[Scar forming alopecia. Comments on classification, differential diagnosis and pathobiology]

Numerous different diseases lead to scarring alopecia with irreversible follicular destruction as a common ending. Current classifications are based on clinical, histopathological or prognostic parameters, as well as on pathogenetic criteria which allow only a rough assessment because the precise mechanisms leading to scarring alopecia are still unknown. Inadequacies of the established classifications are obvious when regarding special forms of scarring alopecia like lichen planopilaris or pseudopelade Brocq. In order to develop more satisfying classifications, recent insights into biology and pathology of the hair follicle and follicular cycling have to be considered. The most important structures for the survival of the hair follicle are the epithelial stem cells which reside in the follicular bulge and the fibroblasts of the dermal papilla including the molecular communication between these two cell populations. Research in the field of scarring alopecia should aim at defining the pathological processes on any of the above mentioned levels which will lead to an irreversible damage of the hair follicle thus allowing the development of new therapeutic agents.