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Jerry Shapiro - One of the best experts on this subject based on the ideXlab platform.
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Primary cicatricial Alopecia: Other lymphocytic primary cicatricial Alopecias and neutrophilic and mixed primary cicatricial Alopecias
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Leonard C Sperling, Jerry ShapiroAbstract:Primary cicatricial Alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary cicatricial Alopecias, which include pseudopelade of Brocq, central centrifugal cicatricial Alopecia, Alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary cicatricial Alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.
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primary cicatricial Alopecia
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Jerry Shapiro, Leonard C SperlingAbstract:Both primary and secondary forms of cicatricial Alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial Alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial Alopecia. This 2-part continuing medical education article will review primary cicatricial Alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial Alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing Alopecia, and Graham–Little syndrome.
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Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations
Journal of the American Academy of Dermatology, 2014Co-Authors: Thamer Mubki, Malgorzata Olszewska, Lidia Rudnicka, Jerry ShapiroAbstract:The use of trichoscopy for evaluating a number of hair and scalp disorders is gaining popularity. It is a simple and noninvasive in vivo tool for visualizing hair shafts and the scalp. Recently, Alopecias have been classified according to their trichoscopic findings. The second part of this 2-part continuing medical education article reviews recent advances in this field and describes a systematic approach for using the differential diagnostic findings of trichoscopy in Alopecia.
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Alopecia areata investigational assessment guidelines part ii
Journal of The American Academy of Dermatology, 2004Co-Authors: Elise A Olsen, Jerry Shapiro, Vera H Price, Maria K Hordinsky, Janet L Roberts, Madeleine Duvic, Doug Canfield, Lloyd E King, Amy J Mcmichael, Valerie RandallAbstract:Alopecia areata is an immunologically mediated disease characterized by extreme variability not only in the time of initial onset of hair loss but in the duration, extent and pattern of hair loss during any given episode of active loss. These variables, as well as the unpredictable nature of spontaneous regrowth and lack of a uniform response to various therapies, has made clinical trials in Alopecia areata difficult to plan and implement. In fact, there are currently no drugs FDA-approved specifically for the indication of Alopecia areata. To help facilitate well-controlled clinical trials for Alopecia areata, this National Alopecia Areata Foundation (NAAF) sponsored subgroup of investigators/clinicians experienced in clinical trials and/or in the clinical care of patients with Alopecia areata has outlined some general principles and potential endpoints for clinical studies in Alopecia areata.Theseguidelines buildontheAlopeciaAreata
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Alopecia areata investigational assessment guidelines
Journal of The American Academy of Dermatology, 1999Co-Authors: Elise A Olsen, Jerry Shapiro, Vera H Price, Maria K Hordinsky, Susan Mcdonaldhull, Janet L Roberts, Kurt S StennAbstract:From Duke University Medical Center, Durhama; University of Minnesota, Minneapolisb; Pontefract General Infirmaryc; University of California at San Franciscod; Northwest Cutaneous Research Specialists, Portlande; The University of British Columbia, Vancouverf; and Johnson & Johnson, Skin Biology Research Center, Skillman.g Reprint requests: Elise A. Olsen, MD, Professor of Medicine, Duke University Medical Center, Box 3294, Durham, NC 27710. J Am Acad Dermatol 1999;40:242-6. *Developed from the Alopecia Areata Consensus meeting sponsored by the National Alopecia Areata Foundation at the First Tricontinental Meeting of the Hair Research Societies, Brussels, Belgium, Oct 8, 1995. Participants are listed at the end of the guidelines. Copyright © 1999 by the American Academy of Dermatology, Inc. 0190-9622/99/$8.00 + 0 16/1/95940 I. PURPOSE To establish criteria for selecting and assessing subjects for both clinical and laboratory studies of Alopecia areata, thereby facilitating collaboration, comparison of data, and the sharing of patient-derived tissue II. DEFINITION OF Alopecia AREATA Alopecia areata is a dermatologic disease characterized in its limited form by circumscribed round or oval patches of Alopecia with well-demarcated borders between normal and affected scalp. There is no scale or induration of the scalp and no loss of follicular markings. Disease extent may progress from this limited form to complete loss of hair on the scalp and/or body. III. INCLUSION CRITERIA These guidelines