Primary cicatricial alopecia subtypes: Clinical and histopathological patterns in a large Turkish cohort

Abstract

Aim: Primary cicatricial alopecias (PCAs) are a group of rare dermatological disorders characterized by irreversible destruction of hair follicles due to inflammatory processes, leading to permanent hair loss. The diagnostic process is often delayed because of nonspecific clinical presentation and overlapping histopathological features. This study aimed to analyze the clinical and histopathological characteristics of PCA subtypes diagnosed in a tertiary dermatology clinic in Türkiye over a 17-year period.

Materials and Methods: A retrospective analysis was conducted on 116 cases of histopathologically confirmed PCA between January 2008 and January 2025. Clinical diagnoses included discoid lupus erythematosus (DLE), lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), pseudopelade of Brocq (PPB), and folliculitis decalvans (FD). Histopathological features were systematically reviewed and statistically analyzed using the Statistical Package for the Social Sciences version 25.0.

Results: The most frequent subtype was DLE (60.3%), followed by LPP (28.4%). DLE was associated with basal membrane thickening (82.9%) and dermal mucin deposition (71.4%), whereas LPP showed higher rates of sebaceous gland loss (51.5%) and interface dermatitis (54.5%). FFA exhibited overlapping features with LPP, including 100% basal cell degeneration. Statistically significant associations were found between specific histopathological patterns and clinical subtypes.

Conclusion: This study provides one of the comprehensive PCA datasets in Türkiye, highlighting distinct histopathological patterns associated with specific clinical subtypes. These findings underscore the importance of clinicopathological correlation in PCA diagnosis and contribute valuable data for improving diagnostic accuracy and patient management.