Cicatricial alopecia encompasses a group of clinical entities that affect the hair unit leaving permanent destruction of the follicular ostia, skin atrophy and irreversible loss of hair follicles. Herein, a 43-year-old lady with erythematous follicular papules, resulting into atrophic scars with permanent loss of hairs, slowly progressing for more than 22 years, is presented. The patient has been consulted by numerous dermatologists and no exact histological diagnosis was verified. Upon proper clinico-pathological work-up, a diagnosis of lichen planopilaris was concluded and treatment with intralesionaly corticosteroids and oral hydroxychloroquine was introduced. The patient improved significantly during the 3-month follow-up. Scarring alopecia should always be evaluated clinically and by scalp biopsy to accurately analyze the change in the follicular architecture and type, distribution and extent of the inflammatory infiltrate. This complex diagnostic approach is crucial for the diagnosis and management of all cases of cicatricial alopecias.
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