Patchy Frontal Fibrosing Alopecia: Description of an Incomplete Clinical Presentation

Area of Science:

• Dermatology
• Pathology

Background:

• Frontal fibrosing alopecia (FFA) is a scarring alopecia often considered a variant of lichen planopilaris (LPP).
• Incomplete presentations of FFA can pose diagnostic challenges.

Purpose of the Study:

• To describe and analyze 6 cases of incomplete frontal fibrosing alopecia.
• To highlight the diagnostic difficulties and importance of recognizing atypical FFA presentations.

Main Methods:

• Case series describing clinical, dermatoscopic, and histological findings.
• Histopathology included evaluation of perifollicular infiltrate, fibrosis, and direct immunofluorescence (DIF).

Main Results:

• Patients presented with irregular frontal/temporal hair loss, minimal inflammation, and vellus hair loss.
• Dermatoscopy showed absent ostia and reduced peripilar erythema/hyperkeratosis.
• Histology revealed perifollicular infiltrate and fibrosis; DIF was negative.
• Associated symptoms included eyebrow loss, hyperpigmentation, and pruritus.

Conclusions:

• Incomplete FFA can mimic LPP with similar histology and negative DIF.
• Accurate diagnosis of incomplete FFA is vital to prevent misdiagnosis and ensure appropriate management.
• Early identification aids in treatment planning and prognosis definition for scarring alopecias.