Localized areas of scarring alopecia of the scalp may result from bacterial, viral and fungal infections. More importantly, lesions of discoid lupus erythematosus, lichen planus, and pseudopelade present with this scarring picture. An accurate diagnosis is necessary to determine the treatment and biopsy is usually necessary to determine the cause. Evidence of cutaneous disease elsewhere on the skin, oral or genital mucous membranes, and nails should be looked for carefully. Treatment of discoid lupus erythematosus of the scalp includes intralesional corticosteroid and, if severe, antimalarials or retinoids.

Pustules on a cicatrizing background.

Follicular hyperkeratosis, atrophy and scarring present.

This can occur after scarring alopecia of any cause. Fibrosis of the follicles can cause tortional changes so that more than one hair can grow from the follicle.

Keloids have been left over much of the scalp.