apply only to terminal hair loss or growth on the scalp. These guidelines focus on the major forms of Alopecia areata (patchy Alopecia areata, Alopecia totalis, and Alopecia universalis) and their expression on the scalp. The terms Alopecia totalis and Alopecia universalis imply 100% scalp hair loss. Areas of hair loss other than on the scalp may be assessed and documented in the data collected on each patient. (See Section IV. B) IV. CRITERIA FOR MEASURING EXTENT OF INVOLVEMENT Those data items in boldface type should be filled out in toto. Those data items not in bold are optional and can be filled out as desired by the investigator. A. The proportion of scalp involvement is determined by dividing the scalp into 4 quadrants and estimating the percentage of the scalp surface that all the alopecic areas would occupy if placed together. The following groups will be used: S: Scalp hair loss _____S0 = No hair loss _____S4 = 76%-99% hair loss _____S1 = ≤ 25% hair loss _____a = 76%-95% hair loss _____S2 = 26%-50% hair loss _____b = 96%-99% hair loss _____S3 = 51%-75% hair loss _____S5 = 100% hair loss B. Other areas of Alopecia or involvement by Alopecia areata may be noted: B: Body hair loss _____B0 = No body hair loss _____B2 = 100% body (excluding scalp) hair loss _____B1 = Some body hair loss N: Nail involvement _____N0 = No nail involvement _____N1 = Some nail involvement _____a. Twenty-nail dystrophy/trachyonychia (must be all 20 nails) SPECIAL ARTICLE
Ramon Grimalt - One of the best experts on this subject based on the ideXlab platform.
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Platelet-Rich Plasma and its Use for Cicatricial and Non-Cicatricial Alopecias: A Narrative Review
Dermatology and Therapy, 2020Co-Authors: Rubina Alves, Ramon GrimaltAbstract:The concept and description of platelet-rich plasma (PRP) started in the field of hematology and is being extensively used in other fields of medicine. Interest in the application of PRP has been increasing in dermatology, such as in tissue regeneration, wound healing, scar revision, skin-rejuvenating effects, and Alopecia. PRP is an autologous blood product containing high concentrations of platelets in a small volume of plasma. Different preparations of PRP may lead to different volumes of PRP, platelet concentration, and presence or absence of leukocytes. PRP is being used as a new therapy for some types of non-cicatricial Alopecia such as androgenetic Alopecia (AGA) and Alopecia areata (AA) and, recently, new insights refer to the possibility of action in the field of cicatricial Alopecia, like lichen planopillaris (LPP) and frontal fibrosing Alopecia (FFA). This article aims to identify the major indications for the application of PRP in the field of hair disorders, including non-cicatricial and cicatricial Alopecia.
Lidia Rudnicka - One of the best experts on this subject based on the ideXlab platform.
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Cyclosporine With and Without Systemic Corticosteroids in Treatment of Alopecia Areata: A Systematic Review
Dermatology and Therapy, 2020Co-Authors: Joanna Nowaczyk, Mariusz Sikora, Adriana Rakowska, Karolina Makowska, Lidia RudnickaAbstract:Introduction Cyclosporine is commonly used in treatment for Alopecia areata. It can be administered as a monotherapy or in combination with systemic corticosteroids, with various outcomes. Methods Efficacy of cyclosporine with and without systemic corticosteroids for Alopecia areata was evaluated by a systematic review. Cochrane, EBSCOhost, Pubmed, Scopus and Web of Science databases were searched. Only studies published before January 2020 were included. Results A total of 2104 studies were initially examined, of which 14 were eligible for the systematic review. Among 340 reported cases, 213 had focal, multifocal or ophiasis form of Alopecia areata, 60 were diagnosed with Alopecia totalis and 67 with Alopecia universalis. The mean response rate in the whole group of patients at the end of treatment was 65.00% (221/340; range 25–100%). Hair regrowth rate was higher in the group with cases of Alopecia areata limited to scalp (124/165; mean 75.15%; range 40–100%) than in the cases with Alopecia totalis (30/46; mean 65.22%; range 25–100%) or Alopecia universalis (24/52; mean 46.15%; range 25–100%). The combined therapy with systemic corticosteroids was superior to the monotherapy (152/219; mean 69.41%; 0–80% vs. 69/121; mean 57.02%; range 6.67–100%) and had a lower recurrence rate (39/108; mean 36.11% vs. 34/46; mean 73.91%, respectively). The combined treatment with methylprednisolone was significantly more effective when compared to the cyclosporine monotherapy (124/183; mean 67.76%; range 0–80% vs. 69/121; mean 57.02%; range 6.67–100%). The mean time of treatment was 6.75 months (range 2–36). Limitations Limitations of our study were the retrospective character of included studies, differences in doses of prescribed drugs, and duration of the treatment and follow-up times. Conclusion Cyclosporine in combination with oral systemic corticosteroids is more effective than in monotherapy for severe Alopecia areata.
