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Fibrosing alopecia in a pattern distribution (FAPD) is a unique entity which presents clinicopathological characteristics of both male/female pattern androgenetic alopecia (AGA) and lichen planopilaris (LPP). This entity was first reported in 2000 and its criteria was recently proposed. Etiopathogenesis of FAPD has been speculated to be immunological destruction involving miniaturized hair follicles but still remains elusive. To date, few Asian FAPD cases have been reported in the literature. In this study, Japanese FAPD cases were identified based on the aforementioned criteria and analyzed to delineate clinicopathological characteristics. By retrospectively revisiting medical records and clinical photographs, 24 Japanese cases comprising 17 women and seven men were diagnosed as FAPD. All male patients had disease onset by their early 30s, whereas most female patients had developed the condition in middle age or later. Their initial diagnoses prior to the diagnostic confirmation of FAPD were mostly LPP. Based on the clinical phenotypes, the cases were categorized into AGA and LPP types. These subtypes were characterized by foremost trichoscopic and histopathological findings of AGA or LPP, respectively. Unlike previously reported cases, our patients tended to manifest hair loss in both vertex and frontal to mid-scalp with minimal regression of anterior hairline, manifesting unique "parachute" pattern, which has been reported as a representative characteristic of East Asian AGA in the literature. Anti-inflammatory therapies seemed to be effective to deter hair loss but insufficient to achieve improvement. Further accumulation of the cases is necessary; however, these findings may provide additional pathophysiological insights into FAPD and highlight uniqueness of the etiology and clinical phenotype of Japanese FAPD putatively influenced by racial predispositions.

Lichen planopilaris is a rare inflammatory condition that is also known as follicular lichen planus. Although the condition commonly affects the scalp, it sometimes involves the other regions of the body with a variety of clinical presentations. The involvement beyond the scalp is considered to be a generalized nature of disease process. In this report, we present a case of generalized follicular lichen planus in a 34-year-old Thai female presenting with comedone-like lesions on the trunk and extremities as well as scarring alopecia on the scalp. Dermoscopic features were also discussed.

Introduction: Scalp rosacea is scarcely reported in the literature, but it is probably not uncommon. Trichoscopic findings have not been specifically established for this entity. Case Presentation: We report 4 cases of chronic scalp rosacea with trichoscopic evidence of peripilar scaling that resolved without scarring after treatment. Discussion/Conclusion: Chronic and persistent inflammation around the isthmus produced in scalp rosacea may form peripilar scaling resembling that found in lichen planopilaris.

Introduction: Reticulated hyperpigmentation is a relatively uncommon dermatologic pattern. It is used to describe brown-colored skin lesions that manifest in a lacy or net-like distribution. When a clinician encounters a patient with reticulated hyperpigmentation, its location is often the most helpful feature in establishing a differential diagnosis. As this pattern is rarely observed on the scalp, this site is currently not included in the diagnostic approach. Case Presentation: In this report, we present a case of lichen planopilaris (LPP) in a black man who presented with reticulated hyperpigmentation over the scalp. Conclusion: We suggest that it may be warranted to add LPP to the differential diagnosis of reticulated hyperpigmentation, especially when arising on the scalp of darker skinned individuals.

Background: Lichen planopilaris (LPP) is a relatively uncommon inflammatory skin condition that causes permanent hair loss. Irreversible hair loss can have a significant psychosocial and psychological impact on patients’ lives. Limited studies have assessed the psychological status of patients suffering from LPP, and to our knowledge, none have evaluated patients with LPP as a separate group in this regard. Objective: This study aimed to assess the quality of life (QoL) and general health of patients with LPP using the Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire-28 (GHQ-28), respectively. Methods: Our study employed a cross-sectional design. In total, 41 patients with LPP attending the follow-up skin clinic at the Razi Hospital in Tehran, Iran were asked to complete the DLQI and GHQ-28. Furthermore, selected demographic information was obtained from patients to evaluate their association with general health and QoL. Results: Forty-one patients (14 men and 27 women) with a mean age of 44.02 ± 10.8 years completed both questionnaires. QoL was affected moderately to extremely in 70.7% of patients. Also, 26 patients (63.4%) were at risk for psychological disorders. Lower QoL was reported by patients age

