Hair loss in pityriasis versicolor lesions: A descriptive clinicopathological study

Background: We have observed that hair thinning and/or loss occur at times as a presenting symptom or sign in patients with pityriasis versicolor (PV). Objective: Our objective was to verify and explore this clinical observation and depict its underlying pathology. Methods: A total of 39 patients with PV were examined during a period of 11 months and skin biopsy specimens were taken from lesional and nonlesional skin. Hematoxylin-eosin- and periodic acid-Schiff-stained sections were examined and described. Results were statistically analyzed. Results: Hair loss and/or thinning within PV lesions was shown in 61.5\% of patients (P value < .0005), appearing most commonly on forearms, abdomen, and neck as well as the beard area (only in male participants). Histopathologically, in addition to the classically described features of PV, basal hydropic degeneration, follicular degeneration, miniaturization, atrophy, plugging, and/or hair shaft absence occurred in 46\% of lesional versus 20.5\% of nonlesional biopsy specimens (P value < .05); these changes appeared to be directly or indirectly related to the presence of Malassezia organisms in hair follicles and/or stratum corneum. Limitations: Some patients with PV lesions on the face did not approve facial biopsy. Conclusion: This study provides clinical and histopathological evidence that PV lesions may be associated with hair thinning and/or loss.