594-8. [Medline].

  28. Aten E, Brasz L, Bornholdt D, Hooijkaas IB, Porteous ME, Sybert VP. Keratosis follicularis spinulosa decalvans is caused by mutations in MBTPS2. Hum Mutat. Jul 29 2010;[Medline].

  29. Prevezas C, Matard B, Pinquier L, Reygagne P. Irreversible and severe alopecia following docetaxel or paclitaxel cytotoxic therapy for breast cancer. Br J Dermatol. Apr 2009;160(4):883-5. [Medline].

  30. Sullivan JR, Kossard S. Acquired scalp alopecia. Part II: A review. Australas J Dermatol. May 1999;40(2):61-70; quiz 71-2. [Medline].

  31. Callen JP. Chronic cutaneous lupus erythematosus. Clinical, laboratory, therapeutic, and prognostic examination of 62 patients. Arch Dermatol. Jun 1982;118(6):412-6. [Medline].

  32. George PM, Tunnessen WW Jr. Childhood discoid lupus erythematosus. Arch Dermatol. May 1993;129(5):613-7. [Medline].

  33. Assouly P, Happle R. A Hairy Paradox: Congenital Triangular Alopecia with a Central Hair Tuft. Dermatology. Jun 26 2010;[Medline].

  34. Armenores P, Shirato K, Reid C, Sidhu S. Frontal fibrosing alopecia associated with generalized hair loss. Australas J Dermatol. Aug 2010;51(3):183-5. [Medline].

  35. Park H, Kim CW, Kim SS, Park CW. The therapeutic effect and the changed serum zinc level after zinc supplementation in alopecia areata patients who had a low serum zinc level. Ann Dermatol. May 2009;21(2):142-6. [Medline].

  36. Amor KT, Rashid RM, Mirmirani P. Does D matter? The role of vitamin D in hair disorders and hair follicle cycling. Dermatol Online J. 2010;16(2):3. [Medline].

  37. Estrada BD, Tamler C, Sodre CT, Barcaui CB, Pereira FB. Dermoscopy patterns of cicatricial alopecia resulting from discoid lupus erythematosus and lichen planopilaris. An Bras Dermatol. Apr 2010;85(2):179-83. [Medline].

  38. Ozcan D, Ozen O, Seçkin D. Vertical vs. transverse sections of scalp biopsy specimens: a pilot study on the comparison of the diagnostic value of two techniques in alopecia. Clin Exp Dermatol. Sep 15 2011;[Medline].

  39. Nguyen JV, Hudacek K, Whitten JA, Rubin AI, Seykora JT. The HoVert technique: a novel method for the sectioning of alopecia biopsies. J Cutan Pathol. May 2011;38(5):401-6. [Medline].

  40. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. Feb 2010;62(2):177-88, quiz 189-90. [Medline].

  41. Elston DM, McCollough ML, Warschaw KE, Bergfeld WF. Elastic tissue in scars and alopecia. J Cutan Pathol. Mar 2000;27(3):147-52. [Medline].

  42. Zinkernagel MS, Trüeb RM. Fibrosing alopecia in a pattern distribution: patterned lichen planopilaris or androgenetic alopecia with a lichenoid tissue reaction pattern?. Arch Dermatol. Feb 2000;136(2):205-11. [Medline].

  43. Sullivan JR, Kossard S. Acquired scalp alopecia. Part II: A review. Australas J Dermatol. May 1999;40(2):61-70; quiz 71-2. [Medline].

  44. Rhee CH, Kim SM, Kim MH, Cinn YW, Ihm CW. Two cases of linear alopecia on the occipital scalp. Ann Dermatol. May 2009;21(2):159-63. [Medline].

  45. Kossard S, Collins A, McCrossin I. Necrotizing lymphocytic folliculitis: the early lesion of acne necrotica (varioliformis). J Am Acad Dermatol. May 1987;16(5 Pt 1):1007-14. [Medline].