Background: Lichen Planopilaris (LPP) is a lymphocyte-mediated scarring alopecia that frequently is treatment resistance to both topical and systemic therapies. Aims and Objectives: The object of this pilot study was to assess the effectiveness of topical mechlorethamine 0.016% gel (Valchlor®) in decreasing disease activity in LPP and the related clinical variant frontal fibrosing alopecia (FAA). Methods: Twelve patients with biopsy-proven LPP/FAA who failed prior topical or systemic therapy with active disease were included. Participants applied mechlorethamine 0.016% gel to involved areas daily for 24 weeks. Outcome measures included LPP Activity Index (LPPAI) score, Physician Global Assessment (PGA) score, Dermatology Quality of Life Index (DQLI) score, and phototrichograms assessing follicular counts before and after six months of therapy. Results: LPP Activity Index (LPPAI) before and after treatment was significantly different (5.0 before treatment, 2.0 after treatment; p value=0.006). Mean follicular density and follicular units were unchanged during the treatment period. Conclusion: Treatment with mechlorethamine 0.016% gel for 24 weeks resulted in statistically significant improvement of LLP/FFA with no change in phototrichogram parameters. Treatment duration was limited by high rate of contact dermatitis. Further investigation to optimize dosing frequency and to assess the role of combination topical therapy is needed.

Graham-Little-Piccardi-Lassueur syndrome (GLPLS) is a rare syndrome characterized by the triad of cicatricial alopecia of the scalp, non-cicatricial alopecia of the axilla and groin and follicular lichen planus eruptions on the trunk and extremities. GLPLS is considered to be a variant of lichen planopilaris. We report two cases that have fulfilled all of the criteria for GLPLS. The first case was a 71-year-old woman, admitted to the Department of Dermatology for pruritic perifollicullar erythema and scaling of the scalp, cicatricial scalp alopecia and hair loss of the axilla and pubic region for five months. Subsequently, follicular hyperkeratotic eruptions and hyperpigmented macules on the skin of the chest and abdomen appeared. The second case was a 48-year-old man with pruritic follicular papules on the face, trunk and extremities for four months. All of the laboratory examinations in both patients were within normal limits. No alternation in the general condition of the patients was observed. Histological examinations in both patients confirmed the diagnosis GLPLS. The patients were treated with systemic and local corticosteroid resulting in marked improvement of the skin lesions; however, cicatricial scalp alopecia showed no response to the treatment.

Although the coexistence of alopecia areata and lichen planopilaris is rare, if alopecic patches appear abruptly, this possible association should be kept in mind.

Despite the little information about the facial papules due to Lichen planopilaris (LPP), we have many cases with facial skin roughness in which histological study has showed LPP. Additionally, in those patients treating for frontal fibrosing alopecia or scalp LPP there was no improvement in facial papules.

Background Classic lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary lymphocytic cicatricial alopecia. In patients with ambiguous clinical presentation, reflectance confocal microscopy (RCM) a new noninvasive skin imaging technique, could be a helpful diagnostic tool. The aim of our study was to describe the characteristic features of classic LPP and FFA using RCM. Materials and methods Ten patients with classic lichen planopilaris and two with frontal fibrosing alopecia were examined with RCM. Results Lichenoid inflammatory infiltrate around the hair follicle was observed in three cases of classic LPP and FFA (3/12; 25.0%). Extensive perifollicular fibrosis was seen in nine patients (9/12; 75.0%) with classic LPP and FFA. An increased number of white, ill-defined, coarse dermal fibers at the level of the superficial dermis were visible in seven cases (7/12; 58.3%). Moreover, dilated blood vessels were present in seven patients with classic LPP and FFA (7/12; 58.3%). Conclusion Summing up, reflectance confocal microscopy allows to visualize major key diagnostic features of classic lichen planopilaris and frontal fibrosing alopecia in the real time. The value of RCM examination in scarring alopecia needs to be further evaluated, but it appears to be a useful adjuvant tool for the initial diagnosis of classic LPP and FFA.

