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

Abstract

Fibrosing alopecia in a pattern distribution (FAPD) is a relatively new entity in the family of cicatricial alopecia. It has been categorized as a member of the lichen planopilaris (LPP) group due to its similarity in clinical and histopathological presentation. Nonetheless, the disease earns its own entity due to its lichenoid inflammation exclusively involving miniaturized hair and area of involvement mimicking pattern hair loss which differentiates itself from other types of LPP or pattern hair loss. Since its first introduction by Zinkernagel and Trüeb in 2000, there have been only few case reports and series of FAPD. We herein report a case of FAPD in a postmenopausal woman who had progressive hair loss over the course of 10 years.

Comedone-Like Lesions as a Manifestation of Lichen Planopilaris beyond the Scalp: A Case Report with Dermoscopic Features and Literature Review

“…LPP can be classified into three clinical variants based on the distribution of the lesions and shared histopathological features: (1) classic LPP, patch/patches of cicatricial alopecia occurring on the scalp, (2) Graham-Little-Piccardi-Lasseur syndrome (GLPLS) characterized by LPP of the scalp, non-cicatricial alopecia of the axillae and pubis, and follicular papules involving the trunk or extremities, and (3) frontal fibrosing alopecia, band-like cicatricial alopecia of the frontotemporal hairline with inconsistent eyebrow loss [ 9 , 10 , 11 , 12 ]. Apart from the aforementioned, fibrosing alopecia in a pattern distribution has been introduced as a new type of LPP involving miniaturized hair [ 13 ].…”

Alopecia Fibrosante em Padrão de Distribuição Androgenética: Patogénese, Diagnóstico e Tratamento

“…It is characterized by a combination of clinical, trichoscopic and histopathological features of both lichen planopilaris (LPP) and androgenetic alopecia (AGA). 1,[2][3][4][5][6][7][8][9][10][11] FAPD may also coexist with frontal fibrosing alopecia (FFA). 2 AGA is the most common form of non-scarring alopecia, caused by hair thinning on androgen dependent scalp.…”

“…Unlike AGA, we find many focal areas of cicatricial alopecia, peripilar erythema and peripilar hyperkeratosis in trichoscopy and lichenoid inflammation in histopathology. 1,2,[6][7][8][9] It has been first described in Caucasians but may also affect Hispanics and African-descents. 2,6,9 It is more common in women, most often in post-menopause or peri-menopause.…”

Comment on Follicular Inflammation and Fibrosis in Pattern Hair Loss

“…This may include drug reactions, viral hepatitis, cutaneous GvHD, and ultimately PHL in FAPD. Ultimately, Olsen [5] approved the existence of cicatricial PHL, while more recently, others [6][7][8] have acknowledged that FAPD earns its own entity due to its lichenoid inflammation exclusively affecting the androgenetic alopecia area of involvement, which differentiates it from all other types of LPP. And yet, some authors continue to ignore the peculiarity of the condition and its nosology in relation to PHL, either failing to differentiate it from LPP or interpreting it as a diffuse variant of LPP [9,10], or totally denying the significance of follicular microinflammation and fibrosis in PHL.…”

“…In fact, their comparative histopathology was inappropriate with regard to differences between the 2 groups in sex and age with a predominance of older males in the control group (71% males with 44% >70 years of age with the probability of senescent alopecia vs. 84% females with 3% >70 years of age in the PHL group). In addition, the authors failed to take into account the possibility that the androgenetic hair follicle may react differently to environmental stress and inflammation, as evidenced by basic research [12], or to acknowledge cicatricial PHL or FAPD, as evidenced by the respective clinical observations [6][7][8].…”