  46. Emer JJ, Stevenson ML, Markowitz O. Novel treatment of female-pattern androgenetic alopecia with injected bimatoprost 0.03% solution. J Drugs Dermatol. Jul 2011;10(7):795-8. [Medline].

  47. Rushton DH, Gilkes JJ. Delaying treatment in male-pattern hair loss affects the therapeutic response. Clin Exp Dermatol. Mar 2011;36(2):204-5. [Medline].

  48. Chiang C, Sah D, Cho BK, Ochoa BE, Price VH. Hydroxychloroquine and lichen planopilaris: efficacy and introduction of Lichen Planopilaris Activity Index scoring system. J Am Acad Dermatol. Mar 2010;62(3):387-92. [Medline].

  49. Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. Jul 2009;66(7):756-63. [Medline].

  50. Earles RM. Surgical correction of traumatic alopecia marginalis or traction alopecia in black women. J Dermatol Surg Oncol. Jan 1986;12(1):78-82. [Medline].

  51. Miranda BH, Farjo N, Farjo B. Eyebrow reconstruction in dormant keratosis pilaris atrophicans. J Plast Reconstr Aesthet Surg. Jul 1 2011;[Medline].

  52. Jimenez F, Izeta A, Poblet E. Morphometric analysis of the human scalp hair follicle: practical implications for the hair transplant surgeon and hair regeneration studies. Dermatol Surg. Jan 2011;37(1):58-64. [Medline].

  53. Meyer-Gonzalez T, Bisanga C. Body-Hair Transplant for Cicatricial Alopecia. Actas Dermosifiliogr. Aug 25 2011;[Medline].

  54. Amor KT, Rashid RM, Mirmirani P. Does D matter? The role of vitamin D in hair disorders and hair follicle cycling. Dermatol Online J. Feb 15 2010;16(2):3. [Medline].

  55. Aaronson CM. Etiologic factors in traction alopecia. South Med J. Feb 1969;62(2):185-6. [Medline].

  56. Ackerman AB, Walton NW III, Jones RE, et al. Hot comb alopecia/follicular degeneration syndrome in African American women is traction alopecia. Dermatopathol Pract Concept. 2000;6:320-36.

  57. Boer A, Hoene K. Transverse sections for diagnosis of alopecia?. Am J Dermatopathol. Aug 2005;27(4):348-52. [Medline].

  58. Callender VD, McMichael AJ, Cohen GF. Medical and surgical therapies for alopecias in black women. Dermatol Ther. 2004;17(2):164-76. [Medline].

  59. Civas E, Aksoy B, Aksoy HM, Eski M, Yucel K. Hair transplantation for therapy-resistant alopecia areata of the eyebrows: is it the right choice?. J Dermatol. Sep 2010;37(9):823-6. [Medline].

  60. Clore ER, Corey A. Hair loss in children and adolescents. J Pediatr Health Care. Sep-Oct 1991;5(5):245-50. [Medline].

  61. Goette DK, Berger TG. Acne keloidalis nuchae. A transepithelial elimination disorder. Int J Dermatol. Sep 1987;26(7):442-4. [Medline].

  62. Hantash BM, Schwartz RA. Traction alopecia in children. Cutis. Jan 2003;71(1):18-20. [Medline].

  63. Harman RR. Traction alopecia due to "hair extension". Br J Dermatol. Jul 1972;87(1):79-80. [Medline].

  64. Ikeda T, Yamada M. [Factors in telogen affluvium and traction alopecia]. Acta Dermatol Kyoto Engl Ed. May 1967;62(2):109-13. [Medline].

  65. Kanwar AJ, Ghosh S, Thami GP, Kaur S. Alopecia and cutis verticis gyrata due to traction presenting as headache. Int J Dermatol. Sep 1992;31(9):671-2. [Medline].

  66. Kanwar AJ, Kaur S, Basak P, Sharma R. Traction alopecia in Sikh males. Arch Dermatol. Nov 1989;125(11):1587. [Medline].

