Demographic, clinical and histopathological characteristics in different kinds of cicatricial alopecias

Cicatricial alopecia is the result of irreversible substitution of hair follicles with fibrotic tissue and presents as permanent loss of hair. Only a few studies have investigated the clinical and histopathological characteristics of cicatricial alopecia in Iran. The aim of this study was to determine the demographic, clinical and histopathological characteristics of patients with cicatricial alopecia who referred to our dermatology outpatient clinic in Farshchian hospital in a two year period, and to evaluate the diagnostic value of histopathologic criteria in diagnosing different kinds of cicatricial alopecias. This was a cross-sectional study. Eighty nine patients who underwent skin biopsy due to clinical diagnosis of cicatricial alopecia were included. Demographic and clinical characteristics of patients as well as clinical diagnosis were recorded and the biopsy samples were evaluated by two different pathologists who were unaware of each other's diagnosis. Histopathological diagnosis of patients according to each pathologist's opinion was recorded separately and statistical analysis was performed to obtain the coincidence coefficient between two pathological diagnosis. The most common forms of cicatricial alopecias due to clinical and histopathological diagnosis were: lichen planopilaris, disciod lupus erythematosus, alopecia areata, pseudopelade of Brocq, folliculitis decalvans and central centrifugal cicatricial alopecia. Moreover, our findings showed a powerful coincidence coefficient between clinical diagnosis and the first pathologist diagnosis (kappa=0.836), an average to powerful coincidence coefficient between the second pathologist diagnosis and clinical diagnosis (kappa=0.703) and finally an average to powerful coincidence coefficient between the two pathologists diagnosis (kappa=0.663). Diagnosis of cicatricial alopecia depends upon clinical and also histopathological examination. Diagnostic value of histopathological criteria even at the end of scarring process when there is considerable overlap between microscopic findings of different etiologies of cicatricial alopecias is still acceptable and there is no need to re-evaluate the biopsy specimen by a second pathologist in order to confirm the diagnosis.