Glabellar Clinical and Trichoscopic Findings in Patients with Frontal Fibrosing Alopecia

Frontal fibrosing alopecia is a type of alopecia diagnosed predominantly clinically. A glabellar skin biopsy provides important findings in cases of diagnostic uncertainty, such as red dots, representing the presence of a perifollicular lymphocytic inflammatory infiltrate affecting the vellus hairs.

A 74-year-old patient with 10 months of progressive frontal hair loss was observed upon examination to show alopecia with a "fringe sign," consistent with a type III pattern of frontal fibrosing alopecia. Ice pick scarring was observed on the glabella. Trichoscopy revealed annular brown pigmentation, peripilar erythema, and hair splayed in different directions. Histopathologically, these lesions corresponded to thickened collagen fibers, predominantly perifollicular, generating conical retraction. 5-alpha reductase inhibitors, oral minoxidil, and high-potency topical corticosteroids are indicated, halting disease progression.

Frontal fibrosing alopecia has multiple non-capillary findings that support the diagnosis. Therefore, a more complete clinical and trichoscopic description of facial areas such as the glabella will help us correlate these findings with patient severity and prognosis.