Case and Research Letters
Frontal Fibrosing Alopecia: Dermoscopic Features
Alopecia frontal fibrosante. Hallazgos dermatoscópicos
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Hallazgos dermatoscópicos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "167" "paginaFinal" => "168" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Frontal Fibrosing Alopecia: Dermoscopic Features" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 698 "Ancho" => 950 "Tamanyo" => 153909 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mujer de 51 años con una placa de alopecia en banda en región fronto-temporal. Nótese la recesión de la línea de implantación del pelo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "H. Mireles-Rocha, L.E. Sánchez-Dueñas, M. Hernández-Torres" "autores" => array:3 [ 0 => array:2 [ "nombre" => "H." "apellidos" => "Mireles-Rocha" ] 1 => array:2 [ "nombre" => "L.E." "apellidos" => "Sánchez-Dueñas" ] 2 => array:2 [ "nombre" => "M." 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Mireles-Rocha, L.E. Sánchez-Dueñas, M. Hernández-Torres" "autores" => array:3 [ 0 => array:3 [ "nombre" => "H." "apellidos" => "Mireles-Rocha" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "L.E." "apellidos" => "Sánchez-Dueñas" "email" => array:1 [ 0 => "dr_lesd@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Hernández-Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Dermatología, Colima Col., Mexico" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Dermatológico de Jalisco Dr. José Barba Rubio, Mexico" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Dermatopatología, Instituto Dermatológico de Jalisco Dr. José Barba Rubio, Mexico" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alopecia frontal fibrosante. Hallazgos dermatoscópicos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1165 "Ancho" => 1587 "Tamanyo" => 267008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Woman aged 51 years with a bald patch in the form of a band on the frontotemporal region. Note the receding hairline.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">First described by Kossard<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1994, frontal fibrosing alopecia is a type of cicatricial alopecia that is clinically characterized by progressive and symmetrical recession of the frontotemporal hairline. It is accompanied by partial alopecia of the eyebrows in most cases<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and loss of body hair in a variable number of patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is more frequent in postmenopausal women, although there have been reports of cases in men and premenopausal women.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> Histopathology shows it to be a variant of lichen planopilaris, which is characterized by a reduced number of hair follicles, a perifollicular lymphocytic inflammatory infiltrate, and fibrosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Few published studies describe the dermoscopic features of frontal fibrosing alopecia.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 51-year-old woman who consulted with a 12-month history of hair loss at the frontal hairline. No other symptoms or associated diseases were present. Physical examination revealed a bald patch in the form of a band that delimited the hairline of the frontal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She also had partial alopecia of the eyebrows. The remaining findings were normal. The patient had previously taken high-potency topical corticosteroids and 2% minoxidil with no signs of improvement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy (Dermlite 00 multispectral) highlighted a marked reduction in the number of follicular ostia in the central area and erythema, perifollicular desquamation, and perifollicular blue-gray dots at the border of the patch (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A biopsy specimen was taken, and histopathology revealed a marked reduction in the density of the pilosebaceous units, as well as laminar fibrosis and a perifollicular lymphocytic inflammatory infiltrate around the isthmus and infundibulum (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The clinical, dermoscopic, and histopathologic findings confirmed a diagnosis of frontal fibrosing alopecia.