Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris.
BACKGROUND
Lichen planopilaris usually produces multifocal areas of scarring alopecia. Recently, a condition in postmenopausal women characterized by progressive frontal hairline recession associated with scarring has been described.


OBJECTIVE
Our purpose was to study the clinical and histopathologic features and results of treatment in a group of women with the frontal variant of lichen planopilaris and to compare the immunohistochemical profile of scalp biopsy specimens from this subset with that found in the multifocal variant of lichen planopilaris.


METHODS
The clinical data as well as the histopathologic findings in 16 women with frontal fibrosing alopecia were collated. The immunohistochemical profile of six scalp biopsy specimens from the frontal hairline were compared with six specimens from women with multifocal lichen planopilaris.


RESULTS
In addition to the progressive frontal fibrosing alopecia in all 16 women, total loss or a marked decrease of the eyebrows was observed in 13. No evidence of lichen planus was observed at other sites. In one patient multifocal areas of lichen planopilaris developed in the scalp. The frontal fibrosing alopecia was slowly progressive but has stabilized in five patients. Biopsy specimens from the frontal hairline showed histologic changes identical to lichen planopilaris. Immunophenotyping failed to reveal any significant differences between the frontal and multifocal variants. No effective treatments emerged although oral steroids and antimalarials may temporarily slow the course. Hormone replacement therapy did not appear to influence the course of the alopecia.


CONCLUSIONS
Progressive frontal fibrosing alopecia is a clinically distinct variant of lichen planopilaris that affects in particular elderly women and frequently involves the eyebrows. The basis for this lichenoid tissue reaction targeting frontal scalp follicles and eyebrows is unknown.
Kossard
S
S
Skin and Cancer Foundation Australia, NSW, Australia.
Lee
M S
MS
Wilkinson
B
B
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000505:Alopecia / Q000188:drug therapy / Q000473:pathology*; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D002738:Chloroquine / Q000008:administration & dosage / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018450:Disease Progression; D015914:Estrogen Replacement Therapy; D005138:Eyebrows / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D018859:Hair Follicle / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D015603:Keratinocytes / Q000473:pathology; D008010:Lichen Planus / Q000188:drug therapy / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology; D008875:Middle Aged; D017698:Postmenopause; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology; D012536:Scalp Dermatoses / Q000188:drug therapy / Q000473:pathology*; D013601:T-Lymphocytes / Q000473:pathology
D000962:Antimalarials; D003879:Dermatologic Agents; D005938:Glucocorticoids; D002738:Chloroquine; D011241:Prednisone