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Central centrifugal cicatricial alopecia amalgamated with alopecia areata: immunologic findings – Case Report

Background: Both scarring and non-scarring alopecias exist; however, rare cases demonstrate features of both classes.

Case report: We describe an interesting alopecia case with amalgamated clinical, histologic and immunopathologic features of scarring and non-scarring alopecia. Specifically, the case displays combined features of alopecia areata(AA) and of central centrifugal cicatricial alopecia (CCCA). A 36 year old female presented with symmetric, round, patchy hair loss on her scalp.

Methods: Biopsies for hematoxylin and eosin(H&E) examination, as well as for special stains, direct immunofluorescence (DIF) and immunohistochemistry (IHC) were performed.

Results: The H&E biopsy revealed focally diminished hair follicular units, and sebaceous gland damage. Perifollicular concentric fibrosis was confirmed by Verhoeff elastin special staining.  Antibodies to micelles were noted. Positive IHC staining for CD4, CD8, CD45 and multiple proteases and protease inhibitors was noted around selected follicular unit remnants. 

Conclusion:  We present a rare alopecia, combining histologic features of CCCA with additional, selected immunologic features of AA.