A scalp biopsy is essential for the diagnosis of cicatricial alopecia and is the necessary first step, as it can be hard to know the diagnosis for sure without a biopsy. Findings of the scalp biopsy, including the type of inflammation present, location and amount of inflammation, and other changes in the scalp, are necessary to diagnose the type of cicatricial alopecia, to determine the degree of activity, and to select appropriate therapy. Clinical evaluation of the scalp is also important. Symptoms of itching, burning, pain, or tenderness usually signal ongoing activity. Signs of scalp inflammation include redness, scaling, and pustules. However, in some cases there are few symptoms or signs and only the scalp biopsy demonstrates the active inflammation. The overall extent and pattern of<unk>  loss is noted and sometimes photographed for future comparison. A<unk>  "pull test" is performed to see if growing, or anagen, where<unk> s are pulled out easily. The pulled<unk> s are mounted on a slide and the<unk>  bulbs are viewed with a light microscope to determine how many are growing<unk> s and how many are resting<unk> s. In addition, if pustules are present, cultures are taken to identify which microbes, if any, may be contributing to the inflammation. A thorough evaluation that includes all of these parameters is important in diagnosing a cicatricial alopecia and in identifying features in individual patients that will help the selection of therapy. New diagnostic techniques, such as trichoscopy may be used for non-invasive differential diagnosis of cicatricial alopecia. Diagnosis and treatment of cicatricial alopecias is often challenging. For this reason, it is helpful to be evaluated by a dermatologist with a special interest or expertise in scalp and<unk>  disorders, and who is familiar with current diagnostic methods and therapies. Classification Boggy, suppurative nodule with patchy<unk>  loss typical of dissecting cellulitis of the scalp. Cicatricial alopecias are classified as primary or secondary. This discussion is confined to the primary cicatricial alopecias in which the<unk>  follicle is the target of the destructive inflammatory process. In secondary cicatricial alopecias, destruction of the<unk>  follicle is incidental to a non-follicle-directed process or external injury, such as severe infections, burns, radiation, tumors, or traction. Primary cicatricial alopecias are further classified by the type of inflammatory cells that destroy the<unk>  follicle during the active stage of the disease. The inflammation may predominantly involve lymphocytes or neutrophils. Cicatricial alopecias that predominantly involve lymphocytic inflammation include lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and pseudopelade (Brocq). Cicatricial alopecias that are due to predominantly neutrophilic inflammation include folliculitis decalvans, tufted folliculitis, and dissecting cellulitis of the scalp. Sometimes the inflammation shifts from a predominantly neutrophilic process to a lymphocytic process. A cicatricial alopecia with a mixed inflammatory infiltrate is folliculitis keloidalis.
Scarring hair loss
Non scarring hair loss
Pattern hair loss
Premature greying of hair
Hypertrichosis
Auricular hypertrichosis
Prepubertal hypertrichosis
Generalized lentiginosis