Journal of the American Academy of Dermatology
Original articleFacial lesions in frontal fibrosing alopecia (FFA): Clinicopathological features in a series of 12 cases
Section snippets
Clinical cases
Twelve women with FFA presented with facial skin lesions (Table I). They all were Caucasian, with a mean age of 54 years, 7 of them premenopausal. The hairline recession was minor in 5 cases, and moderate in 7. They showed total or partial eyebrow alopecia and substantial vellus hair loss on limbs. In 11 of 12 patients, noninflammatory papules were observed over the temples, cheeks, or chin. In some cases there were scattered papules with keratin-filled dilated infundibula, simulating open
Discussion
In FFA, the lichenoid inflammation of facial vellus hair follicles classically manifests as facial papules.6 According to the longest series published up to now, which includes 355 cases, 14% of patients presented these lesions.4 We observed facial papules in 20% of our patients. However, we believe that the recognition of these papules may be very subjective, because of their subtle clinical expression. Moreover, wrinkles and solar elastosis occurring in aged patients may complicate their
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Cited by (51)
Frontal fibrosing alopecia
2021, Clinics in DermatologyCitation Excerpt :Involvement of facial vellus hairs with noninflammatory papules was noted in 14% to 18% of patients (Figure 1H)9,11,39,45,46 or follicular red dots at the glabella region (Figure 1I).47 Other facial clinical signs include diffuse facial erythema, pigmented macules, and prominent and/or depressed forehead veins.46 In men, hair loss of the beard area, sideburns, and occipital scalp are a more prominent feature (Figure 1J).9,10,36,39,48
Therapeutic response of facial papules and inflammation in frontal fibrosing alopecia to low-dose oral isotretinoin
2020, JAAD Case ReportsCitation Excerpt :These papules most commonly are keratotic, presenting as skin roughness on the forehead and frontotemporal portion of the scalp; however, they have also been reported on the chest, back, and extremities.7 The pathogenesis of facial papules in frontal fibrosing alopecia remains unclear.3,8,9 Histologic examination demonstrates mild follicular hyperkeratosis and lichenoid dermatitis involving the infundibulum and isthmus of vellus hair follicles with or without fibrosis, similar to findings observed in lichen planopilaris.10,11
Frontal fibrosing alopecia: A new autoimmune entity?
2019, Medical HypothesesCitation Excerpt :The eyelashes may be affected in 3% of patients; other areas, such as the underarms, pubis and limbs, are rarely involved, with prevalence ranging from 0% to 77% [8,9,11]. Additional findings are perifollicular–reticular erythema, predominantly on the zygomatic arch and hyperkeratosis, which represents active disease [8–10]. Pruritus and facial papules may be seen in up to 72% of patients and may indicate greater severity; these are recognised by their skin-colour pattern, monomorphism and noninflammatory rough appearance [6–10].
Facial Papules in Frontal Fibrosing Alopecia: Good Response to Isotretinoin
2018, Actas Dermo-SifiliograficasFrontal Fibrosing Alopecia: A Retrospective Study of 75 Patients
2020, Actas Dermo-SifiliograficasAlopecias: Practical Tips for the Management of Biopsies and Main Diagnostic Clues for General Pathologists and Dermatopathologists
2023, Journal of Clinical Medicine
Funding sources: None.
Conflicts of interest: None declared.