The ‘eyes’ or ‘goggles’ as a clue to the histopathological diagnosis of primary lymphocytic cicatricial alopecia

Funding sources: none. Conflicts of interest: none declared. Madam, Hair pathology is an essential tool in distinguishing cicatricial from noncicatricial alopecia and in diagnosing the different cicatricial disorders.1 Horizontal sections are very important as they allow for visualization of all hair follicles in a 4‐mm punch biopsy and for detection of focal disease. However, dermatopathologists who are not specifically trained are generally reluctant to evaluate horizontal sections due to the complexity of scalp anatomy and the necessity to evaluate multiple sections. We present here a new simple method to diagnose lymphocytic cicatricial alopecia at low‐power horizontal sections at the isthmus level. This method is based on detection of easy to memorize images that correspond to diagnostic clues. One of us (M.M.) proposed the ‘eyes’ and ‘goggles’ (Fig. 1a, b) as corresponding to two relevant histopathological clues for lymphocytic cicatricial alopecia after 2 years of examining horizontal scalp specimens. The eyes or goggles pattern is characterized by the presence of either ‘eyes’ or ‘goggles’ on a background of decreased follicular density with follicular scars (fibrous tracts replacing the pilosebaceous units). It is due to the grouping of two follicles in compound structures: the eyes resemble the eyes of an owl with big circles of feathers around the eyes; the goggles resemble aviator’s or swimmer’s eyewear (Fig. 2a, b).