Scarring Alopecia

Folliculitis DecalvansA scarring alopecia characterised by the presence of pustules around the hair follicle resulting in permanent loss of hair accompanied by follicle destruction and scarring. The scarring alopecia affects both men and women is inexorable. The onset can occur any time after adolescence. Aetiology is uncertain, but staphylococcus aureus has been implicated.

Impetigo – A skin infection caused primarily by the presence of Group A Beta-hemolytic Streptococci (GABS) aka Streptococcus Pyogenes. Staphylococcus Aureus can also be isolated from impetigo lesions. Impetigo presents as small blisters which rapidly coalesce and rupture. The thin yellow exudate dries forming a crust. The scalp, legs, arms, face and trunk may be affected. 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 scarring alopecia which presents as greatly dilated follicles with horny plugs. Has been attributed to a folliculitis with keratotic micro cysts.

Herpes Zoster (Shingles) – Scalp Shingles presents 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. This condition may be painful. Scarring alopecia may follow.

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

Lichen Planus (Planopilaris)Lichen Planopilaris (scalp lichen planus) presents as follicular and perifollicular violaceous, scaly, pruritic scalp papules which may coalesce into plaques. Hairloss and cicatrix may follow. The disease tends to affect women and causes cicatrical alopecia with inflammation around affected hair follicles. In middle-aged patients distinct bald patches are exhibited. Pseudopelade may be the diagnosis. The skin may present a purple appearance and often concave. A biopsy is often needed to aid diagnosis. Treatment: Oral / topical steroids may be helpful.

Lupus Erythematosus (discoid & systemic) – A chronic inflammatory condition caused by an autoimmune disease (tissue attacked by its own immune system). Antibodies fight infectious agents. Lupus sufferers produce abnormal antibodies which target own-body tissue rather than foreign infectious agents. This condition can cause many and varied diseases. It presents itself as:

i)    Discoid Lupus Erythematosus affecting the skin.
ii)   Systemic Lupus Erythematosusinternal organs are involved

Lupus is 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 scarring alopecia which may become extensive.

Pseudo-pelade (Brocq) – Early stages shows similarities to alopecia areata presenting as one or more small bald patches which are smooth and atrophic. Many more such patches may appear. Affected areas include the scalp, in particular the vertices and parietal regions. Also known as footsteps in the snow.

scarring alopeciaTraction Alopecia –  Scarring Alopecia which is often permanent. Tends to affect girls and adults (afroid and caucasoid) Tends to affect the anterior margins, 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 scalp folliculitis that presents as an uncomfortable erythematous skin with adherent crust and follicular hyperkeratosis. Multiple hairshafts (5-12) may emerge from single dilated follicles. these hairshafts may depigment. Lesions are often symmetrical. Response to topical (intralesional) or systemic treatments is uncertain.

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