Telogen Effluvium

Telogen Effluvium CrownTelogen Effluvium Crown

Figure 3 Mild female pattern hair loss (FPHL) with early widening of the part on the crown (A), compared with the occipital scalp (B). Severe female pattern hair loss with thinning hair over the entire crown, vertex, and posterior vertex (C) with relative sparing of only the lower occipital scalp (D).

Figure 3 Mild female pattern hair loss (FPHL) with early widening of the part on the crown (A), compared with the occipital scalp (B). Severe female pattern hair loss with thinning hair over the entire crown, vertex, and posterior vertex (C) with relative sparing of only the lower occipital scalp (D).

Perifollicular Hyperkeratosis

Figure 4 Low power view at the level of the isthmus (A) and infundibula (B) demonstrating normal to slightly decreased follicular density, variability in hair shaft diameter and miniaturized follicles (T/V = 2/1) in a scalp biopsy from the patient in Figure 3A and 3B. Medium-sized terminal hair shafts (thick arrow) and vellus hair shafts (thin arrows) are better visualized with AFB (acid-fast bacillus, Ziehl-Neelsen) stain (B). (C) Higher power view of teminal hairs (thick arrows) and vellus hairs (thin arrows) in the same patient with FPHL. (D) Two telogen germinal units (arrows) in the scalp biopsy from the same patient with FPHL.

Figure 4 Low power view at the level of the isthmus (A) and infundibula (B) demonstrating normal to slightly decreased follicular density, variability in hair shaft diameter and miniaturized follicles (T/V = 2/1) in a scalp biopsy from the patient in Figure 3A and 3B. Medium-sized terminal hair shafts (thick arrow) and vellus hair shafts (thin arrows) are better visualized with AFB (acid-fast bacillus, Ziehl-Neelsen) stain (B). (C) Higher power view of teminal hairs (thick arrows) and vellus hairs (thin arrows) in the same patient with FPHL. (D) Two telogen germinal units (arrows) in the scalp biopsy from the same patient with FPHL.

Telogen Hair Has Bulb

Figure 5 (A) Severe thinning of the parietal scalp hair in a woman with severe acute telogen effluvium (TE) that occurred four months after hospitalization for pneumonia and cirrhosis. (B) Acute TE causing temporal thinning in a woman three months postpartum. (C) Same patient as in A demonstrating partial regrowth of hair after four months. (D) Photograph taken nine months after A demonstrating complete resolution of the patient's acute TE and full hair regrowth.

Figure 5 (A) Severe thinning of the parietal scalp hair in a woman with severe acute telogen effluvium (TE) that occurred four months after hospitalization for pneumonia and cirrhosis. (B) Acute TE causing temporal thinning in a woman three months postpartum. (C) Same patient as in A demonstrating partial regrowth of hair after four months. (D) Photograph taken nine months after A demonstrating complete resolution of the patient's acute TE and full hair regrowth.

Telogen Hair Histology
(B)
Telogen Efflivium Before And After Pics

Figure 6 (A) Low power view of telogen effluvium (TE) demonstrating normal numbers of follicular units (arrows). (B) Low power view demonstrating lack of follicular miniaturization (T/V = 5/1) in TE (AFB stain). (C) Higher power view demonstrating numerous telogen germinal units (arrows) in a patient with acute TE. (D) High power view of telogen follicles (arrows) in a patient with acute TE.

Figure 6 (A) Low power view of telogen effluvium (TE) demonstrating normal numbers of follicular units (arrows). (B) Low power view demonstrating lack of follicular miniaturization (T/V = 5/1) in TE (AFB stain). (C) Higher power view demonstrating numerous telogen germinal units (arrows) in a patient with acute TE. (D) High power view of telogen follicles (arrows) in a patient with acute TE.

Chronic Telogen EffluviumChronic Telogen Effluvium
Figure 7 Woman with chronic telogen effluvium demonstrating essentially the same part widths on crown (A) and occiput (B); and mild bitemporal thinning (C,D).
Telogen Effluvium CrownTelogen Effluvium Histology

Figure 8 (A) Biopsy of chronic telogen effluvium (TE), horizontally sectioned at the level of the infundibula, demonstrating minimal follicular miniaturization (T/V = 5/1).

