Fibrosing alopecia in a pattern distribution - 17/02/20

Doi : 10.1016/j.jaad.2019.12.056

Jacob Griggs, BA ^a,^⁎ , Ralph M. Trüeb, MD ^b, Maria Fernanda Reis Gavazzoni Dias, MD ^c, Maria Hordinsky, MD ^d, Antonella Tosti, MD ^a
^a Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
^b Center for Dermatology and Hair Diseases, Zurich-Wallisellen, Switzerland
^c Department of Dermatology of the Fluminense Federal University, Antonio Pedro University Hospital, Niteroi, Brazil
^d Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota

^∗Correspondence to: Jacob Griggs, BA, Department of Dermatology and Cutaneous Surgery, University of Miami Hospital, 1475 NW 12th Ave, Ste 2175, Miami, FL 33136.Department of Dermatology and Cutaneous SurgeryUniversity of Miami Hospital1475 NW 12th Ave, Ste 2175MiamiFL33136

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Abstract

Background/Objectives

Fibrosing alopecia in a pattern distribution (FAPD) is a newly recognized form of scarring alopecia sharing characteristics of both androgenetic alopecia (AGA) and lichen planopilaris. The existing literature on FAPD and current understanding of the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of this disease are reviewed.

Methods

PubMed searches were performed to identify all articles discussing FAPD. The references of articles were used to identify additional articles.

Results

A total of 15 articles were found describing FAPD in a total of 188 patients (164 women and 24 men; average age, 53.8).

Conclusions

FAPD affects the androgen-dependent scalp and is typically associated with hair follicle miniaturization. The scalp affected by FAPD shows features of both lichen planopilaris and AGA, and FAPD may possibly represent an exaggerated inflammatory response to damaged hair follicles, triggered by AGA. Physical examination and trichoscopic evidence of follicular inflammation and, occasionally, fibrosis are important to identify the condition, and a dermoscopy-guided biopsy can confirm the diagnosis. Unless recognized, clinicians may misdiagnose FAPD as AGA associated with seborrheic dermatitis. Data on treatment modalities are limited; however, based on pathogenesis, combined therapy with anti-inflammatory and hair growth–promoting agents is warranted.

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Key words : androgenetic alopecia, central centrifugal cicatricial alopecia, cicatricial alopecia, FAPD, fibrosing alopecia in a pattern distribution, frontal fibrosing alopecia, lichen planopilaris, scarring alopecia

Abbreviations used : AGA, CCCA, FAPD, FFA, LPP