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The value of dermoscopy in diagnosing eyebrow loss in patients with Alopecia areata and frontal fibrosing Alopecia.
Journal of The European Academy of Dermatology and Venereology, 2018Co-Authors: Anna Waśkiel-burnat, Malgorzata Olszewska, Adriana Rakowska, Marta Kurzeja, Joanna Czuwara, Mariusz Sikora, Lidia RudnickaAbstract:INTRODUCTION: Alopecia areata and frontal fibrosing Alopecia are common causes of eyebrow loss (madarosis). OBJECTIVE: Assessment of trichoscopic markers of eyebrow loss in Alopecia areata and frontal fibrosing Alopecia. MATERIALS AND METHODS: The analysis included 50 patients with scalp Alopecia areata with madarosis, 50 patients with scalp frontal fibrosing Alopecia with madarosis and 50 healthy controls. In every case, trichoscopy of the eyebrow area was performed. RESULTS: Empty follicular and eccrine duct openings were observed in all patients and presented predominantly as yellow dots. Exclamation mark hairs were only detected in patients with Alopecia areata (30%). Tapered hairs, broken hair, black dots and Pohl-Pinkus constrictions were observed in 14%, 36%, 26% and 4% of patients with Alopecia areata, respectively, 4%, 16%, 2% and 0% of patients with frontal fibrosing Alopecia, respectively, and they were not present in healthy controls. Dystrophic hairs and whitish areas were observed only in patients with frontal fibrosing Alopecia (28% and 32%, respectively). Eyebrow regrowth in distinct directions was present in 32% of patients with frontal fibrosing Alopecia, 8% of patients with Alopecia areata and 4% of healthy controls. Diffuse erythema was detected in 60% of patients with Alopecia areata and frontal fibrosing Alopecia and 56% of healthy controls. Vellus hairs and upright regrowing hairs were observed in patients with Alopecia areata (62% and 58%, respectively), frontal fibrosing Alopecia (60% and 84%, respectively) and healthy controls (100% and 100%, respectively). CONCLUSION: Trichoscopy of the eyebrow area is useful in diagnosing patients with isolated eyebrow loss. The most characteristic trichoscopic features of eyebrow loss in Alopecia areata include exclamation mark hairs, tapered hairs, broken hairs and black dots. Frontal fibrosing Alopecia of the eyebrows is characterized by the presence of dystrophic hairs, white areas and eyebrow regrowth in distinct directions.
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Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations
Journal of the American Academy of Dermatology, 2014Co-Authors: Thamer Mubki, Malgorzata Olszewska, Lidia Rudnicka, Jerry ShapiroAbstract:The use of trichoscopy for evaluating a number of hair and scalp disorders is gaining popularity. It is a simple and noninvasive in vivo tool for visualizing hair shafts and the scalp. Recently, Alopecias have been classified according to their trichoscopic findings. The second part of this 2-part continuing medical education article reviews recent advances in this field and describes a systematic approach for using the differential diagnostic findings of trichoscopy in Alopecia.