(B) Hairs are best visualized on the AFB stain.

(C) Normal follicular units, normal follicular density, and increased numbers of telogen follicles (arrows) in active phase of chronic TE. (D) Higher power view of one follicular unit with two telogen follicles (arrows) and two terminal anagen follicles.

Figure 8 (A) Biopsy of chronic telogen effluvium (TE), horizontally sectioned at the level of the infundibula, demonstrating minimal follicular miniaturization (T/V = 5/1).

(B) Hairs are best visualized on the AFB stain.

(C) Normal follicular units, normal follicular density, and increased numbers of telogen follicles (arrows) in active phase of chronic TE. (D) Higher power view of one follicular unit with two telogen follicles (arrows) and two terminal anagen follicles.

Loose Anagen
Figure 9 (A) Young girl with loose anagen syndrome and thinning of hair on the parietal scalp. Hairs obtained from the patient in (A) by loosely pulling demonstrate a dystrophic anagen bulb (B) and ruffling of the cortex (B,C).
Anagen Effluvium Images

Figure 10 Adolescent female with trichotillomania, demonstrating broken-off hairs on the frontal crown. Her scalp exam was completely unchanged on several visits over a nine-month period.

Vellus Hair Histology Vertical

Figure 11 (A) Vertical section of trichotillomania demonstrating hyperkeratosis, slight superficial perifollicular fibrosis, and a catagen hair follicle (arrow). (B) Pigment casts (arrow) in an infundibulum of a patient with trichotillomania. (C) Increased numbers of telogen germinal units (arrows) in a patient with trichotillomania.

Figure 11 (A) Vertical section of trichotillomania demonstrating hyperkeratosis, slight superficial perifollicular fibrosis, and a catagen hair follicle (arrow). (B) Pigment casts (arrow) in an infundibulum of a patient with trichotillomania. (C) Increased numbers of telogen germinal units (arrows) in a patient with trichotillomania.

Trichotillomania Photomicrograph

Figure 12 Marginal hair loss with preservation of the "marginal fringe" in an African-American woman (A) and Latina woman (B) with permanent traction alopecia. (C) Scalp biopsy from the patient in (B) demonstrates preservation of sebaceous glands. However, several follicular units contain no follicles (thin arrows) or one to two follicles, often vellus follicles (thick arrow).

Figure 12 Marginal hair loss with preservation of the "marginal fringe" in an African-American woman (A) and Latina woman (B) with permanent traction alopecia. (C) Scalp biopsy from the patient in (B) demonstrates preservation of sebaceous glands. However, several follicular units contain no follicles (thin arrows) or one to two follicles, often vellus follicles (thick arrow).

Telogen Efluvium Afro HairFulminant Hair Thining

Figure 13 (A) Erythema (thin arrow) and minute scales (thick arrow) at bases of hair shafts at the periphery of an area of scarring alopecia in a patient with typical lichen planopilaris (LPP). (B) Woman with fulminant LPP that eventuated into complete scalp alopecia. Erythema and scaling typical of LPP is seen at the periphery of the involved areas. (C) Postmenopausal frontal fibrosing alopecia (variant of LPP) characterized by a band of scarring alopecia on the frontal scalp with erythema and scaling typical of LPP (arrows) at the advancing border. (D) End-stage scarring alopecia (pseudopelade of Brocq pattern) can be seen in old LPP lesions.

Figure 13 (A) Erythema (thin arrow) and minute scales (thick arrow) at bases of hair shafts at the periphery of an area of scarring alopecia in a patient with typical lichen planopilaris (LPP). (B) Woman with fulminant LPP that eventuated into complete scalp alopecia. Erythema and scaling typical of LPP is seen at the periphery of the involved areas. (C) Postmenopausal frontal fibrosing alopecia (variant of LPP) characterized by a band of scarring alopecia on the frontal scalp with erythema and scaling typical of LPP (arrows) at the advancing border. (D) End-stage scarring alopecia (pseudopelade of Brocq pattern) can be seen in old LPP lesions.

