Cutaneous Lupus Erythematosus Presenting as Frontal Fibrosing Alopecia: Report of 2 Patients

Abstract

Frontal fibrosing alopecia represents a peculiar condition with a quasi-symmetrical, marginal scarring alopecia along the frontal and temporal hairline. The condition has been associated with further histopathologic and/or clinical evidence of lichen planopilaris. Since its emergence with the original report of Kossard in 1994, frontal fibrosing alopecia has been recognized to be associated with a number of comorbidities, including lupus erythematosus. So far, respective case reports and case series have given account of frontal fibrosing alopecia with the histopathologic features of lichen planopilaris associated or overlapping with lupus erythematosus. In contrast, we present cases of histopathologically proven cutaneous lupus erythematosus presenting as frontal fibrosing alopecia with a good response to the respective treatment with oral hydroxychloroquine and/or intralesional triamcinolone acetonide.

Hyperpigmented Upper Eyelid: A Clue to the Diagnosis of Facial Lichen Planus Pigmentosus in a Patient with Frontal Fibrosing Alopecia

“…Since then, the association with other comorbidities such as other variants of LP, endocrinopathies, and lupus erythematosus has been reported by other authors [3, 7], with a possible genetic background involving the pathogenesis of FFA [8]. …”

Case report of connubial frontal fibrosing alopecia

“…Steven Kossard is credited with the original description of the condition,[ 1 ] and eventually its nosological classification as a frontal variant of lichen planopilaris,[ 2 ] though there is circumstantial evidence of its existence well before 1994,[ 17 ] and the observation of cutaneous lupus erythematosus presenting as FFA[ 18 ] suggests that the pattern of clinical disease presentation may be more specific for the condition than the underlying inflammatory autoimmune reaction, whether lichen planus or lupus erythematosus. Ultimately, it has been discussed to what extent a background of androgenetic alopecia may contribute to the particular clinical presentation of a pattern-type of cicatricial hair loss.…”

Baricitinib for recalcitrant subacute cutaneous lupus erythematosus with concomitant frontal fibrosing alopecia

“…FFA often occurs in association with autoimmune diseases. Several cases of FFA coexisting with CLE have been reported in the literature, and the clinical and histopathological distinction between both conditions can be challenging 3 …”