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Psoriatic Alopecia
The most common form of psoriatic alopecia is circumscribed and non-cicatricial. It occurs within psoriatic plaques and a specific finding is hair loss in tufts as thick psoriatic scales are shed from the scalp. Although clinically apparent psoriatic alopecia is rare, a decreased hair density is frequently observed histologically in scalp psoriasis along with an increased number of telogen hair follicles. The rapid development of severe psoriatic alopecia has been described as a paradoxical phenomenon in patients whose psoriasis has otherwise been successfully treated with TNF inhibitors (e.g. infliximab, adalimumab).
Only rarely will psoriasis of the scalp lead to a cicatricial alopecia. Trichoscopy of psoriatic cicatricial alopecia shows milky-red areas with no follicular openings (dots) in addition to vascular abnormalities typical for psoriasis, i.e. regularly distributed red dots or lace-like structures in a linear arrangement as well as bushy or glomerular structures.