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Since it was first described in 1994, just under 200 cases of frontal fibrosing alopecia have been reported throughout the world.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4</span></a> Although initially considered an uncommon entity, this condition is believed to be a much more common cause of cicatricial alopecia than previously thought.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> There are few published reports of dermoscopic findings in patients with this condition. Several dermoscopic findings are characteristic of frontal fibrosing alopecia, whereas others also appear in other types of cicatricial alopecia, such as discoid lupus erythematosus or lichen planopilaris. Inui et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> reported 3 dermoscopic findings in 4 patients with frontal fibrosing alopecia, namely, reduced follicular ostia, erythema, and perifollicular scale, which were also found in the case we report. Other dermoscopic findings also reported in patients with this condition include ramified capillaries, honeycomb-like pigment network, white patches, white dots, and vellus hair.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In the present case, we also identified blue-gray dots around some follicles, a finding that has previously been reported in discoid lupus erythematosus, but not in frontal fibrosing alopecia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Although no studies have established a correlation between dermoscopic findings and histopathologic findings in cicatricial alopecia, it has been suggested that the white patches correspond to fibrosis and that they are more commonly found in long-standing bald patches.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The blue-gray dots correspond to melanophages in the papillary dermis and the white dots to pigment incontinence<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>; the honeycomb pattern is the result of exposure of the bald patches to sunlight.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Erythema and hyperkeratosis are the results of inflammation in the follicle and the hyperkeratosis that develops in lichen planopilaris and frontal fibrosing alopecia.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Dermoscopic criteria are proving useful in the diagnosis of alopecia.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In the present case, dermoscopic findings enabled us to rule out other causes of alopecia, such as alopecia areata. The correlation between clinical findings, dermoscopic findings, and histopathologic findings enabled us to establish a diagnosis of frontal fibrosing alopecia.</p><p id="par0030" class="elsevierStylePara elsevierViewall">To date, no cases of frontal fibrosing alopecia have been reported in Latin America. Although this condition has characteristic manifestations, dermoscopy provides more detailed information. The present case underlines the role of dermoscopy for evaluating cicatricial alopecia and establishing a differential diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Mireles-Rocha H, et al. Alopecia frontal fibrosante. Hallazagos dermatoscópicos. Actas Dermosifliogr. 2012;103:167–8.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1165 "Ancho" => 1587 "Tamanyo" => 267008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Woman aged 51 years with a bald patch in the form of a band on the frontotemporal region. Note the receding hairline.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1037 "Ancho" => 1587 "Tamanyo" => 156784 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy (Dermlite 00 multispectral) revealed markedly reduced follicular ostia, scale, erythema, and perifollicular blue-gray dots.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1677 "Ancho" => 2087 "Tamanyo" => 634663 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology revealed a reduction in the number of hair follicles, lymphocytic inflammatory infiltrate, and laminated perifollicular fibrosis (hematoxylin–eosin, original magnification 40×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postmenopausal frontal fibrosing alopecia. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 4 | 10 |
| 2024 Octubre | 103 | 33 | 136 |
| 2024 Septiembre | 123 | 23 | 146 |
| 2024 Agosto | 151 | 49 | 200 |
| 2024 Julio | 132 | 32 | 164 |
| 2024 Junio | 125 | 43 | 168 |
