Version May 2024
| Epidemiology | Clinical features on scalp | Nonscalp involvement | Pathology | |
| Lymphocytic primary cicatricial alopecias | ||||
| Discoid lupus erythematosus | Onset usually in young adulthood; more common in females than males; may occur independently or in patients with SLE | Erythematous, atrophic plaques with follicular plugging present centrally, hyperpigmentation, and/or hypopigmentation | Face, ears, and other sites may be affected; a minority of cases are associated with SLE | Interface dermatitis, epidermal atrophy, follicular plugging, basement membrane thickening, perifollicular superficial and deep lymphoplasmacytic infiltrate; DIF shows IgG, IgM, and C3 at the BMZ |
| Lichen planopilaris | Most common in White and East Indian females | Areas of scarring and follicles with erythema and scale; itching and pain may be severe | May be accompanied by cutaneous, nail, or mucous membrane lichen planus | Lichenoid infiltrate around the isthmus and infundibulum, interface dermatitis, concentric lamellar fibroplasia |
| Frontal fibrosing alopecia | Mostly postmenopausal females | Perifollicular erythema, follicular hyperkeratosis, band-like frontal alopecia | Loss of eyebrows common, papules on face | Lichenoid infiltrate around the isthmus and infundibulum, apoptotic keratinocytes in outer root sheath, concentric lamellar fibroplasia |
| Classic pseudopelade of Brocq | Most common in middle-aged females | Skin-colored scarred plaques resembling "footprints in the snow" | N/A | Lymphocytic infiltrate around infundibulum, concentric lamellar fibroplasia around follicles in later lesions |
| Central centrifugal cicatricial alopecia | Most common in females of African origin | Patch of scarring alopecia on crown of scalp that progresses centrifugally | N/A | Premature desquamation of the inner root sheath, loss of sebaceous glands, variable perifollicular chronic inflammation at isthmus and infundibulum, concentric lamellar fibroplasia |
| Alopecia mucinosa | May be associated with mycosis fungoides or CTCL | Erythematous or skin-colored indurated plaques with alopecia, follicular papules | Eyebrow involvement may be present | Mucin deposits in outer root sheath, eventual replacement of follicles by mucin, lymphocytic infiltrate |
| Keratosis folliculars spinulosa decalvans | X-linked inheritance of mutation in the MBTPS2 gene; less commonly autosomal dominant transmission | Noninflammatory, hyperkeratotic follicular papules and progressive hair loss | Eyebrow and eyelash involvement may be present, photophobia | Follicular plugging and hypergranulosis, primarily lymphocytic perifollicular infiltrate, fibrosis |
| Neutrophilic primary cicatricial alopecias | ||||
| Dissecting cellulitis of the scalp | Most common in young Black males | Inflammatory papules, pustules, fluctuant nodules, abscesses; may also have keloidal scarring | May be associated with hidradenitis suppurativa and acne conglobata | Follicular occlusion, intrafollicular and perifollicular neutrophilic and lymphoplasmacytic infiltrate; follicular perforation, deep abscesses and sinus tracts in later stages |
| Folliculitis decalvans | Most common in young and middle-aged adults, particularly males | Patches of alopecia, erythematous follicular papules, pustules, follicular hyperkeratosis, tufted folliculitis | N/A | Interfollicular and perifollicular neutrophilic infiltrate; mixed infiltrate, granulomas, and fibrosis in later lesions |
| Mixed primary cicatricial alopecias | ||||
| Acne keloidalis nuchae | Most common in young Black males | Dome-shaped papules and pustules on the occipital scalp and nape of the neck; keloids may develop | N/A | Neutrophilic or lymphoplasmacytic inflammatory infiltrate around the isthmus and infundibulum; granulomatous infiltrate may also be present; marked fibrosis |
| Acne necrotica | Usually occurs in adults | Umbilicated, pruritic, painful papules that undergo central necrosis and resolve with varioliform scars | N/A | Infundibular folliculitis with necrosis, lymphocytic or mixed inflammatory infiltrate |
| Erosive pustular dermatosis of the scalp | Most common in older adults, particularly females | Pustules, erosions, and crusted plaques | N/A | Nonspecific early findings; older lesions with a chronic mixed inflammatory infiltrate and fibrosis |
| Other | ||||
| Tinea capitis | Usually affects children | Scaly patches or plaques; kerion may develop | Tinea corporis may be present | Perifollicular inflammation and fungal elements within or around the hair shaft |
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