Secondary Scarring Alopecia: Diagnosis and Treatment

Diagnostic Approach

• The American Academy of Dermatology recommends examining for follicular ostia disappearance on dermoscopy to distinguish scarring from non-scarring alopecia, as their absence with lack of yellow dots, exclamation mark hairs, and cadaverized hairs is indicative of scarring alopecia 1
• The British Association of Dermatologists suggests looking for associated scalp inflammation, scaling, or abnormal skin texture to aid in diagnosis 2

Laboratory Testing

• The British Association of Dermatologists recommends obtaining targeted tests based on clinical suspicion of the underlying systemic disease, such as fungal culture if tinea capitis or deep fungal infection is suspected, and serology for lupus erythematosus (ANA, anti-dsDNA) if systemic lupus is suspected 2, 3

Critical Pitfalls to Avoid

• The American Academy of Dermatology advises against assuming stress caused the scarring, as psychological stress impacts quality of life but does not cause cicatricial alopecia 1

Permanent Scarring Alopecia after Infected Sebaceous Cyst on the Scalp

Clinical Presentation and Diagnosis

• The affected area will show permanent hair loss with smooth, shiny skin where follicular openings have been replaced by scar tissue, distinguishing it from reversible forms of alopecia like alopecia areata, as reported by the British Journal of Dermatology 4, 5.

Important Diagnostic Considerations

• Rule out other causes of scarring alopecia by obtaining fungal culture if deep fungal infection is suspected, as tinea capitis can cause cicatricial alopecia and may be misdiagnosed as bacterial abscess, according to the British Journal of Dermatology 4, 6.