Case Number : Case 1929 - 20 Oct - Dr Richard Carr Posted By: Guest

Inner root sheath appears to be prematurely desquamating. Favor CCCA for clinical correlation.

Agree with Mona. Scarring alopecia with premature desquamation of inner root sheath (desquamation below mid-isthmus, as is demonstrated in Figures 2 and 7 by the follicle's proximity to eccrine glands and subcutaneous fat) favors CCCA.

Agree

Agree 

Thanks for your opinions. My first impression was LPP. We referred to Sperling's book and after some study ended up slightly favouring CCCA. Having found the case challenging we shared the images with Catherine Stefanato (who has an interest in alopecia) and she strongly came down in favour of lichen planopilaris.  I guess alopecia's are a challenge!

Update following sharing the clinical images with Catherine as follows:

Thanks for the feedback. Clinically CCCA but both LPP and CCCA on path. Virtually very similar...so much so I think they might be the same disease!

Catherine