Primary cicatricial alopecia

Cicatricial alopecias encompass a diverse group of disorders characterized by permanent destruction of hair follicles and irreversible hair loss leading to fibroplasia and collagen hyalinisation. Destruction of the hair follicle can result from primary, folliculocentric disease (primary cicatricial alopecia) or as a secondary result (secondary cicatricial alopecia). According to the North American Hair Research Society classification based on inflammatory cell type prevailing in scalp biopsy specimens taken from representative, clinically active lesions, primary cicatricial alopecias were divided into four groups: with predominant lymphocytic, neutrophilic, mixed and unclassified type of infiltration. This article focuses on primary cicatricial alopecias. The diagnosis of these disorders is difficult and histopathological evaluation often inconclusive. Trichoscopy is a newly developed method of hair imaging and analysis, based on videodermoscopy of hair and scalp and could be helpful in the diagnostic process. It is essential to become familiar with clinical features characteristic for individual types of cicatricial alopecia in order to recognize them at a very early stage.