Histopathologic and dermoscopic features of 42 cases of folliculitis decalvans: A case series

Folliculitis decalvans (FD) is a form of inflamed primary cicatricial alopecia (PCA). FD is classified as a neutrophilic PCA; however, only a few previous studies have described its histopathology, including the assessment of systematically evaluated and quantified follicular changes in horizontally...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2021-11, Vol.85 (5), p.1185-1193
Main Authors: Uchiyama, Masaki, Harada, Kazutoshi, Tobita, Rie, Irisawa, Ryokichi, Tsuboi, Ryoji
Format: Article
Language:English
Subjects:
Alopecia
cicatricial alopecia
dermoscopy
Fibrosis
Folliculitis
folliculitis decalvans
histology
horizontal sections
Humans
Keloid
Retrospective Studies
scarring alopecia
transverse sections
trichoscopy
tufted folliculitis
vertical sections
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Summary:Folliculitis decalvans (FD) is a form of inflamed primary cicatricial alopecia (PCA). FD is classified as a neutrophilic PCA; however, only a few previous studies have described its histopathology, including the assessment of systematically evaluated and quantified follicular changes in horizontally sectioned biopsy specimens with clinical and dermoscopic findings of the early and advanced stages. We aimed to clarify the histopathologic and dermoscopic features of early and advanced active stage FD. We conducted a case series study of 42 patients with FD by dermoscopy and both horizontally and vertically sectioned biopsy specimens. The histopathologic findings of the early-stage lesions included loss of sebaceous glands; interfollicular acanthosis; and fibrosis with depressed, fused follicular infundibula showing thickened interfollicular keloid-like areas with tufted hairs on dermoscopy. Active lesions showed a greater number of hair clusters, clefting, and fused infundibula with dense inflammation predominantly in the upper follicles. Neutrophil-predominant infiltrates were observed in fewer than half of the patients, including those with early-stage lesions. This was a retrospective study. FD has the features of mixed-cell PCA. The features of early-stage FD are thickened interfollicular keloid-like areas with tufted hairs and loss of sebaceous glands.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2020.03.092