differentiate from non scarring:

  • absence of follicular openings

  • presence of frank scarring

  • presence of fibrosis on histology

Chronic discoid lupus erythematosus

well defined patches of:

erythema

follicular plugging

scaly skin

ultimately scarring

on scalp: leads to permanent hair loss

  • should stay out of the sun - aggravated by ultraviolet light

  • first line is very potent topical steroids: clobetasol

  • hydroxychloroquine usually next line

Lichen palnus:

  • lichen planopilaris when affects hair follicles

redness around hair follicles - perifollicular erythema

follicular plugging

Folliculitis decalvans

intense focal scalp erythema

follicular pustules and crusting

subsequent dense scarring of the scalp

Dissecting cellulitis

  • related to severe acne
  • purulent nodules on scalp
> localised scarring alopecia

Idiopathic