Lymphocytic |
Lichen planopilaris
| Women | Itchy, multifocal or central patches with follicular hyperkeratosis and perifollicular erythema; nonscalp areas may be affected | Intralesional triamcinolone +/− topical steroids | Potent topical steroids | Calcineurin inhibitors | If not treated, will burn out |
Intralesional triamcinolone +/− topical steroids | Hydroxychloroquine | Doxycycline, mycophenolate or cyclosporine |
Oral corticosteroids | Oral corticosteroids | Oral corticosteroids |
Chronic cutaneous lupus erythematosus | Women, genetic, ultraviolet sensitive | Single or multifocal patches with pronounced activity in the centre of the patch, ulceration, follicular plugging, atrophy and depigmentation | Intralesional triamcinolone | Hydroxychloroquine +/− mepacrine (quinacrine) | Retinoids (e.g., isotretinoin), azathioprine, methotrexate, mycophenolate mofetil or thalidomide | Systemic lupus erythematosus will develop in less than 5% of patients (higher risk in children and adolescents: 25%–30%); spontaneous remission occurs in one-third of patients |
Frontal fibrosing alopecia | Postmenopausal women | Band-like distribution around the frontal hairline; may be present in eyebrows | Hydroxychloroquine | Mycophenolate | Antiandrogens or calcineurin inhibitors | If not treated, will burn out |
Central centrifugal cicatricial alopecia | Black women | Resembles lichen planopilaris; burning, scaling and itchiness may occur | Cease traumatic hair care | Topical steroids | Topical steroids | If not treated, will burn out |
Brocq pseudopelade | Adults | Small and/or large, irregular patches of hair loss on the scalp with no detectable symptoms or inflammation; end-stage burnout | Intralesional triamcinolone +/− topical steroids | Hydroxychloroquine, isotretinoin or prednisone | Hydroxychloroquine, isotretinoin or prednisone | End-stage burnout |
Neutrophilic |
Folliculitis decalvans | Adults; can occur in adolescent males but not seen in women until > age 30 yr | Single patch of complete alopecia that expands circumferentially, slowly over years; typically found on hair-bearing periphery of scalp; pustules, honey- coloured crusting, tufting; nonscalp involvement is rare | Rifampicin +/− clindamycin | Doxycycline, ciprofloxacin or clarithromycin | Fusidic acid + zinc | If not treated, will burn out |
Dissecting cellulitis of the scalp | Black adolescent and adult males | Multiple fluctuant nodules found across the scalp, often interconnected by sinus tracts; may be associated with acne conglobata: discharge is common and should be cultured | Oral isotretinoin | Intralesional triamcinolone | Oral corticosteroids | If not treated, will burn out |