Abstract

We report two cases of alopecia in which histopathologic features of scarring alopecia were identified in patients that clinically had non-scarring alopecia as evidenced by regrowth of alopecic patches. Case 1: A 56-year-old woman presented with patchy hair loss on the frontal scalp and vertex. A biopsy revealed a diminished number of terminal follicles with distinct perifollicular fibrosis, prompting a diagnosis of lymphocytic scarring alopecia. Due to lack of clinically evident scarring, alopecia areata was considered clinically and topical sensitization therapy with Anthralin was initiated. At 1 month follow up there was a significant hair regrowth in areas of alopecia supporting a diagnosis of alopecia areata. Case 2: A 35-year-old woman presented with hair thinning at the scalp vertex. She was initially diagnosed with androgenetic alopecia, but subsequently developed an oval patch of alopecia at the vertex. There was no clinical evidence of scarring and alopecia areata was suspected. Scalp biopsy showed perifollicular fibrosis at the level of the isthmus with perifollicular lymphocytic inflammation, consistent with scarring alopecia. The patient was treated with intralesional steroids and hair regrowth was noted supporting a diagnosis of alopecia areata. Perifollicular fibrosis with mucin and perifollicular lymphocytic inflammation combined with loss of sebaceous glands are prototypic histopathologic findings of lymphocyte mediated scarring alopecia. Despite these diagnostic histopathologic findings in both these patients, the clinical evolution for the patients supports a non-scarring alopecia with significant hair regrowth in patches of alopecia. It is feasible that these cases represent an undescribed histopathologic pattern of alopecia areata that mimics lymphocytic scarring alopecia. Alternatively, it is possible that these patients have both alopecia areata and lymphocytic scarring alopecia concurrently.

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