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trichoscopy of cicatricial Alopecia
Journal of Drugs in Dermatology, 2012Co-Authors: Adriana Rakowska, Malgorzata Olszewska, Joanna Czuwara, Monika Slowinska, Elzbieta Kowalskaoledzka, Olga Warszawik, Lidia RudnickaAbstract:BACKGROUND: Trichoscopy is widely used in differential diagnosis of non-cicatricial Alopecia. OBJECTIVE: The aim of this prospective study was to identify possible characteristic trichoscopy patterns of diseases leading to primary cicatricial Alopecia. METHODS: Trichoscopy was performed in a total of 1,884 consecutive patients presenting with hair loss. In this group, 84 patients were diagnosed with cicatricial Alopecia and 1,800 patients with non-cicatricial Alopecia. Sixty healthy persons served as healthy controls. Trichoscopy was performed with the use of Fotofinder II videodermoscopy system. Following unique or characteristic features were identified: scattered dark-brown discoloration of the skin, large yellow dots and thick arborizing vessels in cutaneous (discoid) lupus erythematosus (n=20), tubular perifollicular scaling and elongated blood vessels in lichen planopilaris (n=28), minor perifollicular scaling in frontal fibrosing Alopecia (n=19), tufted hairs with starburst pattern perifollicular hyperplasia in folliculitis decalvans (n=9) and large, "3D" yellow dots imposed over dystrophic hairs in dissecting cellulitis (n=8). RESULTS: All patients with cicatricial Alopecia trichoscopy showed white and milky-red areas lacking follicular openings. These features were not found in patients with non-cicatricial Alopecia or healthy controls. CONCLUSION: These results indicate that trichoscopy may be applied as a quick and non-invasive auxiliary method in differential diagnosis of diverse diseases leading to cicatricial Alopecia, such as cutaneous lupus erythematosus, classic lichen planopilaris, frontal fibrosing Alopecia, folliculitis decalvans, and dissecting cellulitis.
Vera H Price - One of the best experts on this subject based on the ideXlab platform.
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Childhood Alopecia areata-Data from the National Alopecia Areata Registry.
Pediatric Dermatology, 2018Co-Authors: Iris Wohlmuth-wieser, Vera H Price, Maria K Hordinsky, Joyce S. Osei, David A. Norris, Angela M. Christiano, Madeleine DuvicAbstract:BACKGROUND/OBJECTIVES: Alopecia areata may occur at any age and is the third-most-common dermatosis in children. The objective of this study was to investigate the clinical and epidemiologic features of children and adolescents with Alopecia areata based on the data of the National Alopecia Areata registry on children and adolescents. METHODS: Two thousand two hundred eighteen children and adolescents with Alopecia areata self-enrolled in the National Alopecia Areata Registry and completed a web-based, self-administered, short-intake screening questionnaire (first tier). In the second tier, 643 patients participated in a clinical examination and completed a long-form questionnaire. RESULTS: Mean age of onset was 5.9 ± 4.1 years. With a female to male ratio of 1.5:1, Alopecia areata was more prevalent in girls, but boys were significantly more likely to have a severe type (P = .009). One-fourth of all children had a positive family history, with 8% having more than three affected relatives. The disease most commonly associated with Alopecia areata was atopic dermatitis (32.7%). CONCLUSION: Childhood Alopecia areata is more prevalent in girls than in boys, but boys have more extensive Alopecia areata. Despite the low prevalence, congenital Alopecia areata is an important differential diagnosis for neonatal hair loss. Alopecia areata runs in families, suggesting an underlying genetic background. One-quarter of the children reported at least one affected first-degree relative; 8% had more than three affected relatives.
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primary cicatricial Alopecia histopathologic findings do not distinguish clinical variants
Journal of The American Academy of Dermatology, 2005Co-Authors: Paradi Mirmirani, Andrea Willey, John T Headington, Kurt S Stenn, Timothy H Mccalmont, Vera H PriceAbstract:Background: Primary cicatricial Alopecias encompass a group of disorders characterized by permanent destruction of the hair follicle. The varied clinical features and differences in terminology have led to difficulties in defining consistent clinicopathologic correlation. Objective: We sought clinicopathologic correlation of 6 clinically distinct primary cicatricial Alopecias: lichen planopilaris, frontal fibrosing Alopecia, pseudopelade (Brocq), central centrifugal Alopecia, folliculitis decalvans, and tufted folliculitis. Methods: We conducted prospective and blinded histopathologic evaluation of clinically typical primary cicatricial Alopecias. Biopsy specimens were taken from early affected scalp lesions and paired with samples from clinically unaffected areas in the same patient. Results: The lymphocytic and neutrophilic groups were readily distinguished histologically. However, within the two groups clinically distinct primary cicatricial Alopecias could not be distinguished with current histopathologic techniques. Conclusion: A descriptive, standardized histopathologic reporting of follicular architecture, type, location, and extent of the inflammatory infiltrate, and presence or absence of sebaceous glands, may be of greatest value in guiding the treatment of patients with primary cicatricial Alopecias. ( J Am Acad Dermatol 2005;52:637-43.)
