Scarring Alopecia Flashcards
What is the histopathologic feature of lichen planopilaris?
Perifollicular band-like lymphoid cell infiltrate obscuring the interface between follicular epithelium and dermis
Typical features include vacuolar alteration at the interface and hyper-granulosis within affected infundibula, sometimes with colloid or Civatte bodies.
What areas of the follicle are predominantly affected in lichen planopilaris?
Upper portion of the follicle (infundibulum and isthmus)
Inflammation primarily occurs in these areas.
What histopathologic changes to sebaceous glands in lichen planopilaris?
Reduced or absent sebaceous glands
What does the histopathologic feature of late stage lichen planopilaris?
Prominent fibrosis over time with lymphocytic infiltrate backing away from the follicle. Follicular tufting.
What is often found between the epithelium and stroma in lichen planopilaris?
Artifactual cleft with epithelium floating within the cleft (Max-Joseph spaces)
What are the end-stage features of lichen planopilaris?
Follicular ‘tufting’ and fragments of ‘naked’ hair shafts in giant cells
What does direct immunofluorescence show in lichen planopilaris?
Colloid bodies (usually IgM) adjacent to the follicular epithelium and a linear ‘shaggy’ band of fibrinogen when epidermis is involved
What characterizes central centrifugal cicatricial alopecia?
Premature desquamation of the inner root sheath in the subisthmic area
What type of inflammation is present in central centrifugal cicatricial alopecia?
Variably dense lymphocytic perifollicular inflammation
Primarily at the level of the upper isthmus and lower infundibulum.
What advanced histopathologic changes occur in central centrifugal cicatricial alopecia?
Total destruction of the follicular epithelium with retained hair shaft fragments and granulomatous inflammation
What is a key histopathologic feature of discoid lupus erythematosus?
Vacuolar interface alteration of the epidermis and follicular epithelium
What is observed in the late stages of discoid lupus erythematosus?
Follicular and/or epidermal basement membrane zone thickening
What type of inflammation is noted in discoid lupus erythematosus?
Chronic inflammation with lymphocytes (often including plasma cells) of the eccrine sweat glands and arrector pili
What is a significant feature of direct immunofluorescence in discoid lupus erythematosus?
Granular deposits of IgG and C3 at the dermal-epidermal junction
What characterizes folliculitis decalvans in histopath?
Pustular neutrophilic folliculitis rich in lymphocytes and plasma cells
What is seen in the early stages of folliculitis decalvans?
Perifollicular inflammation with mixed, predominantly neutrophilic, infiltrate
What occurs in the late stages of folliculitis decalvans?
Perifollicular scarring with ‘tufting’ and interfollicular dermal scarring
What is a notable feature in histopath in acne keloidalis?
Perifollicular, chronic inflammation, most intense at the level of the isthmus and lower infundibulum
What happens to sebaceous glands in histopath in acne keloidalis?
Loss of sebaceous glands
What is observed in dissecting cellulitis in histopath?
Moderately dense, perifollicular lymphocytic inflammation affecting the lower half of the dermis
What happens to the follicles in dissecting cellulitis in histopath
Numerous intact and seemingly undamaged follicles in the upper dermis
What is a characteristic of ‘end-stage’ cicatricial alopecia in histopath?
A decreased total number of hairs, especially terminal hairs
What features are seen in advanced ‘end-stage’ cicatricial alopecia in histopath?
Residual ‘naked’ hair shafts within histiocytic giant cells surrounded by mild, granulomatous inflammation
