Frontal fibrosing alopecia and lichen planus pigmentosus: diagnosis and therapeutic challenge

Abstract

Frontal fibrosing alopecia is a variant of lichen planopilaris with marginal progressive hair loss on the scalp, eyebrows and axillae. We report a case of frontal fibrosing alopecia and lichen planus pigmentosus in a postmenopausal woman, that started with alopecia on the eyebrows and then on the frontoparietal region, with periocular and cervical hyperpigmentation of difficult management. The condition was controlled with systemic corticosteroid therapy and finasteride. Lichen planus pigmentosus is an uncommon variant of lichen planus frequently associated with frontal fibrosing alopecia in darker phototipes. It should be considered in patients affected by scarring alopecia with a pattern of lichen planopilaris and areas of skin hyperpigmentation revealing perifollicular hyperpigmentation refractory to multiple treatments. This case illustrates diagnostic and therapeutic challenge in face of scarring alopecia and perifollicular hyperpigmentation.

On the Intricacies of Facial Hyperpigmentation and the Use of Herbal Ingredients as a Boon for Its Treatment: Cosmeceutical Significance, Current Challenges and Future Perspectives

“…Lesions are often symmetrical and can present in unilateral, linear fashion. The etiology for the disease is unknown, but immunological mechanisms associated with cellular immunity and exposure to ultraviolet light appear to be concerned [33,34].…”

Lichen planus pigmentosus

“…The dermoscopy Letter to the Editor of lichen plan pigmentosus can reveal reduction of the follicular openings, follicular hyperkeratosis, keratotic plugs, perifollicular erythema, white dots, interfollicular vessels with single loops, arborizing vessels and pigment network. Blue-grey structures in an annular or speckled pattern can also be found [3]. Erythema dyschromicum perstans is considered as the principal differential diagnosis of lichen plan pigmentosus.…”

“…The management includes the use of topical medications such as steroids, immunomodulators, keratolytics, hydroquinone with or without retinoic acid, azelaic acid, kojic acid, glycolic acid, vitamin A, aqueous solution of 10% dimethylsulfoxide, among others, with variable results. There are favorable recent reports of the use of Nd: YAG laser, intense pulsed light and dermabrasion [3].…”

Peripilar “Guttate” Hypopigmentation of the Scalp and Idiopathic Guttate Hypomelanosis in Frontal Fibrosing Alopecia

“…Frontal fibrosing alopecia (FFA) is characterized by progressive band-like scarring alopecia involving the frontotemporal hairline and sideburns and irreversible alopecia of the eyebrows, beard (in men), and limbs [1].…”

“…(1) Hyperpigmentation: lichen planus pigmentosus (LPPigm) is a variant of lichen planus characterized by dark brown macules distributed in sun-exposed areas [1]. More than 50% of the FFA patients from African and Indian ethnic backgrounds have co-existent LPPigm [2].…”