A clinicopathological study was designed to evaluate hair loss in PV lesions.Patients and Methods: Thirty-nine patients with PV were examined clinically and histopathologically. Two biopsies were obtained from each patient; one from lesional and one from clinically uninvolved skin. Both Haematoxylin and Eosin (H&E) & Periodic Acid Schiff (PAS) stained sections were examined microscopically.Results: Clinical hair involvement in the form of small areas of hypotrichosis or alopecia within one or more PV lesions was observed in 24 patients (61.5%); the finding was of high statistical significance (p: 000). The body areas most commonly affected by hair loss were the beard (in males), forearms, abdomen and neck.Histopathological abnormalities in hair follicles in the form of follicular degeneration, miniaturization, atrophy, absence of hair shafts and follicular plugging were observed in 46.2% of lesional versus 20.5% of non-lesional biopsies, (p:<0.05). Fungal hyphae were observed in 25.6% of hair follicles and in 51.3% within stratum corneum of lesional biopsies. Hydropic degeneration in the epdidermal basal cell layer was the commonest pathological finding encountered and correlated positively with the presence of hyphae in the pathological follicular infundibula. Scalp scaling was common and correlated with the presence of infundibular hyphae.Conclusion: Hair loss occurring concurrently within PV lesions is for the first time described. Underlying pathological evidence includes follicular infundibulum abnormalities with or without presence of hyphae in the biopsies, hyphae in the stratum corneum and a prevalence of hydropic degeneration of the epidermal basal layer, which effects appear to be directly or indirectly related to the presence of Malassezia species.