The correct answer is A. Central centrifugal cicatricial alopecia.

On histology, central centrifugal cicatricial alopecia demonstrates premature desquamation of the inner root sheath, eccentric epithelial atrophy (thining) with hair shafts in close proximity to the dermis, and concentric lamellar fibroplasia of affected follicles. There is variably dense lymphocytic perifollicular inflammation, primarily at the level of the upper isthmus and lower infundibulum. There is occasional fusion of infundibula (polytrichia). In advanced lesions, total destruction of the follicular epithelium with retained hair shaft fragments and granulomatous inflammation are present.

1 – Trichotillomania:
– In trichotillomania, follicles are normal size, there is trichomalacia and pigment casts without significant inflammation. There is an increased number of terminal catagen or telogen hairs. There is incomplete disrupted follicular anatomy. The total number of hairs both terminal and vellus is normal.
2 – Androgenetic alopecia:
– In androgenetic alopecia there is a normal total numbr of follicles and no significant inlfmamation, increased number and percentage of vellus hairs, numerous fibrous streamers, and slightly increased telogen count. Uninvolved scalp appears normal.
3 – Telogen effluvium:
– Telogen effluvium demosntrates a normal total number of hairs, normal number of terminal (large) hairs, absence of inflammation and scarring. There is an increase in telogen count to > 20%.
4 – Lichen planopilaris:
– Lichen planopilaris demonstrates a band-like mononuclear cell infiltrate obscuring the interface between follicular epithelium and dermis; vacuolar alteration at the interface and hypergranulosis within affected infundibula is typical. Colloid or Civatte bodies are occasionally found as part of the itnerface alteration. Inflammation affects the upper portion of the follicle (infundibulum and isthmus) most severely. Occasionally, epidermal changes of lichen planus are found.

References:

Stefanato CM. Histopathology of alopecia: a clinicopathological approach to diagnosis. Histopathology. 2010 Jan;56(1):24-38. Review. PMID: 20055903

Gathers RC, Lim HW. Central centrifugal cicatricial alopecia: past, present, and future. J Am Acad Dermatol. 2009 Apr;60(4):660-8. Review. PMID: 19293013

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