Background and objectives: Lichen planopilaris (LPP) is one of the important causes of cicatricial alopecia. We aimed to evaluate the efficacy and safety of low-dose naltrexone (LDN) in the setting of a clinical trial in patients with LPP.Methods: We included patients with LPP between 2018 and 2020. Patients were allocated to two groups. The first group received topical clobetasol plus oral low dose naltrexone (3 mg) while the second received topical clobetasol plus placebo. The assessment was made for the disease severity by lichen planopilaris activity index (LPPAI) instrument and the safety of the drug in 2-month intervals up to 6 months. To compare both groups, we used the ANOVA test for repeated measures. Clinical trials registry code: IRCT20180809040747N1.Results: Thirty-four patients were analyzed in an intention-to-treat fashion. There was a decrescendo pattern on LPPAI scores that was statistically significant within the LDN (p = .001) but almost significant within the placebo group (p = .060) and non-significant between the groups (p = .813). The side effects attributable to the low dose naltrexone was not statistically different between studied groups.Conclusion: Low-dose naltrexone (3 mg) failed to improve the severity of the LPP more than what is achievable with topical clobetasol.

Background: Clinical and histological features may overlap between lichen planopilaris-associated and discoid lupus erythematosus-associated scarring alopecia. Objectives: The aim of this study was to demonstrate the cutaneous infiltration of plasmacytoid dendritic cells and to compare their distribution pattern in discoid lupus erythematosus and lichen planopilaris. Methods: Twenty-four cases of discoid lupus erythematosus and 30 cases of lichen planopilaris were examined for immunostaining of the CD123 marker. The percentage and distribution pattern of plasmacytoid dendritic cells and the presence of the plasmacytoid dendritic cells clusters were evaluted in the samples. Results: The number of plasmacytoid dendritic cells was higher in the discoid lupus erythematosus specimens. Aggregations of 10 cells or more (large cluster) were observed in half of the discoid lupus erythematosus specimens and only 2 lichen planopilaris, with 50% sensitivity and 93% specificity for differentiating discoid lupus erythematosus from lichen planopilaris. Study limitations: Incidence and prevalence of discoid lupus erythematosus-associated scarring alopecia in the scalp are low, so the samples size of our study was small. Conclusions: We suggest that a plasmacytoid dendritic cells cluster of 10 cells or more is highly specific for distinguishing discoid lupus erythematosus from lichen planopilaris. It also appears that CD123 immunolabeling is valuable in both active and late stages of the disease.

Lichen Planopilaris (LPP) is an uncommon scalp disorder of unknown etiology and prevalence. It is thought to be an autoimmune process triggered by unknown genetic and/or environmental factors that attack hair follicles of the scalp. LPP has been reported to mimic or present in association with various autoimmune diseases and immunomodulatory therapies. We present two atypical case of LPP in Caucasian patients; the first is a patient with generalized pruritus, skin eruptions, and scalp hair loss. Biopsy of the lesions revealed exocytosis of atypical lymphocytes at the Dermo-Epidermal Junction (DEJ) and formation of small Pautrier’s microabscesses in the interfollicular epidermis as well as a robust lymphocytic inflammatory infiltrate with destruction of perifollicular appendages. This led us to the diagnosis of LPP-like Folliculotropic Mycosis Fungoides (FMF). The second case is a patient with a history of Systemic Lupus Erythematosus (SLE) who presented clinically with perifollicular erythema and alopecic patches, with loss of follicular ostia on the frontal and vertex scalp and evidence of follicular tufting. Histologically, she had decreased number of follicles with a peri-infundibular lymphocytic infiltrate and vacuolization at the Dermoepidermal Junction (DEJ) and there was also thickening of the basement membrane highlighted with a periodic acidic Schiff stain. This led to a diagnosis of SLE/LPP overlap. Keywords: Lichen Planopilaris (LPP); Cicatricial; Alopecia; Frontal Fibrosing Alopecia (FFA), Folliculotropic Mycosis Fungoides (FMF), Lichen Planus (LP).

