WITH THE PUBLICATION of the article by Zinkernagel and Trüeb1 in this issue of the ARCHIVES, we have an opportunity to welcome a new member into the family of scarring alopecia. But should we? If we do, where will this new entity fit within the classification of scarring alopecia?
Zinkernagel and Trüeb describe 15 women and 4 men with a distinctive form of hair loss. Their basic premise is that these 19 patients suffer from a specific type of lichenoid inflammation selectively targeting the miniaturizing hairs of common balding. Evidence to support this novel hypothesis is as follows: All 19 patients had clinical and histologic features suggestive of androgenetic alopecia. These patients also had features of an inflammatory scarring alopecia confined to the zone involved by common balding. Perifollicular erythema and the loss of follicular ostia and follicular keratosis, features commonly seen in inflammatory scarring alopecia, were present in the majority of patients. Chronic inflammation was found around the upper portion of some hair follicles in all 19 patients, with an interface dermatitis pattern in 57% of cases (n = 8). Concentric perifollicular lamellar fibrosis was seen in 93% of cases (n = 13). Focal liquefaction degeneration of the follicular basal cell layer along with prominent apoptosis of follicular keratinocytes was seen in 29% of cases (n = 4).
Leonard C. Sperling, Alvin R. Solomon, David A. Whiting. A New Look at Scarring Alopecia. Arch Dermatol. 2000;136(2):235–242. doi:10.1001/archderm.136.2.235