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Alopecia areata investigational assessment guidelines part ii
Journal of The American Academy of Dermatology, 2004Co-Authors: Elise A Olsen, Jerry Shapiro, Vera H Price, Maria K Hordinsky, Janet L Roberts, Madeleine Duvic, Doug Canfield, Lloyd E King, Amy J Mcmichael, Valerie RandallAbstract:Alopecia areata is an immunologically mediated disease characterized by extreme variability not only in the time of initial onset of hair loss but in the duration, extent and pattern of hair loss during any given episode of active loss. These variables, as well as the unpredictable nature of spontaneous regrowth and lack of a uniform response to various therapies, has made clinical trials in Alopecia areata difficult to plan and implement. In fact, there are currently no drugs FDA-approved specifically for the indication of Alopecia areata. To help facilitate well-controlled clinical trials for Alopecia areata, this National Alopecia Areata Foundation (NAAF) sponsored subgroup of investigators/clinicians experienced in clinical trials and/or in the clinical care of patients with Alopecia areata has outlined some general principles and potential endpoints for clinical studies in Alopecia areata.Theseguidelines buildontheAlopeciaAreata
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Alopecia areata investigational assessment guidelines
Journal of The American Academy of Dermatology, 1999Co-Authors: Elise A Olsen, Jerry Shapiro, Vera H Price, Maria K Hordinsky, Susan Mcdonaldhull, Janet L Roberts, Kurt S StennAbstract:From Duke University Medical Center, Durhama; University of Minnesota, Minneapolisb; Pontefract General Infirmaryc; University of California at San Franciscod; Northwest Cutaneous Research Specialists, Portlande; The University of British Columbia, Vancouverf; and Johnson & Johnson, Skin Biology Research Center, Skillman.g Reprint requests: Elise A. Olsen, MD, Professor of Medicine, Duke University Medical Center, Box 3294, Durham, NC 27710. J Am Acad Dermatol 1999;40:242-6. *Developed from the Alopecia Areata Consensus meeting sponsored by the National Alopecia Areata Foundation at the First Tricontinental Meeting of the Hair Research Societies, Brussels, Belgium, Oct 8, 1995. Participants are listed at the end of the guidelines. Copyright © 1999 by the American Academy of Dermatology, Inc. 0190-9622/99/$8.00 + 0 16/1/95940 I. PURPOSE To establish criteria for selecting and assessing subjects for both clinical and laboratory studies of Alopecia areata, thereby facilitating collaboration, comparison of data, and the sharing of patient-derived tissue II. DEFINITION OF Alopecia AREATA Alopecia areata is a dermatologic disease characterized in its limited form by circumscribed round or oval patches of Alopecia with well-demarcated borders between normal and affected scalp. There is no scale or induration of the scalp and no loss of follicular markings. Disease extent may progress from this limited form to complete loss of hair on the scalp and/or body. III. INCLUSION CRITERIA These guidelines apply only to terminal hair loss or growth on the scalp. These guidelines focus on the major forms of Alopecia areata (patchy Alopecia areata, Alopecia totalis, and Alopecia universalis) and their expression on the scalp. The terms Alopecia totalis and Alopecia universalis imply 100% scalp hair loss. Areas of hair loss other than on the scalp may be assessed and documented in the data collected on each patient. (See Section IV. B) IV. CRITERIA FOR MEASURING EXTENT OF INVOLVEMENT Those data items in boldface type should be filled out in toto. Those data items not in bold are optional and can be filled out as desired by the investigator. A. The proportion of scalp involvement is determined by dividing the scalp into 4 quadrants and estimating the percentage of the scalp surface that all the alopecic areas would occupy if placed together. The following groups will be used: S: Scalp hair loss _____S0 = No hair loss _____S4 = 76%-99% hair loss _____S1 = ≤ 25% hair loss _____a = 76%-95% hair loss _____S2 = 26%-50% hair loss _____b = 96%-99% hair loss _____S3 = 51%-75% hair loss _____S5 = 100% hair loss B. Other areas of Alopecia or involvement by Alopecia areata may be noted: B: Body hair loss _____B0 = No body hair loss _____B2 = 100% body (excluding scalp) hair loss _____B1 = Some body hair loss N: Nail involvement _____N0 = No nail involvement _____N1 = Some nail involvement _____a. Twenty-nail dystrophy/trachyonychia (must be all 20 nails) SPECIAL ARTICLE
Leonard C Sperling - One of the best experts on this subject based on the ideXlab platform.
