< Current issue
Dermatopathology: Practical & Conceptual October - December 2000
Quandary Resolved!: “Hot Comb Alopecia”/“Follicular Degeneration Syndrome” in African-American Women Is Traction Alopecia!
A. Bernard Ackerman, M.D.
Norman W. Walton, III, M.D.
Robert E. Jones, M.D.
Christine Charissi, M.D.
Synonymy of “Follicular Degeneration Syndrome” and “Hot Comb Alopecia”
Importance of Knowledge of Histology and the Follicular Cycle
Crtitique of the Notion of “Follicular Degeneration”
Histopathologic Findings in Chronological Sequence
“Hot Comb Alopecia”/“Follicular Degeneration Syndrome” is Traction Alopecia
Synonymy of "Follicular Degeneration Syndrome" and "Hot Comb Alopecia"
Hot comb alopecia and follicular degeneration syndrome were both said to have predilection for African-American women (although in 1994, Sperling and coworkers asserted that follicular degeneration syndrome also was common in black men) and to have several features in common: localization to the crown of the scalp; infiltration of lymphocytes followed by fibroplasia around the upper part of follicles; complete destruction eventually of follicles with replacement of them by "dense collagen"; and sparing of muscles of hair erection. But based on what has been written about these conditions by Lo Presti
and by Sperling, some clinical and histopathologic differences would seem to exist between hot comb alopecia and follicular degeneration syndrome. Those differences, culled from articles by those authors, are listed in the table that follows (
Despite this set of contrasting findings, it is likely, based on all the information available, that
follicular degeneration syndrome
is synonymous with
hot comb alopecia.
as it is used in the phrase
follicular degeneration syndrome,
turns on a single histopathologic finding in tissue sections cut horizontally, a finding that Sperling claimed to be specific for it—namely, premature "disintegration of the inner sheath." He averred that even a single affected follicle was sufficient to enable coiled hairs to spring through the "soft" outer sheath and to initiate perifolliculitis, which in turn leads in time to permanent alopecia. In brief, the absence of an inner sheath as a result of premature desquamation of it is supposed to be the basis for so-called follicular degeneration syndrome.
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