Alopecia, or hair loss, can be a challenging and emotionally painful medical condition. .  It can be the result of an inflammatory process that may ultimately cause scarring, or may be related to a genetic predisposition and cause a non-scarring process.  It is important to identify the underlying cause, as the primary treatment depends on the etiology of the alopecia.

Scarring hair loss is a result of the destruction of the hair follicle.  This can be an internal or an external process.  Some of the internal causes of scarring hair loss include lichen planopilaris (LPP), discoid lupus erythematosus (DLE), folliculitis decalvans, dissecting cellulitis of the scalp, in addition to some other less common etiologies.  A punch biopsy can often discriminate between the different types of alopecia.  The punch biopsy can determine which portion of the hair follicle is being destroyed.