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia of unknown etiology. The incidence of FFA appears to be increasing with time, leading to suspicion of a possible environmental trigger. Observational studies have reported a positive correlation between facial sunscreen use and FFA. This finding raises the question of whether sunscreen use plays a role in disease development. In this article, we review the available literature on the association of sunscreen with FFA. There is insufficient evidence to establish a direct causal relationship between sunscreen and FFA. Further studies are required to better characterize the role of sunscreen and the environment in the pathogenesis of this unique disease.

Lichen planopilaris (LPP) is a cell-mediated scarring alopecia that causes inflammation of the scalp and the eventual destruction of hair follicles in affected areas. Current literature on treatment of LPP remains limited with no definitive treatment approach being recognized, although a combination of topical/intralesional steroids and orally administered hydroxychloroquine remains the most utilized option. Low-level light therapy (LLLT) is an expanding technology shown to be effective in a variety of dermatologic conditions. We report here four patients with LPP who show a dramatic response to LLLT, including a reduction of inflammation, disappearance of symptoms, and evident hair regrowth with no side effects. We review the possible role of LLLT in LPP and other lichenoid conditions.

Ocular involvement of lichenoid dermatoses, such as lichen planus (LP), lichen planus pigmentosus (LPP), and lichen planopilaris (LPL), although uncommon, is associated with skin manifestations. Isolated ocular involvement is very rare. When lesions are confined to the skin, the dermatologist inquires and evaluates for oral and genital symptoms and lesions, respectively; hence, eye manifestations are commonly neglected by the non-ophthalmologist. Ocular involvement in LP, LPP, and LPL may result in significant morbidity. An ophthalmic interrogatory and a gross ophthalmic evaluation performed by the dermatologist may unravel ocular signs and symptoms that require evaluation by an eye specialist. Ocular surface inflammation and scarring, when untreated, results in serious complications such as corneal perforation and permanent vision loss. This review aims to present an up-to-date overview for the dermatologist of the ocular involvement and complications of LP, LPP, and LPL, and when to refer to the ophthalmologist to prevent blinding complications.

Graham‐Little Piccardi Lassueur Syndrome (GLPLS) is a rare variant of lichen planopilaris (LPP) which characterized by triad of fibrosing alopecia of the scalp, non‐fibrosing alopecia of the axilla and groin, and a follicular spinous papule over the body. LPP is a rare follicular subtype of lichen planus which causes scarring alopecia of scalp, and there are three clinical subtypes of LPP including classic lichen planopilaris, frontal fibrosing alopecia, and GLPLS. Herein, we describe an adult dark‐skinned Saudi male with GLPLS who has numerous body follicular papules, complete loss of axillary hair, and partial loss of groin hair in addition to patchy fibrosing alopecia of the scalp. To the best of our knowledge, this is the first reported case of GLPLS in Saudi Arabia., Graham‐Little Piccardi Lassueur Syndrome (GLPLS) is a rare variant of Lichen planopilaris(LPP) which characterized by triad of fibrosing alopecia of the scalp, non‐fibrosing alopecia of the axilla and groin, and a follicular spinous papule over body. LPP is a rare follicular subtype of lichen planus. Which affects female most commonly.

Trichoscopy in dermatology has opened up the new concept in overcoming the optical challenge faced clinically. It reveals the diagnostic details to the depth of superficial dermis, and thereby increasing the clinician's diagnostic accuracy and the level of confidence. The importance of trichoscopy in cicatricial alopecia is very evident in the current scenario for its precise diagnosis. The clinical picture in delineating lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) from each other and also from other close mimickers such as androgenetic alopecia, alopecia areata, female patterned hair loss, and other cicatricial alopecia is bewildered due to its varied presentation and co-existence with the above disease. The indecisive comparative findings on histopathology make the situation even more perplexed. In this article, we have reviewed the characteristic trichoscopy patterns that can differentiate LPP and FFA and from their close mimickers.

