Hair Breakage as a Presenting Sign of Early or Occult Central Centrifugal Cicatricial Alopecia:  Clinicopathologic Findings in 9 Patients

Figure 1. Patient 6. Patient has a large area of hair breakage with minimally decreased hair density and scarring. Histopathologic analysis revealed early changes of central centrifugal cicatricial alopecia.

Figure 2. Patient 9. Patient had decreased hair density and hair breakage on the vertex of the scalp. Histopathologic analysis revealed premature desquamation of the inner root sheath of a few follicles but an otherwise normal scalp.

Figure 3. Hematoxylin-eosin–stained specimen from patient 6. A horizontal section through the deep dermis demonstrates early changes of central centrifugal cicatricial alopecia, namely, premature desquamation of the inner root sheath (note the 2 boxed follicles in A; magnified in B; original magnification ×40 [A] and ×200 [B]).

Figure 4. Hematoxylin-eosin–stained specimen from patient 6. Vertical section from a biopsy site adjacent to the one sampled in Figure 3. At the level of the lower infundibulum, eccentric epithelial thinning, concentric fibroplasia, and mild perifollicular chronic inflammation can be seen (original magnification ×200 [A] and ×400 [B]).

Figure 5. Hematoxylin-eosin–stained specimens from patient 5. A, Two follicles sectioned at the level of the lower dermis show premature desquamation of the inner root sheath. B, At the level of the lower infundibulum, these follicles show concentric, lamellar fibroplasia and a moderate amount of perifollicular, chronic inflammation (original magnification ×200).