African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia . In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to understand their findings thoroughly to establish a good diagnosis. Differential diagnosis on the frontal scalp includes traction alopecia and frontal fibrosing alopecia . Disorders such as central centrifugal cicatricial alopecia , fibrosing alopecia in a pattern distribution, discoid lupus erythematosus , and lichen planopilaris usually affect the middle scalp. Folliculitis decalvans , dissecting cellulitis , and acne keloidalis nuchae are the main differential diagnosis of the posterior scalp.