For the first time in 1994, Kossard described a new member of the scarring alopecia disorders wich is called frontal fibrosing alopecia (FFA) (1). It affects post-menopausal females mainly (1, 2). But it may affect premenopausal females (3) and men (4). Some dermatologists consider FFA as a clinical variant of another disorder called lichen planopilaris (LPP), as both show similair histological character (2, 5) but with higher apoptotic activity and less inflammation in FFA. Regarding its behavior and clinical presentations; it shows variations of either slow, rapid, or self-limiting progression (6). Now, its incidence has been markedly increasing (7). Besides, the exact etiology is still unknown, thus, the exact tretment regimen has not been identified. However, several reports found different responses (either improvement or stabilization) on regimens containing topical and intralesional steroids, topical and oral immunomodulators, hydroxychloroquine, and antibiotics (8-10).

Lichen planopilaris (LPP) is characterized by chronic cicatricial alopecia that is lymphocytic in nature. The underlying pathophysiology of LPP is not well understood. Failure of therapeutic management occurs quite often resulting in significant psychosocial stress on the patient when they are unable to prevent further hair loss or reverse it. Although the occurrence of LPP is rare, it is especially seldom observed in the pediatric population. Herein, we discuss a case of a nine-year-old child who was recently diagnosed with LPP.

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are chronic lymphocytic cicatricial alopecias (CAs) with unclear etiopathogenesis. While LPP usually presents as inflamed and quickly progressing lesions over the vertex, FFA tends to affect primarily women as a slowly progressive frontotemporal alopecia. Both diseases can be associated with certain nonscalp lesions that may even precede the scalp lesions,(1-4) and be very distressing, leading to impaired self-esteem and quality of life (QoL).(5-7) We aimed to assess the relationship between QoL, signs and symptoms of inflammation, and associated nonscalp lesions in LPP and FFA.

Graham Little-Piccardi-Lassueur syndrome is a type of lichen planopilaris characterized by the triad of patchy cicatricial alopecia of the scalp, non-cicatricial alopecia of the axilla and pubis, and follicular spinous papules on the body, scalp or both. This rare syndrome primarily affects middle-aged postmenopausal women with only three male cases being reported in literature. Herein we report a 53-year-old man who is fourth male patient diagnosed with Graham Little-Piccardi-Lassueur syndrome up to now.

Adalimumab (Humira; Abbott Laboratories, Puerto Rico) is a recombinant human IgG1 monoclonal antibody for tumor necrosis factor and is a treatment option for both hidradenitis suppurativa (HS) and rheumatoid arthritis (RA). We report a case of a patient with lichen planopilaris (LPP) that had hair regrowth when treated with adalimumab, originally prescribed to the patient for RA and HS.

Lichen planus follicularis tumidus (LPFT) is an extremely rare variant of lichen planus characterized by white to yellow milia-like cysts and comedones on a violaceous to hyperpigmented plaque most commonly involving retroauricular area. Clinically, it resembles milia en plaque. It is usually asymptomatic, more common in middle-aged females. Histopathologically, it has features of lichen planopilaris along with follicular cysts in dermis surrounded by lichenoid infiltrate. We are reporting a case of LPFT in a 62-year-old male patient involving bilateral retroauricular areas due to the rarity of this condition.

Certain types of alopecia, such as traction alopecia, discoid lupus erythematosus, and central centrifugal cicatricial alopecia, occur more commonly in African-American individuals than in those of other ethnicities. Both intrinsic hair qualities and hair care practices play a role. Lower baseline tensile strength, hair density, and growth rates, as well as the use of high-tension hairstyles and chemical relaxers may contribute to alopecia in this group. Alopecia can also occur as a result of discoid lupus erythematosus, which involves chronic lymphocytic infiltration and eventual scarring of the hair follicle. Lichen planopilaris is a less common cause of scarring alopecia that can appear clinically similar to other forms of cicatricial alopecia. Lastly, although not classically associated with hair loss, recent evidence indicates that seborrheic dermatitis may play a role in shedding and alopecia. Recognizing and differentiating these alopecic subtypes clinically and histopathologically is important for prompt diagnosis and treatment. This article is based on a chapter in Ethnic Skin and Hair, and intended as a supplemental article to “Current and Emerging Treatment Strategies for Hair Loss in Women of Color.” Keywords: Alopecia, Traction alopecia, Seborrheic dermatitis, Lichen planopilaris, Discoid lupus erythematosus