Brocq Pseudopelade HistologyLichen Planopilaris The Scalp

Figure 14 (A) A band-like lymphocytic Infiltrate In the papillary dermis obscures the dermal-epidermal junction and Is dense around a follicular ¡nfundibulum in a scalp biopsy of fulminant lichen planopilaris (LPP) (patient in Fig. 13B). Although the inflammation extends into the deep dermis, it is much denser in the superficial dermis, favoring LPP over discoid lupus erythematosus. (B) Typical changes of lichen planus, such as saw-toothing of the rete ridges, hypergranulosis, and Max Joseph spaces, are sometimes identified in the interfollicular epidermis in LPP, as demonstrated in this case. (C,D) There is dense perifollicular and follicular lichenoid lymphocytic inflammation that has resulted in follicular destruction (arrows) in this patient with LPP. The inflammation is starting to "back away" from some of the follicles that are surrounded by fibrosis (D).

Figure 14 (A) A band-like lymphocytic Infiltrate In the papillary dermis obscures the dermal-epidermal junction and Is dense around a follicular ¡nfundibulum in a scalp biopsy of fulminant lichen planopilaris (LPP) (patient in Fig. 13B). Although the inflammation extends into the deep dermis, it is much denser in the superficial dermis, favoring LPP over discoid lupus erythematosus. (B) Typical changes of lichen planus, such as saw-toothing of the rete ridges, hypergranulosis, and Max Joseph spaces, are sometimes identified in the interfollicular epidermis in LPP, as demonstrated in this case. (C,D) There is dense perifollicular and follicular lichenoid lymphocytic inflammation that has resulted in follicular destruction (arrows) in this patient with LPP. The inflammation is starting to "back away" from some of the follicles that are surrounded by fibrosis (D).

Alopecia African American WomenDiscoid Lupus Erythematosus Histology

Figure 16 (A) Periodic-acid Schiff (PAS) stain demonstrates marked basement membrane zone thickening in discoid lupus erythematosus (DLE). (B) Dilated plugged infundibula, interface changes, and prominent deep perivascular and perifollicular inflammation characterized this vertically sectioned scalp biopsy from a DLE lesion. (C) A horizontal section through the deep dermis of a DLE scalp lesion demonstrates a dense perivascular and follicular mononuclear cell infiltrate.

Figure 16 (A) Periodic-acid Schiff (PAS) stain demonstrates marked basement membrane zone thickening in discoid lupus erythematosus (DLE). (B) Dilated plugged infundibula, interface changes, and prominent deep perivascular and perifollicular inflammation characterized this vertically sectioned scalp biopsy from a DLE lesion. (C) A horizontal section through the deep dermis of a DLE scalp lesion demonstrates a dense perivascular and follicular mononuclear cell infiltrate.

Follicular Degeneration Syndrome
Figure 17 (A-C) Areas of scarring alopecia on the scalp appear noninflammatory in these African-American women with the follicular degeneration syndrome.
Lesion Scalp African American Nuchal

Figure 18 (A) Low power view of a scalp biopsy from a patient with follicular degeneration syndrome (FDS). Almost all follicles have been replaced by fibrosis. Two remaining follicles demonstrate absence of inner root sheaths in their inferior portions (section from deep dermis as evidenced by ecrrine glands). (B) Earlier stage of FDS, prior to the destruction of follicles and sebaceous glands. One follicle (thick arrow) demonstrates loss of the inner root sheath, eccentric hair placement, and slight perifollicular fibrosis. Two other follicles at the same level of sectioning have normal inner root sheaths (thin arrows); however, there is slight perifollicular fibrosis and eccentric hair placement in the follicle on the lower left. (C) Prominent perifollicular fibrosis, eccentric hair placement, and loss of the inner root sheath in FDS. Affected follicles (arrows) also demonstrate loss of sebaceous glands. There is a perifollicular lymphocytic infiltrate. (D) High power view of a follicle in FDS illustrates the classic findings of concentric lamellar perifollicular fibrosis, eccentric hair placement with marked thinning of the follicular epithelium (arrows), and loss of the inner root sheath.

