Hair Development, Growth, and Loss 66 capitis is treated by oral administration of antifungal agents. Cicatricial alopecia: Cicatricial alopecia or scarring alopecia denotes permanent disruption of hair follicles, which leads to irreversible hair loss. Cicatricial alopecia can result from a primary inflammatory process involving the bulge region of the hair follicles or secondary to a destructive process from unrelated events such as trauma, neoplasm, and chronic infections (see Table 2).96 Damage to hair follicle epithelial stem cells that reside in the bulge area is the key process of the permanent hair loss.97 Discoid lupus erythematosus is a common cause of primary cicatricial alopecia and is characterized by erythematous plaques, scaling, and follicular plugging (Figure 15). Lichen planopilaris predominantly affects adult women and presents as perifollicular hyperkeratosis with variable erythema on reticulate and atrophic plaques with intense pruritus. Frontal fibrosing alopecia is mostly encountered in postmenopausal woman featuring a band of frontotemporal recession and is regarded as a variant of lichen planopilaris. Primary Secondary Discoid lupus erythematosus Radiation Lichen planopilaris Burns Classic lichen planopilaris Malignancies Frontal fibrosing alopecia Sarcoidosis Graham-Little syndrome Severe infections Classic Pseudopelade (Brocq) Morphea Central centrifugal cicatricial alopecia Alopecia mucinosa Keratosis follicularis spinulosa decalvans Folliculitis decalvans Dissecting cellulitis Acne keloidalis Acne necrotica Erosive pustular dermatosis Table 2. Classification of cicatricial alopecia95
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