  67. Laude TA. Approach to dermatologic disorders in black children. Semin Dermatol. Mar 1995;14(1):15-20. [Medline].

  68. Monk BE, Neill SM, du Vivier A. Fashion causes traction alopecia. Practitioner. May 1986;230(1415):401-2. [Medline].

  69. Phillips JH 3rd, Smith SL, Storer JS. Hair loss. Common congenital and acquired causes. Postgrad Med. Apr 1986;79(5):207-15. [Medline].

  70. Pongpudpunth M, Demierre MF, Goldberg LJ. A case report of inflammatory nonscarring alopecia associated with the epidermal growth factor receptor inhibitor erlotinib. J Cutan Pathol. Dec 2009;36(12):1303-7. [Medline].

  71. Rashid R, Hymes S. Folliculitis, follicular mucinosis, and papular mucinosis as a presentation of chronic myelomonocytic leukemia. Dermatol Online J. May 15 2009;15(5):16. [Medline].

  72. Rhee CH, Kim SM, Kim MH, Cinn YW, Ihm CW. Two cases of linear alopecia on the occipital scalp. Ann Dermatol. May 2009;21(2):159-63. [Medline]. [Full Text].

  73. Scott DA. Disorders of the hair and scalp in blacks. Dermatol Clin. Jul 1988;6(3):387-95. [Medline].

  74. Shapiro J, Wiseman M, Lui H. Practical management of hair loss. Can Fam Physician. Jul 2000;46:1469-77. [Medline]. [Full Text].

  75. Singh G. Letter: Traction alopecia in Sikh boys. Br J Dermatol. Feb 1975;92(2):232-3. [Medline].

  76. Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician. Jul 1 2003;68(1):93-102. [Medline].

  77. Van Neste D, Sandraps E, Herbaut D, Lelubre P, Leroy T. Validation of scalp coverage scoring methods for scalp hair loss in male pattern hair loss (androgenetic alopecia). Skin Res Technol. May 2006;12(2):89-93. [Medline].

  78. Whiting DA, Olsen EA. Central centrifugal cicatricial alopecia. Dermatol Ther. Jul-Aug 2008;21(4):268-78. [Medline].

 
Previous
Next
 
Traction alopecia.
Alopecia due to primary cutaneous follicular center cell lymphoma. Used with permission, rights retained, courtesy of Rashid M. Rashid, MD, PhD, Morzak Research Collaborative.
Recalcitrant scarring pressure alopecia several years after an ICU stay. Used with permission, rights retained, courtesy of Rashid M. Rashid, MD, PhD, Morzak Research Collaborative.
End-stage scarring alopecia (ESSA) with prior history of itching and burning, along with a receding hairline. Started as the lichen planopilaris variant, frontal fibrosing alopecia. Used with permission, rights retained, courtesy of Rashid M. Rashid, MD, PhD, Morzak Research Collaborative.
Dissecting scalp cellulitis. Used with permission, rights retained, courtesy of Rashid M. Rashid, MD, PhD, Morzak Research Collaborative.
Armpit scarring alopecia in lichen planopilaris variant. Patient presented with frontal fibrosing alopecia. Used with permission, rights retained, courtesy of Rashid M. Rashid, MD, PhD, Morzak Research Collaborative.
Acne keloidalis. A misnomer term based on clinical examination findings. Used with permission, rights retained, courtesy of Rashid M. Rashid, MD, PhD, Morzak Research Collaborative.
Lichen planopilaris in its active stage presenting in a lighter-skinned patient. Courtesy of Rashid M Rashid, MD, PhD, and Ronald Rapini, MD.
Alopecic and aseptic nodules of the scalp (AANS) is a new entity reported first in Japan as "pseudocyst of the scalp." The main location of the nodules was the occiput. The associated alopecia was nonscarring. Histology is nonspecific but often shows deep granulomas. AANS reponds to tetracyclines. Photo courtesy of Sami Abdennader, MD (rights retained).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.