C1 SCALP HISTOPATHOLOGY WITH SPECIAL ATTENTION TO CICATRICIAL ALOPECIAS
Whiting D1, Schärer L2, Trüeb RM2, Kempf W3, Misciali C4
1Baylor Hair Research and Treatment Center, Dallas, Texas, USA
2 Department of Dermatology, University Hospital of Zurich, Switzerland
3 Kempf & Pfalz, Histologic Diagnostics, Zurich, Switzerland
4 Department of Dermatology, University of Bologna, Italy

The cicatricial alopecias are from experience often a diagnostic and therapeutic challenge to the clinician. Accurate diagnosis is a prerequisite to effective therapy. Where there is no obvious physical/chemical injury or acute infectious etiology, clinical differential diagnosis of scarring alopecia is often difficult. The loss of follicular orifices in an area of alopecia points to a permanent loss of hair follicles. In all of these cases a scalp biopsy is indicated. Primary and secondary scarring alopecias are differentiated: While the former are due to preferential destruction of the follicle, the latter result from events outside the follicle, which eventually impinge upon and eradicate the follicle. In the group of primary scarring alopecias, well-defined chronic-inflammatory diseases of the scalp amenable to specific therapies are differentiated microscopically on the basis of the pattern of inflammation and the type of inflammatory cell that predominates (lymphocyte-dominated versus neutrophil-dominated). Secondary scarring alopecias include infiltrative processes such as granulomatous inflammation and neoplastic disease. Where end-stage fibrosis is established, histopathology tends to be unspecific, and treatment most problematic. This course focuses on the differentiation of the types of scarring alopecias on the basis of histopathologic findings and their clinico-pathologic correlations.