PMC9167836_01
Clinical manifestations of the patient. (A) Two symmetrical cicatricial alopecia patches on the scalp; (B) Recurrent follicular papules, pustules, and hemorrhagic crusts in the early stage (photographed by the patient herself); (C) Perifollicular erythema, keratosis, scales, and follicular tufts in the late stage.
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No lesions were found on the face, extremities, mouth, nails, or the remaining (Figure 1).
Histopathological findings in a vertical section showing (A) hyperkeratosis and mild epidermal hyperplasia (HEx40), (B) epithelial basal layer destruction of the hair follicle with surrounding infiltration of dense lymphocytes and histiocytes (HEx200); (C) significant plasma cell infiltration (HEx400); Horizontal section showing (D) partial destruction of hair follicles (HEx40); (E) only the structure of the arrector pill remains (HEx200).
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On horizontal sections, partial destruction of hair follicles was seen with surrounding fibrosis; only the structure of the arrector pill muscle remained (Figure 2).
Trichoscopy showing follicular tufts, pustules and dilated blood vessels in an area of scarring alopecia.
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Trichoscopy revealed loss of partial follicular opening, follicles surrounded by milky red areas, dilated blood vessels, pustules, and follicular tufts (Figure 3).