Case Number : Case 2113 - 12 July 2018 Posted By: Iskander H. Chaudhry

Folliculitis decalvans.

This is a non scarring alopecia. The sebaceous glands are well preserved. The lymphocytic infiltrate surrounding the follicles is at a deeper level and looks like a swarm of bees. I think this is alopecia areata

I favor allopecia areata based on peribulbar inflammation, increased catagen hair, small caliber hair ("nanogen hair"?). In one area the lymphocytic infiltrate is rather exuberant, makes me wonder for lupus. But I favor AA.

I can see a dense inflammatory infiltrate surrounding the adnexa in the isthmus along with a swarm of bees at the bulbus. At first, I thought this was AA, but with this dense superficial infiltrate I think we should consider the possibilities of Syphilis and the non-scarring alopecia of the systemic LE. Clinical data and immunostais for treponema and CD123 can be of great help.