Frontal Fibrosing Alopecia: Role of Dermoscopy in Differential Diagnosis

Abstract

Frontal fibrosing alopecia (FFA) is more common in postmenopausal women, but it can occur in younger women. Some authors consider FFA to be a distinct frontal variant of lichen planopilaris. From a clinical point of view, this relatively uncommon condition is characterized by progressive frontotemporal recession due to inflammatory destruction of hair follicles. Dermoscopy can be very useful, as the differential diagnosis between traction alopecia, alopecia areata, FFA and cicatricial marginal alopecia may be difficult. It is not clear whether or not treatment alters the natural history of the disease - the disease stabilized with time in most of the patients with or without continuing treatment. Here we report a case of a 50-year-old woman with FFA and discuss the relevance of dermoscopy in the differential diagnosis of this disease.

Fig. 1

a Frontal recession with uniformly pale skin and loss of follicular orifices; b temporal recession and slight perifollicular erythema at the hair margin; c on dermoscopic examination decrease of follicular openings and follicular hyperkeratoses are evident; absence of miniaturization and/or yellow dots.

Fig. 2

Mild chronic lymphocytic inflammatory infiltrate around the infundibular and the isthmus; reduction in the number of hair follicles and replacement by fibrous tracts (hematoxylin-eosin, ×5).