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Background and Aim: Cicatricial
alopecia is the result of irreversible substitution of hair follicles with
fibrotic tissue and presents as permanent loss of hair. Only a few studies
have investigated the clinical and histopathological characteristics of
cicatricial alopecia in Iran. The aim of this study was to determine the
demographic, clinical and histopathological characteristics of patients with
cicatricial alopecia who referred to our dermatology outpatient clinic in
Farshchian hospital in a two year period, and to evaluate the diagnostic
value of histopathologic criteria in diagnosing different kinds of
cicatricial alopecias.
Methods: This was a
cross-sectional study. Eighty nine patients who underwent skin biopsy due to
clinical diagnosis of cicatricial alopecia were included. Demographic and
clinical characteristics of patients as well as clinical diagnosis were
recorded and the biopsy samples were evaluated by two different pathologists
who were unaware of each other's diagnosis. Histopathological diagnosis of
patients according to each pathologist's opinion was recorded separately and
statistical analysis was performed to obtain the coincidence coefficient between
two pathological diagnosis.
Results: The most common
forms of cicatricial alopecias due to clinical and histopathological
diagnosis were: lichen planopilaris, disciod
lupus erythematosus, alopecia
areata, pseudopelade
of Brocq, folliculitis
decalvans and
central centrifugal cicatricial alopecia. Moreover,
our findings showed a powerful coincidence coefficient between clinical
diagnosis and the first pathologist diagnosis (kappa=0.836), an average to
powerful coincidence coefficient between the second pathologist diagnosis and
clinical diagnosis
(kappa=0.703) and finally an average to powerful coincidence coefficient
between the two pathologists diagnosis
(kappa=0.663).
Conclusion: Diagnosis of
cicatricial alopecia depends upon clinical and also histopathological
examination. Diagnostic value of histopathological criteria even at the end
of scarring process when there is considerable overlap between microscopic
findings of different etiologies of cicatricial alopecias is still acceptable
and there is no need to re-evaluate the biopsy specimen by a second
pathologist in order to confirm the diagnosis.
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