Diffuse Alopecia With Stem Cell Folliculitis

A 34-year-old woman experienced an 8-year history of slowly progressive diffuse nonscarring alopecia with reduced hair density. Scalp biopsies revealed increased miniaturized follicles and a distinctive lymphocytic infiltrate in the stem cell-rich regions, suggesting a possible stem cell folliculitis. This pattern was similar to reactions seen in graft versus host disease and androgenetic alopecia. The presence of peribulbar lymphocytic inflammation suggested a variant of alopecia areata. The findings indicated that lymphocytes might inhibit stem cell function without destroying them, prompting a reconsideration of cases classified as chronic diffuse alopecia areata.