What is the most likely diagnosis? — Donovan Hair Clinic

What is the most likely diagnosis?

What is the most likely diagnosis of this patient with a long history of a diagnosis of “chronic dandruff” by some and “chronic folliculitis” by others. The condition does not respond all that well to dandruff shampoos. The patient has itching and burning and tenderness.

ANSWER: This is folliculitis decalvans.

There are similar features to lichen planopilaris but some important differences. The process here is far more “joining” and “fusing” and “hugging” than seen in LPP. Hair follicles are keeping their basic groupings or even fusing together. Bundles of EIGHT HAIRS are seen on the left and SIX hairs on the top (see next instagram post). In LPP, this is uncommon. In LPP, the three hair bundles become two haired bundles and the two haired bundles become one. LPP is a bit more “destructive” even in these early stages. But the key here is to recognize these bundles. Bundles of 6 or more hairs are really unusual and called compound follicles. The third feature is the perifollicular scale. Similar scale can be seen in LPP but scale that forms a tube in this manner is more typical of FD than LPP. Scale in LPP tends to be more circular around the hair rather than forming a tube. There are exceptions of course. The fourth feature here is the linear fibrosis around the hair or so called “linear fibrotic bands” (LFB). This will evolve eventually to a starburst pattern of scaling and fibrosis seen in advanced FD.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss.
To schedule a consultation, please call the Whistler office at 604.283.1887

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