Frontal fibrosing alopecia versus lichen planopilaris: a clinicopathological study

Authors

  • Enrique Poblet MD,

    1. From the Department of Pathology, Hospital General Universitario de Albacete, Albacete, Spain, Private Practice, Las Palmas de Gran Canaria, Canary Islands, Spain, and Hospital General de Lanzarote, Canary Islands, Spain
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  • Francisco Jiménez MD,

    1. From the Department of Pathology, Hospital General Universitario de Albacete, Albacete, Spain, Private Practice, Las Palmas de Gran Canaria, Canary Islands, Spain, and Hospital General de Lanzarote, Canary Islands, Spain
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  • Alejandro Pascual MD,

    1. From the Department of Pathology, Hospital General Universitario de Albacete, Albacete, Spain, Private Practice, Las Palmas de Gran Canaria, Canary Islands, Spain, and Hospital General de Lanzarote, Canary Islands, Spain
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  • Enric Piqué MD

    1. From the Department of Pathology, Hospital General Universitario de Albacete, Albacete, Spain, Private Practice, Las Palmas de Gran Canaria, Canary Islands, Spain, and Hospital General de Lanzarote, Canary Islands, Spain
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Francisco Jiménez, MD Calle Angel Guimerá, 2 Las Palmas de Gran Canaria 35003 Spain E-mail: fjimenez@clinicadelpelo.com

Abstract

Background  Frontal fibrosing alopecia (FFA) is an acquired scarring alopecia currently considered a clinical variant of lichen planopilaris (LPP). Our purpose was to examine the clinicopathological features of FFA. In addition, we investigated the similarities and differences between FFA and LPP.

Methods  Biopsies from the scalp lesions of eight patients with FFA and eight patients with LPP were microscopically analyzed. Two cases of FFA and four cases of LPP were studied using direct immunofluorescence.

Results  In spite of the completely different clinical characteristics of FFA and LPP patients, the histopathological findings for the two entities were similar. Common microscopic findings for both FFA and LPP included an inflammatory lymphocytic infiltrate involving the isthmus and infundibulum of the hair follicles, the presence of apoptotic cells in the external root sheath, and a concentric fibrosis surrounding the hair follicles that resulted in their destruction with subsequent scarring alopecia. Biopsies taken from FFA patients showed less follicular inflammation and more apoptotic cells than those from LPP patients. In some cases of LPP, the inflammatory infiltrate involved the interfollicular epidermis, a finding never present in our FFA cases. Direct immunofluorescence was negative in the two cases of FFA studied and showed deposits of immunoglobulins and/or complement in two of the four LPP cases examined.

Conclusions  The characteristic findings for FFA were more prominent apoptosis and less inflammation than found in LPP, along with spared interfollicular epidermis. FFA cases showed a rather characteristic histopathological pattern, although we could not find any clear-cut histological differences between FFA and LPP.

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