Clinicopathologic and immunophenotypic characterization of lichen planopilaris and central centrifugal cicatricial alopecia: A comparative study of 51 cases

J Cutan Pathol. 2020 Feb;47(2):128-134. doi: 10.1111/cup.13592. Epub 2019 Nov 25.


Background: The purpose of the study was to compare the histopathologic and immunophenotypic features of central centrifugal cicatricial alopecia (CCCA) and lichen planopilaris (LPP) to better characterize and differentiate these two clinical entities. CCCA remains an ill-defined and still-unsettled histologic entity and many hair loss experts regard CCCA to be histologically indistinguishable from LPP. Given the overlapping histologic features of these two lymphocyte-predominant cicatricial alopecias, and the lack of consensus regarding the significance of proposed distinctions, dermatopathologists face difficulty in providing clinicians and patients certainty with a definitive diagnosis of CCCA vs LPP.

Methods: We performed a retrospective review of 51 scalp biopsies of patients with either the clinical diagnosis of CCCA (27 cases) or LPP (24 cases). Clinical information, histologic features of hematoxylin-eosin-stained sections, and a panel of immunohistochemical markers were evaluated on scalp biopsies. Tested parameters were quantified, and statistical analysis was performed.

Results: Our study found no differences on either histologic assessment or immunophenotypic characterization between cases of classic LPP and CCCA.

Conclusion: The conclusion of this study is that the inflammatory infiltrates in CCCA and LPP are not only histologically similar but also immunophenotypically indistinguishable.

Keywords: biopsy; central centrifugal alopecia; cicatricial; cicatricial alopecia; diagnosis; hair; immunohistochemistry; lichen planopilaris; scarring.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alopecia* / immunology
  • Alopecia* / pathology
  • Female
  • Humans
  • Lichen Planus* / immunology
  • Lichen Planus* / pathology
  • Male
  • Middle Aged

Supplementary concepts

  • Lichen planus follicularis