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Follicular hyperkeratosis is a feature of many diseases. Although its nature and pathogenesis have been attributed to diverse multiple and correlated factors, it still constitutes one of the most perplexing and controversial problems in dermatology. This is particularly true of those resulting in generalized cicatricial follicular atrophy with permanent alopecia. Nor is this divergence of opinion limited to the cause of the process; it includes the problem of terminology. In the European literature, mention is made of follicular hyperkeratoses associated with cicatricial alopecia but few cases have been reported. In the American literature, except for Graham-Little's disease (lichen planopilaris), consisting of the triad of lichen planus, acuminate follicular lesions, and alopecia, there is no mention of a condition corresponding to that described in the report which follows. Report of a Case A 69-year-old Italian woman consulted us for the first time in November, 1949, complaining of

In 1922 1 and 1936 2 Feldman presented detailed discussions of the subject of folliculitis decalvans et lichen spinulosus of Graham Little. According to Feldman, numerous investigators have studied this interesting disease and have reported it or closely similar conditions under the following titles: folliculitis decalvans et atrophicans (Little), 3 folliculite destructive des regions velues (Quinquand), folliculitis decalvans et lichen spinulosus (Ormsby, 4 Senear, 5 Graham Little 6 and others), lichen spinulosus et folliculitis atrophica sycosiformis capillitii (Zurhelle and Beijerinch), lichen albus (von Zumbusch), dermatitis lichenoides chronica atrophicans (Csillag), lichen planus sclerosus et atrophicus (Hallopeau), lichen plan atrophique (Hallopeau), lichen plan sclereaux keloidiformis (Pawlow), lichen planus morphoeicus (Crocker), lichen planus seu spinulosus (Crocker, and Adamson 7 ), folliculitis decalvans et atrophicans (McCarthy 8 ), keratosis follicularis decalvans (McCafferty 9 ) and lichen planopilaris of Pringle (Fruchtbaum 10 ). A review of the literature and the presentation of our cases support Feldman's contention that Graham

In this communication we report 6 cases of lichen planopilaris. We feel that the disease called lichen spinulosus and folliculitis decalvans (Little) and lichen planus et acuminatus atrophicans (Feldman) is one and the same as that recognized and fully described by Pringle (lichen planopilaris). We should like to emphasize that follicular lichen planus (lichen planopilaris) when it affects the scalp may simulate the end stage of pseudopelade (Brocq). In 1895 Pringle1reported that follicular lesions were to be seen in lichen planus, and he called this condition lichen planopilaris (follicular type of lichen planus). He observed a patient with "a patch of lichen planus, the size of half a crown, on the right arm... and a band of lichen pilaris on either side of the neck." Two years later he2reported a similar case. A third case was that of a 69 year old man who had, in