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Case of a female with frontal fibrosing alopecia and Alopecia Areata

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    24 June 2021

Introduction

Both alopecia areata (AA) and frontal fibrosing alopecia (FFA) are hair follicle disorders that cause alopecia. With a prevalence of 0.1 percent to 0.2 percent, AA is one of the most common causes of inflammation-induced hair loss, affecting both children and adults, as well as all hair colours. Up to one-third of those affected are under 30 years old.

This syndrome is linked to a 16 percent higher risk of autoimmune diseases such lupus erythematosus, vitiligo, and autoimmune thyroid illness. AA can appear in a variety of clinical forms, ranging from the well-known patches to more widespread, difficult-to-diagnose patterns.

FFA, on the other hand, is a type of primary scarring alopecia characterised by increasing frontotemporal regression in postmenopausal women. Loss of follicular orifices, perifollicular erythema at the scalp edge, and an unpredictable course are all symptoms of this illness. Other common clinical signs include entire eyebrow loss or thinning, face papules, glabelar red dots and depression of the frontal veins.

While FFA is generally irreversible, corticosteroids and other treatments for AA sometimes lead to partial or complete recovery. As a result, distinguishing between the two diagnosis is critical.

Case Report

A 57-year-old postmenopausal woman with acute shedding and diffuse frontotemporal hair loss for two months came for the treatment. There was no expansion of the parietaloccipital margins on clinical examination, as seen in ophiasis AA. The hair pull test revealed a positive result along the front hairline.

Female pattern hair loss was seen, as was diffuse hair thinning throughout the midfrontal scalp. Her brows and eyelashes were preserved, her hair on all other body sites was normal, and her nails were normal. There was no past history of AA in the family. Asthma and eczema were among her previous medical conditions.

Exclamation mark hairs at the alopecic areas margin were confirmed by dermoscopic examination, with no indication of perifollicular erythema or scaling. A clinical diagnosis of AA was obtained, and a 12-week tapering regimen of 15 mg prednisolone and 0.25 mg minoxidil was started.

The patient experienced complete terminal hair regrowth of the afflicted area six weeks later. She was still in remission eight weeks after going off prednisolone at her follow-up visit.

Conclusion

Due to the variety of symptoms, diagnosing AA can be difficult. A 59-year-old female patient was presented with clinical symptoms that were initially indicative of FFA. Dermoscopic findings along with a timely reply to systemic corticosteroids favored an atypical alternative of AA. The importance of incorporating AA in the differential diagnosis for FFA is highlighted by these findings.

Early detection of AA through dermoscopic examination is critical for prompt treatment and patient comfort, as this condition is curable. 

Source

  1. Alopecia areata. Gilhar A, Etzioni A, Paus R. N Engl J Med. 2012;366:1515–1525.
  2. Bitemporal alopecia areata. Meah N, Wall D, Trindade de Carvalho L, Sinclair R. Australas J Dermatol. 2020;61:263–265.
  3. Frontal fibrosing alopecia: a review of 60 cases. MacDonald A, Clark C, Holmes S. J Am AcadDermatol. 2012;67:955–961.
  4. Updated diagnostic criteria for frontal fibrosing alopecia. Vañó-Galván S, Saceda-Corralo D, Moreno-Arrones ÓM, Camacho-Martinez FM. J Am AcadDermatol. 2018;78:0–2. 

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