Cicatricial alopecia: do clinical, trichoscopic, and histopathological diagnosis agree?

Abstract

Cicatricial alopecia (CA) results from irreversible destruction and fibrosis of hair follicles. Trichoscopy offers a noninvasive method for diagnosis. Thirty-two patients clinically diagnosed with CA were subjected to trichoscopy and histopathology assessment. The sensitivity and specificity of clinical and trichoscopic diagnoses were compared to histopathology. Thirty-two patients were clinically diagnosed as follows: 12 with discoid lupus erythematosus, four with lichen planopilaris (LPP), two with frontal fibrosing alopecia (FFA), three with folliculitis decalvans (FD), nine with central cicatricial centrifugal alopecia (CCCA), and two with long-term alopecia areata. Trichocopy revealed discoid lupus in 13 patients, LPP in nine, FFA in two, FD in three, central centrifugal alopecia in four, and pseudopelade in one. Histopathology confirmed discoid lupus in 13 patients, LPP in five, FFA in two, FD in three, CCCA in six, pseudopelade in two, and sarcoidosis in one. The sensitivity and specificity of clinical diagnosis were 69.2% and 84.2% in discoid lupus, 40.0% and 92.6% in LPP, 100.0% and 100.0% in FFA, 66.7% and 96.6% in FD, and 66.7% and 80.8% in central centrifugal alopecia. The sensitivity and specificity of trichoscopy were 84.6% and 89.5% in discoid lupus, 100.0% and 85.2% in LPP, 100.0% and 100.0% in FFA and FD, 66.7% and 100.0% in central centrifugal alopecia, and 50.0% and 100.0% in pseudopelade. Trichoscopy can be equivalent to histopathology for diagnosing some cases of CA.