Follicular Degeneration Syndrome

Figure 18 (A) Low power view of a scalp biopsy from a patient with follicular degeneration syndrome (FDS). Almost all follicles have been replaced by fibrosis. Two remaining follicles demonstrate absence of inner root sheaths in their inferior portions (section from deep dermis as evidenced by ecrrine glands). (B) Earlier stage of FDS, prior to the destruction of follicles and sebaceous glands. One follicle (thick arrow) demonstrates loss of the inner root sheath, eccentric hair placement, and slight perifollicular fibrosis. Two other follicles at the same level of sectioning have normal inner root sheaths (thin arrows); however, there is slight perifollicular fibrosis and eccentric hair placement in the follicle on the lower left. (C) Prominent perifollicular fibrosis, eccentric hair placement, and loss of the inner root sheath in FDS. Affected follicles (arrows) also demonstrate loss of sebaceous glands. There is a perifollicular lymphocytic infiltrate. (D) High power view of a follicle in FDS illustrates the classic findings of concentric lamellar perifollicular fibrosis, eccentric hair placement with marked thinning of the follicular epithelium (arrows), and loss of the inner root sheath.

Folliculitis Keloidalis Images

Figure 19 (A) Folliculitis decalvans is characterized by areas of scarring hair loss with pustules at the active periphery and the so-called "tufted folliculitis" (arrow). (B) There is complete follicular destruction in folliculitis decalvans, with marked inflammation consisting of lymphocytes, neutrophils, plasma cells, and macrophages. (C) Gram-positive cocci (arrow) are often found in the dermis in areas of inflammation in lesions of folliculitis decalvans.

Figure 19 (A) Folliculitis decalvans is characterized by areas of scarring hair loss with pustules at the active periphery and the so-called "tufted folliculitis" (arrow). (B) There is complete follicular destruction in folliculitis decalvans, with marked inflammation consisting of lymphocytes, neutrophils, plasma cells, and macrophages. (C) Gram-positive cocci (arrow) are often found in the dermis in areas of inflammation in lesions of folliculitis decalvans.

Dissecting Cellulitis Pics

Figure 20 (A) African-American male with long history of dissecting cellulitis of the scalp, resulting In large areas of scarring alopecia, fibrotlc ridges, and sinus tract formation. (B) Low power view of dissecting cellulitis demonstrating cystically dilated follicles that result in sinus tract formation and surrounding inflammation. (C) High power view of the same biopsy shows mixed follicular and perifollicular inflammation consisting of neutrophils and lymphocytes.

Cellulitis The Scalp

Figure 20 (A) African-American male with long history of dissecting cellulitis of the scalp, resulting In large areas of scarring alopecia, fibrotlc ridges, and sinus tract formation. (B) Low power view of dissecting cellulitis demonstrating cystically dilated follicles that result in sinus tract formation and surrounding inflammation. (C) High power view of the same biopsy shows mixed follicular and perifollicular inflammation consisting of neutrophils and lymphocytes.

Perifollicular Hyperkeratosis

Figure 21 (A) Area of scarring hair loss with "keloidal" papules at the nape In this African-American man with acne keloidalis nuchae (AKN). (B) Dense inflammation and follicular destruction with resultant hair granulomas in AKN. (C) AKN scars look clinically like keloids, but histologically they are typical or hypertrophic scars, as shown in this biopsy.

Figure 21 (A) Area of scarring hair loss with "keloidal" papules at the nape In this African-American man with acne keloidalis nuchae (AKN). (B) Dense inflammation and follicular destruction with resultant hair granulomas in AKN. (C) AKN scars look clinically like keloids, but histologically they are typical or hypertrophic scars, as shown in this biopsy.

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Responses

  • SAMUEL NEGASSI
    Does your part widen with telogen effluvium?
    6 years ago
  • Janina Vogel
    What is follicular hyperkeritosis?
    5 years ago
  • thelma
    How to style hair after telogen effluvium?
    1 year ago

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