Introduction Photobiomodulation therapy with the use of light-emitting diodes (LEDs) is a fast growing therapeutic technique with a wide range of dermatologic indications. Recently it has been suggested that LED therapy could be beneficial in scarring alopecia. Aim Assessment of the efficacy of novel superluminescent diodes (sLED) with a “soft- start” as an adjuvant treatment in selected types of scarring alopecia. Methods This pilot study included 16 female patients: 8 with frontal fibrosing alopecia (FFA) and 8 with lichen planopilaris (LPP), aged 41–76 years with a stable treatment, either topical or systemic. In all patients, sLED irradiations were performed once a week for a 10-week period. The sLEDs’ effectiveness was assessed clinically and using trichoscopy. Results The therapy was well tolerated. Both Lichen Planopilaris Activity Index (LPPAI) and Frontal Fibrosing Alopecia Severity Score (FFASS) were significantly reduced after the therapy (p = 0.012, p = 0.017 respectively). Within the treated area, the number of thick hairs significantly increased after the therapy (p = 0.009), whereas the number of medium-sized hairs and thin hairs did not change significantly (p = 0.836, p = 0.675 respectively). Conclusions Irradiations with sLEDs were demonstrated to be safe and well tolerated. This noninvasive therapy leads to the reduction of subjective symptoms, and improve the outcome both in FFA and in LPP. This effective novel light source can be used as an adjuvant therapy in patients with chronic LPP or FFA. However, further studies including a larger study group and a control group are needed to evaluate the long-term effects of the therapy.

Fibrosing alopecia in a pattern distribution (FAPD) is a relatively new entity in the family of cicatricial alopecia. It has been categorized as a member of the lichen planopilaris (LPP) group due to its similarity in clinical and histopathological presentation. Nonetheless, the disease earns its own entity due to its lichenoid inflammation exclusively involving miniaturized hair and area of involvement mimicking pattern hair loss which differentiates itself from other types of LPP or pattern hair loss. Since its first introduction by Zinkernagel and Trüeb in 2000, there have been only few case reports and series of FAPD. We herein report a case of FAPD in a postmenopausal woman who had progressive hair loss over the course of 10 years.

Generally, cicatricial alopecias are relentlessly and slowly progressive. We describe clinical and histologic features of rapidly progressive cicatricial alopecia in a young man, with overlapping features of frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), fibrosing alopecia with a pattern distribution (FAPD), and cicatricial pattern hair loss (CPHL), suggesting that these conditions may exist along a spectrum.

Lichen planus (LP) is an idiopathic inflammatory disease of the skin, hair, nails, and mucous membranes. Classic cutaneous LP is characterized by violaceous flat-topped papules that typically favor the extremities. LP on the scalp, otherwise known as lichen planopilaris, classically presents with scarring alopecia, perifollicular erythema and follicular prominence. Although LP pigmentosus presents primarily as hyperpigmentation, there is only one previous report of hypopigmented LP. In this report, the authors report 2 cases of LP that presented primarily as hypopigmented macules in 2 African American men. The first patient presented with hypopigmented macules on face and scalp as well as trunk and extremities. The second patient presented with hypopigmented macules on scalp with associated alopecia. Histopathological examination from both patients showed features of LP. The authors propose a new variant of LP that presents acutely as hypopigmented lesions.

BACKGROUND/OBJECTIVES Videodermoscopy is a valuable tool for the diagnosis of cicatricial alopecias such as lichen planopilaris. Lichen planopilaris activity index is used for evaluating lichen planopilaris severity. Our aim was to examine the utility of videodermoscopy in the assessment of lichen planopilaris severity. METHODS One hundred and seventeen histopathologically confirmed lichen planopilaris patients under went videodermoscopy. Lichen planopilaris activity index was calculated according to cicatricial alopecia standardised flowchart. Differences and correlations between trichoscopic features, clinical findings and lichen planopilaris activity index were calculated. RESULTS Most trichoscopic features had statistically significant higher prevalence than similar clinical findings. Targetoid pigment pattern, perifollicular scale and milky-red areas were significantly correlated with lichen planopilaris activity index (P-value

