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On pathologic analysis of the biopsy, lymphocytic hair loss can be seen with lichen planopilaris and CLE; neutrophilic hair loss may be associated with folliculitis decalvans or dissecting cellulitis. The hair loss pattern in individuals with CLE presents as background erythema, variable hypopigmentation, and/or follicular plugging. Other skin lesions of CLE may or may not be present. A thorough evaluation of other signs and symptoms, a family history, and blood work are important pieces of the diagnostic puzzle.
Treatments include topical and intralesional steroids, systemic steroids, antimalarials, and thalidomide (Thalomid).7 Lichen planopilaris typically shows perifollicular erythema and scarring with a background violaceous discoloration to the scalp. Intralesional steroids and referral to a dermatology practice are essential aspects in appropriate management of lichen planopilaris.
Summary
The workup of the chief complaint of hair loss in the adult female patient is neither quick nor simple. A comprehensive personal history and family history, thorough physical examination, and blood work are crucial elements leading to the proper diagnosis.
Find a dermatology practice that you know can offer these patients additional counseling, provide support in the initial workup, and continue your baseline workup with the appropriate referral.
Abby A. Jacobson, MS, PA-C, is the past president of the Society of Dermatology Physician Assistants and currently practices at Delaware Valley Dermatology Group in Wilmington, Del.
References
- Thiedke CC. Alopecia in women. Am Fam Physician. 2003;67:1007-1114. Available at www.aafp.org/afp/2003/0301/p1007.html.
- Sperling LC, Mezebish DS. Hair diseases. Med Clin North Am. 1998;82:1155-1169.
- Ninan PT, Rothbaum BO, Marsteller FA, et al. A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry. 2000;61:47-50.
- Huang KP, Mullangi S, Guo Y, Qureshi AA. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States. JAMA Dermatol. 2013;149:789-794.
- Medscape. Hypothyroidism clinical presentation. Available at emedicine.medscape.com/article/122393-clinical.
- ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. Obstet Gynecol. 2009;114:936-949.
- Maender JL, Krishnan RS, Angel TA, Hsu S. Complete resolution of generalized lichen planus after treatment with thalidomide. J Drugs Dermatol. 2005;4:86-88.
All electronic documents accessed September 15, 2013.
This article originally appeared on Clinical Advisor