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primary cicatricial Alopecia
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Jerry Shapiro, Leonard C SperlingAbstract:Both primary and secondary forms of cicatricial Alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial Alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial Alopecia. This 2-part continuing medical education article will review primary cicatricial Alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial Alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing Alopecia, and Graham–Little syndrome.
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Primary cicatricial Alopecia: Other lymphocytic primary cicatricial Alopecias and neutrophilic and mixed primary cicatricial Alopecias
Journal of The American Academy of Dermatology, 2016Co-Authors: Chantal Bolduc, Leonard C Sperling, Jerry ShapiroAbstract:Primary cicatricial Alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary cicatricial Alopecias, which include pseudopelade of Brocq, central centrifugal cicatricial Alopecia, Alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary cicatricial Alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.
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The histopathology of primary cicatricial Alopecia.
Seminars in Cutaneous Medicine and Surgery, 2006Co-Authors: Leonard C Sperling, Shawn E. CowperAbstract:Alopecia typically is divided into cicatricial (scarring) and noncicatricial (nonscarring) forms. "Scarring" Alopecia implies that follicular epithelium has been replaced by connective tissue and is therefore an irreversible process. In contrast, nonscarring Alopecia is potentially reversible as follicular epithelia remain intact. Classification of cicatricial Alopecia can be confusing and controversial as most disorders demonstrate overlapping clinical and histologic features. Herein, we present an overview of the histologic assessment of cicatricial Alopecia, including an algorithmic approach to the evaluation of biopsy specimens from patients with scarring Alopecia.
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Scarring Alopecia and the dermatopathologist
Journal of Cutaneous Pathology, 2001Co-Authors: Leonard C SperlingAbstract:BACKGROUND: The evaluation of patients with cicatricial Alopecia is particularly challenging, and dermatopathologists receive little training in the interpretation of scalp biopsy specimens. Accurate interpretation of specimens from patients with hair disease requires both qualitative (morphology of follicles, inflammation, fibrosis, etc.) and quantitative (size, number, follicular phase) information. Much of this data can only be obtained from transverse sections. In most cases, good clinical/pathologic correlation is required, and so clinicians should be expected to provide demographic information as well as a brief description of the pattern of hair loss and a clinical differential diagnosis. RESULTS: The criteria used to classify the various forms of cicatricial Alopecia are relatively imprecise, and so classification is controversial and in a state of evolution. There are five fairly distinctive forms of cicatricial Alopecia: 1) chronic, cutaneous lupus erythematosus (discoid LE); 2) lichen planopilaris; 3) dissecting cellulitis (perifolliculitis abscedens et suffodiens); 4) acne keloidalis; and 5) central, centrifugal scarring Alopecia (follicular degeneration syndrome, folliculitis decalvans, pseudopelade). Not all patients with cicatricial Alopecia can be confidently assigned to one of these five entities, and "cicatricial Alopecia, unclassified" would be an appropriate label for such cases. CONCLUSION: The histologic features of five forms of cicatricial Alopecia are reviewed. Dermatopathologists can utilize a "checklist" to catalog the diagnostic features of scalp biopsy specimens. In many, but not all, cases the information thus acquired will "match" the clinical and histologic characteristics of a form of cicatricial Alopecia. However, because of histologic and clinical overlap between the forms of cicatricial Alopecia, a definitive diagnosis cannot always be rendered.