Scarring alopecia: clinical and pathologic study of 54 African-American women

Background  Cicatricial or scarring alopecia results in the destruction of hair follicles and is a significant cosmetic concern in African-American women.
Objective  To correlate the clinical examination and histologic findings in African-American women with scarring alopecia with a history of hairstyling practices.
Methods  We reviewed retrospectively the medical records and scalp biopsy specimens of 54 women with scarring alopecia. Patients were selected from two dermatologic practices in the Detroit Metropolitan area.
Results  Alopecia commonly presents in patients who use a variety of traumatic haircare techniques, including chemical and physical straighteners, traction, braiding, hair extensions, hair gluing, and chemical curls. Histologic findings are centered around the follicular infundibulum with a lymphocytic infiltrate and perifollicular fibrosis.
Conclusion  Traumatic hairstyling techniques are common in African-American women, and all result in a similar picture of a peri-infundibular lymphocytic infiltrate and fibrosis, leading to alopecia.