Diffuse scarring alopecia in a female pattern hair loss distribution

Abstract

We describe three cases of hair loss in a female pattern hair loss (FPHL) distribution with histologic features of lichen planopilaris (LPP). All patients had a history of diffuse, gradual hair loss in a Christmas tree pattern that clinically presented as FPHL on gross and dermoscopic examination. Notably, there were no characteristic clinical signs of LPP and no histologic features of FPHL. These cases are most consistent with cicatricial pattern hair loss (CPHL). This relatively new entity is similar to fibrosing alopecia in a pattern distribution (FAPD) in that they are both scarring alopecias confined to a FPHL distribution, but CPHL lacks the clinical signs of perifollicular erythema and perifollicular keratosis seen in FAPD. These three cases may present an early, subtle form of CPHL and will be of interest to clinicians and histopathologists alike.

Rapidly progressive diffuse fibrosing alopecia

“…FFA, once considered an uncommon condition, has now become common 9 . There remains much overlap in the spectrum of these entities, 10 and because the pathogenesis has not been clarified, distinctions between them remain speculative 1 …”

Clinical study of fibrosing alopecia in a pattern distribution in a Latin American population

“…Since its first description in 2000, few other cases of FAPD in European, North American, and Asian populations have been reported . Although recent scarring (cicatricial) alopecia classification includes FAPD in the lichen planopilaris group, it is unclear if it is a true form of lichen planopilaris or a lichenoid reaction that selectively involves miniaturized hair follicles.…”

“…Although recent scarring (cicatricial) alopecia classification includes FAPD in the lichen planopilaris group, it is unclear if it is a true form of lichen planopilaris or a lichenoid reaction that selectively involves miniaturized hair follicles. Other clinical settings such as androgenetic alopecia, cicatricial pattern hair loss, and frontal fibrosing alopecia share clinical and/or histological findings, suggesting an overlap or progression between these conditions . Enhanced local effects of androgens (and other unidentified triggering factors) may modify the hair follicle immune status, induce inflammation, and increase connective tissue remodeling.…”

Fibrosing Alopecia in a Pattern Distribution: A Case Report and Literature Review

“…Cases of FAPD have been reported in many regions worldwide [1, 7, 8, 9, 10, 11]. The distinctive histopathologic features of FAPD were miniaturization of hair follicles with prominent lichenoid inflammation and destruction of the follicular basilar epithelium in the isthmus and infundibular region of the follicle.…”