Frontal fibrosing alopecia versus lichen planopilaris: a clinicopathological study

Poblet, Enrique; Jiménez, Francisco; Pascual, Alejandro; Piqué, Enric

doi:10.1111/j.1365-4632.2006.02507.x

Cited by 131 publications

(78 citation statements)

References 17 publications

(20 reference statements)

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“…In cases with long-term FFA, the performed biopsies are only reported as cicatricial alopecia, and fibrous tracts without follicle and inflammatory infiltrate are seen (13). Therefore, while some authors show several clinical presentation, they accept FFA as a special variant of lichen planopilaris (5,20). The histopathological examinations of our cases who underwent biopsy could not be distinguished from LPP.…”

Section: Discussionmentioning

confidence: 67%

“…However, this measurement was not taken in our cases. 96% of the published cases were reported to have paleness in alopecic skin, destruction of follicular orifices, and skin atrophy without clinical induration and sclerosis (1,5,6,20). All our cases had cicatricial alopecia.…”

Section: Discussionmentioning

confidence: 78%

“…The distinctive pathological characteristic of FFA from LPP is that lymphocytic infiltrate and fibrosis of the FFA selectively affect vellus-like follicles on frontal line and muscles. Although not necessarily, perifollicular localized inflammatory lymphocytic infiltrate may be observed on the upper part of the hair follicle (5,23,25). Mild to moderate follicular inflammation is the common pathological characteristic of female-type hair loss (FMA).…”

Section: Discussionmentioning

confidence: 99%

“…Itching was present in 21% of the cases (3 cases). While the ethiopathogenesis of the FFA is not exactly known, the key role is thought be played by T-cell mediated autoimmune reaction against hair follicles (2,(3)(4)(5)9,16). Another opinion regarding FFA ethiopathogenesis is the effect of androgen hormonal factors.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis is usually made on a clinical basis. Histopathological examination is supportive in diagnosis (2,5,7). While the pathogenesis is not exactly known, its everincreasing incidence in recent years indicates possible involvement of environmental factors (4).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Examination of Clinical and Demographic Characteristics of 14 Cases with Frontal Fibrosing Alopecia

Akbaş

Kılınç

2018

Medical Science and Discovery

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Examination of Clinical and Demographic Characteristics of 14 Cases with Frontal Fibrosing Alopecia

Akbaş

Kılınç

2018

Medical Science and Discovery

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The spectrum of fibrosing alopecias

Orlando

Piraccini

Starace

2022

JEADV Clinical Practice

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Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia considered the most common cause of scarring hair loss in adults. It has been classified into three clinical variants: classical LPP, frontal fibrosing alopecia (FFA) and Graham Little-Piccardi-Lassueur syndrome. Classical LPP usually presents as a circumscribed cicatricial patch on the vertex and FFA as a band-like scarring alopecia of the frontotemporal hairline. Fibrosing alopecia in a pattern distribution (FAPD) and lichen planopilaris diffuse pattern (LPPDP) are two recently described subtypes of LPP that exhibit a diffuse involvement of the androgen-dependent region or the whole scalp, respectively. Classical LPP, FFA, FAPD and LPPDP share trichoscopic (cicatricial areas, absence of follicular openings, perifollicular erythema and hyperkeratosis) and histologic features (interface dermatitis involving follicular epithelium and concentric fibrosing around the isthmus and infundibulum).The remarkable clinical and histological overlap between these entities has led to the concept that these diseases exist along a spectrum. In the effort to identify classical LPP, FFA, FAPD and LPPDP with an umbrella term, we suggest to use 'lichenoid alopecias', as the distinguishing hallmark of these diseases is the lichenoid bandlike inflammatory infiltrate in the superficial dermis involving the infundibulum and isthmus of the hair follicle.

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Lichen planopilaris is characterized by immune privilege collapse of the hair follicle's epithelial stem cell niche

et al. 2013

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Lichen planopilaris (LPP) is a chronic inflammatory disease of unknown pathogenesis that leads to permanent hair loss. Whilst destruction of epithelial hair follicle stem cells (eHFSCs) that reside in an immunologically protected niche of the HF epithelium, the bulge, is a likely key event in LPP pathogenesis, this remains to be demonstrated. We have tested the hypotheses that bulge immune privilege (IP) collapse and inflammation-induced eHFSC death are key components in the pathogenesis of LPP. Biopsies of lesional and non-lesional scalp skin from adult LPP patients (n = 42) were analysed by quantitative (immuno)histomorphometry, real-time quantitative polymerase chain reaction (qRT-PCR), laser capture microdissection and microarray analysis, or skin organ culture. At both the protein and transcriptional level, lesional LPP HFs showed evidence for bulge IP collapse (ie increased expression of MHC class I and II, β2microglobulin; reduced TGFβ2 and CD200 expression). This was accompanied by a Th1-biased cytotoxic T cell response (ie increased CD8(+) GranzymeB(+) T cells and CD123(+) plasmacytoid dendritic cells, with increased CXCR3 expression) and increased expression of interferon-inducible chemokines (CXCL9/10/11). Interestingly, lesional LPP eHFSCs showed both increased proliferation and apoptosis in situ. Microarray analysis revealed a loss of eHFSC signatures and increased expression of T cell activation/binding markers in active LPP, while bulge PPARγ transcription was unaltered compared to non-lesional LPP HFs. In organ culture of non-lesional LPP skin, interferon-γ (IFNγ) induced bulge IP collapse. LPP is an excellent model disease for studying and preventing immune destruction of human epithelial stem cells in situ. These novel findings raise the possibility that LPP represents an autoimmune disease in whose pathogenesis IFNγ-induced bulge IP collapse plays an important role. Therapeutically, bulge IP protection/restoration may help to better manage this highly treatment-resistant cicatricial alopecia.

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Frontal fibrosing alopecia versus lichen planopilaris: a clinicopathological study

Cited by 131 publications

References 17 publications

Examination of Clinical and Demographic Characteristics of 14 Cases with Frontal Fibrosing Alopecia

Examination of Clinical and Demographic Characteristics of 14 Cases with Frontal Fibrosing Alopecia

The spectrum of fibrosing alopecias

Lichen planopilaris is characterized by immune privilege collapse of the hair follicle's epithelial stem cell niche

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