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skINsight
Oct 2011

Lonely HairA Clue to the Diagnosis of Frontal Fibrosing Alopecia

Arch Dermatol. 2011;147(10):1240. doi:10.1001/archdermatol.2011.261

Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris that mostly affects postmenopausal women and is characterized by progressive bandlike scarring alopecia involving the frontal hairline and the eyebrows. A 45-year-old white woman presented with a 2-year history of progressive hair loss. Clinical examination revealed a band of alopecia with regression of the frontal hairline. A few single terminal hairs were present in the midfrontal area (Figure 1). Her eyebrows were sparse, and she had no hair on her upper and lower limbs. The diagnosis of FFA was confirmed by the findings of pathologic examination (Figure 1, inset), which showed a lichenoid infiltrate at the level of the upper follicle. The infiltrate was seen within the outer root sheaths surrounded by layers of perifollicular fibrosis. There were a few apoptotic keratinocytes in the outer root sheaths and a prominent cleft between the follicular epithelium and the stroma.

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