| 2024 Mayo | 127 | 30 | 157 |
| 2024 Abril | 119 | 39 | 158 |
| 2024 Marzo | 114 | 31 | 145 |
| 2024 Febrero | 113 | 52 | 165 |
| 2024 Enero | 107 | 54 | 161 |
| 2023 Diciembre | 96 | 19 | 115 |
| 2023 Noviembre | 138 | 26 | 164 |
| 2023 Octubre | 114 | 32 | 146 |
| 2023 Septiembre | 132 | 40 | 172 |
| 2023 Agosto | 92 | 23 | 115 |
| 2023 Julio | 135 | 53 | 188 |
| 2023 Junio | 107 | 48 | 155 |
| 2023 Mayo | 90 | 45 | 135 |
| 2023 Abril | 96 | 44 | 140 |
| 2023 Marzo | 107 | 62 | 169 |
| 2023 Febrero | 85 | 37 | 122 |
| 2023 Enero | 71 | 46 | 117 |
| 2022 Diciembre | 105 | 64 | 169 |
| 2022 Noviembre | 62 | 32 | 94 |
| 2022 Octubre | 55 | 28 | 83 |
| 2022 Septiembre | 60 | 52 | 112 |
| 2022 Agosto | 56 | 40 | 96 |
| 2022 Julio | 54 | 38 | 92 |
| 2022 Junio | 59 | 37 | 96 |
| 2022 Mayo | 140 | 32 | 172 |
| 2022 Abril | 100 | 42 | 142 |
| 2022 Marzo | 89 | 62 | 151 |
| 2022 Febrero | 75 | 35 | 110 |
| 2022 Enero | 84 | 42 | 126 |
| 2021 Diciembre | 77 | 51 | 128 |
| 2021 Noviembre | 84 | 42 | 126 |
| 2021 Octubre | 60 | 55 | 115 |
| 2021 Septiembre | 73 | 49 | 122 |
| 2021 Agosto | 54 | 42 | 96 |
| 2021 Julio | 77 | 35 | 112 |
| 2021 Junio | 78 | 46 | 124 |
| 2021 Mayo | 94 | 37 | 131 |
| 2021 Abril | 153 | 87 | 240 |
| 2021 Marzo | 245 | 32 | 277 |
| 2021 Febrero | 108 | 31 | 139 |
| 2021 Enero | 57 | 22 | 79 |
| 2020 Diciembre | 65 | 25 | 90 |
| 2020 Noviembre | 70 | 19 | 89 |
| 2020 Octubre | 49 | 8 | 57 |
| 2020 Septiembre | 47 | 15 | 62 |
| 2020 Agosto | 62 | 18 | 80 |
| 2020 Julio | 144 | 20 | 164 |
| 2020 Junio | 100 | 27 | 127 |
| 2020 Mayo | 44 | 22 | 66 |
| 2020 Abril | 36 | 28 | 64 |
| 2020 Marzo | 32 | 27 | 59 |
| 2020 Febrero | 9 | 11 | 20 |
| 2020 Enero | 0 | 8 | 8 |
| 2019 Diciembre | 0 | 14 | 14 |
| 2019 Noviembre | 0 | 11 | 11 |
| 2019 Octubre | 0 | 8 | 8 |
| 2019 Septiembre | 0 | 10 | 10 |
| 2019 Agosto | 0 | 6 | 6 |
| 2019 Julio | 0 | 11 | 11 |
| 2019 Junio | 1 | 22 | 23 |
| 2019 Mayo | 0 | 13 | 13 |
| 2019 Abril | 2 | 20 | 22 |
| 2019 Marzo | 0 | 5 | 5 |
| 2019 Febrero | 0 | 3 | 3 |
| 2019 Enero | 1 | 2 | 3 |
| 2018 Diciembre | 0 | 7 | 7 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 2 | 4 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Abril | 0 | 5 | 5 |
| 2018 Marzo | 3 | 13 | 16 |
| 2018 Febrero | 119 | 11 | 130 |
| 2018 Enero | 175 | 11 | 186 |
| 2017 Diciembre | 133 | 7 | 140 |
| 2017 Noviembre | 106 | 17 | 123 |
| 2017 Octubre | 116 | 14 | 130 |
| 2017 Septiembre | 116 | 29 | 145 |
| 2017 Agosto | 172 | 15 | 187 |
| 2017 Julio | 131 | 25 | 156 |
| 2017 Junio | 149 | 24 | 173 |
| 2017 Mayo | 126 | 15 | 141 |
| 2017 Abril | 105 | 9 | 114 |
| 2017 Marzo | 90 | 28 | 118 |
| 2017 Febrero | 85 | 24 | 109 |
| 2017 Enero | 100 | 23 | 123 |
| 2016 Diciembre | 118 | 16 | 134 |
| 2016 Noviembre | 146 | 27 | 173 |
| 2016 Octubre | 185 | 17 | 202 |
| 2016 Septiembre | 245 | 14 | 259 |
| 2016 Agosto | 218 | 26 | 244 |
| 2016 Julio | 99 | 10 | 109 |
| 2016 Junio | 12 | 13 | 25 |
| 2016 Mayo | 9 | 12 | 21 |
| 2016 Abril | 14 | 1 | 15 |
| 2016 Marzo | 5 | 16 | 21 |
| 2016 Febrero | 7 | 2 | 9 |
| 2016 Enero | 14 | 20 | 34 |
| 2015 Diciembre | 11 | 1 | 12 |
| 2015 Noviembre | 40 | 16 | 56 |
| 2015 Octubre | 73 | 2 | 75 |
| 2015 Septiembre | 30 | 8 | 38 |
| 2015 Agosto | 16 | 7 | 23 |
| 2015 Julio | 191 | 11 | 202 |
| 2015 Junio | 134 | 16 | 150 |
| 2015 Mayo | 125 | 24 | 149 |
| 2015 Abril | 159 | 15 | 174 |
| 2015 Marzo | 173 | 15 | 188 |
| 2015 Febrero | 155 | 13 | 168 |
| 2015 Enero | 110 | 20 | 130 |
| 2014 Diciembre | 99 | 13 | 112 |
| 2014 Noviembre | 113 | 14 | 127 |
| 2014 Octubre | 94 | 13 | 107 |
| 2014 Septiembre | 129 | 14 | 143 |
| 2014 Agosto | 78 | 15 | 93 |
| 2014 Julio | 105 | 19 | 124 |
| 2014 Junio | 112 | 16 | 128 |
| 2014 Mayo | 146 | 13 | 159 |
| 2014 Abril | 113 | 12 | 125 |
| 2014 Marzo | 127 | 25 | 152 |
| 2014 Febrero | 33 | 15 | 48 |
| 2014 Enero | 46 | 6 | 52 |
| 2013 Diciembre | 67 | 13 | 80 |
| 2013 Noviembre | 50 | 7 | 57 |
| 2013 Octubre | 31 | 13 | 44 |
| 2013 Septiembre | 38 | 11 | 49 |
| 2013 Agosto | 62 | 13 | 75 |
| 2013 Julio | 45 | 8 | 53 |
| 2013 Junio | 22 | 12 | 34 |
| 2013 Mayo | 19 | 17 | 36 |
| 2013 Abril | 16 | 6 | 22 |
| 2013 Marzo | 17 | 20 | 37 |
| 2013 Febrero | 50 | 14 | 64 |
| 2013 Enero | 100 | 10 | 110 |
| 2012 Diciembre | 50 | 6 | 56 |
| 2012 Noviembre | 1 | 4 | 5 |
| 2012 Octubre | 3 | 7 | 10 |
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