Lichen planopilaris (LPP) is an immune-mediated cicatricial alopecia. The main clinical presentations of LPP include classic form, frontal fibrosing alopecia (FFA), and Graham-Little-Piccardi-Lassueur syndrome (GLPLS). We reviewed medical records of all 291 patients diagnosied with LPP from 2006 to 2017 in Department of Dermatology, Tehran University of Medical Sciences. LPP was more common in women than men. Lichen planus (LP) was seen in 59 of patients (20.3%). Parietal lesions (69.75%), frontal (27.14%), occipital (23.71%), and temporal (21.64%) were frequently seen in LPP patients. However, trunk hair involvement (15.4% vs. 2.7%

Background: We report a case of acute and severe lichen planopilaris (LPP)-like alopecia in a 35-year-old male construction worker following occupational exposure to trichloroethylene (TCE) and tetrachloroethylene (PCE). Case Report: Two weeks after initiating ground-intrusive construction at a previous dry-cleaning facility site, the patient developed sudden scalp pruritus and associated patchy hair loss. As subsequent scalp biopsies revealed LPP, he was started on hydroxychloroquine at 200 mg twice daily and clobetasol solution once daily. Despite treatment, the patient’s hair loss rapidly progressed to involve >95% of his scalp within 3 years. An official “work clean” policy report revealed high-concentration exposure to TCE and PCE. Conclusion: Although causation cannot be proven, the close temporal relationship and rapid progression of LPP-like alopecia in an atypical patient demographic support a strong correlation between chemical exposure to TCE/PCE and scarring hair loss.

Frontal fibrosing alopecia (FFA) is a relatively new scarring alopecia that is considered a variant of lichen planopilaris (LPP) with no recognized promising treatments. In this study, we tried to clarify the underlying signaling pathways and their roles in the pathogenesis and progression of FFA. Because of several differences in clinical manifestations, response to treatments, and pathological findings, these two conditions could be differentiated from each other. Taking into account the already discussed signaling pathways and involved players such as T cells, mast cells, and sebaceous glands, different possible therapeutic options could be suggested. In addition to treatments supported by clinical evidence, such as 5 alpha-reductase inhibitors, topical calcineurin inhibitors, hydroxychloroquine, peroxisome proliferator-activated receptor gamma agonists, and oral retinoid agents, various other treatment strategies and drugs, such as phototherapy, Janus kinase inhibitors, dehydroepiandrosterone, sirolimus, cetirizine, and rituximab, could be suggested to mitigate disease progression. Of course, such lines of treatment need further evaluation in clinical trials. Keywords: Autoimmunity, scarring alopecia, frontal fibrosing alopecia, lichen planopilaris, immune response, treatment

Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris (LPP) with characteristic band-like frontotemporal hairline involvement and eyebrow loss. It most commonly occurs in post-menopausal White women.1 In skin of color (SOC) individuals, FFA is often misdiagnosed as traction alopecia (TA),2 and little data exists regarding the presentation of FFA in the SOC patient population.3 As FFA incidence continues to increase,4 we aim to understand differences in the presentation of FFA between White and Black women in order to aid in the accurate and timely diagnosis as well as help inform prognosis and management.

Lichen planopilaris is a primary lymphocytic cicatricial alopecia that commonly presents with hair loss at the vertex or parietal scalp. Patients may also have associated scalp itching, burning or tenderness. Due to scarring, hair loss is typically permanent. The main goals of treatment are reducing symptoms and preventing disease progression and further hair loss. Currently, the literature has limited evidence on treatments for this difficult condition, and most available evidence is from case reports and case series. Furthermore, the evidence shows a varied response to therapy, with frequent reports of poor response. This article reviews the diagnosis of this rare disease, summarize the currently available treatments, and provide insights and practices from alopecia experts.

Lichen planopilaris is an uncommon dermatological manifestation of lichen planus of the scalp and results in cicatricial alopecia. We present a patient with lichen planopilaris and significant post-inflammatory pigmentary alteration, confirmed by histopathology. The patient's case represents a clinically important variation from an expected typical pattern of dyschromia at periphery of alopecic zones in lichen planopilaris.