Occipital Fibrosing Alopecia in a Young Male: A Case Report

Abstract

Introduction: Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia with 3 recognized clinical variants. Lately, LPP clinical spectrum has expanded with new and overlapping clinical variants. First considered as a subtype of LPP affecting postmenopausal women, the increasing worldwide incidence of FFA including atypical lesions in young female and male suggests a different pathomechanism for this disease. Although LPP-spectrum disorders may share similar histopathological findings, clinical features and prognosis are different.

Case report: A 26-year-old Caucasian male presented with occipital scarring alopecia and pruritus for the last 6 months. The patient had been treated for an associated androgenetic alopecia and superficial recurrent scalp folliculitis over the vertex scalp for the last 5 years. Trichoscopy of the occipital scalp showed mild diffuse erythema, moderate peripilar scaling, and absence of follicular openings, suggestive of a scarring process. The patient underwent an occipital scalp biopsy that confirmed the diagnosis of a LPP-spectrum disorder.

Discussion/conclusion: Both LPP and FFA mostly affect the anterior-mid scalp of females. However, recent reports on FFA also in premenopausal women and men should make physicians aware of atypical features of this disease and unusual clinical presentation.

Keywords: Frontal fibrosing alopecia; Lichen planopilaris; Occipital alopecia; Occipital fibrosing alopecia; Primary scarring alopecia; Scarring alopecia.

Fig. 1

Clinical examination: occipital alopecia with erythematous papules.

Fig. 2

Trichoscopy of the occipital scalp: decreased hair density, moderate peripilar tubular scaling, and mild diffuse erythema. Note some small white scarring areas devoid of follicular openings over the interfollicular areas and the lack of vellus hairs (marked blue).

Fig. 3

Histopathology: note a mild lymphocytic inflammation and concentric lamellae surrounding the isthmic region of the hair follicle. No sebaceous gland could be seen around this follicle (HE, cross section, ×200).