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March 2001

A Peculiar Pattern of Alopecia

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Arch Dermatol. 2001;137(3):365-370. doi:

The skin biopsy specimen revealed a reduced number of terminal hair follicles. The epidermis showed vacuolar change at the basal layer of the epidermis. The reticular and papillary dermis demonstrated fibrosis, with the reticular dermis containing vessels that were oriented perpendicularly to the skin surface. There was a lymphocytic perivascular and perifollicular infiltrate. The results of direct immunofluorescence were negative.

Postmenopausal frontal fibrosing alopecia was originally described by Kossard1 in 1994. Affected women are postmenopausal, with a mean age of 66 years. Clinical examination shows an asymmetrical band of alopecia in the frontal scalp area, with frontal hairline recession. This band of alopecia contains pale skin resembling a scar, with loss of follicular orifices and perifollicular erythema around some hairs at the new hairline. This area of alopecia may contrast with sun-damaged skin of the remainder of the forehead and may extend to involve the temporoparietal areas and the eyebrows. The rest of the skin is normal. There are no mucous membrane or nail changes.

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