title: Facial papules in frontal fibrosing alopecia: evidence of vellus follicle involvement.
abstract: BACKGROUND
  Frontal fibrosing alopecia is considered a particular clinical form of lichen planopilaris that primarily involves the scalp hair over the frontal hairline. Concomitant involvement of vellus at different body sites has recently been reported. To our knowledge, this is the first report on the involvement of facial vellus by effects of the inflammatory process. Unlike the usual noninflammatory clinical presentation of vellus involvement over other body areas, facial vellus involvement can lead to surface changes that may be recognized both by patients and dermatologists.
  
  
  METHODS
  Four patients with typical clinical features of frontal fibrosing alopecia presented with noninflammatory follicular papules over the face, most often inside the temporal area, and described as "roughness" by the patients. Histologic samples showed lichen planopilaris features involving the facial vellus.
  
  
  CONCLUSIONS
  The new concept of frontal fibrosing alopecia as a generalized disease is important for treatment planning and research. Dermatologists must learn to recognize facial surface changes and discuss these with the patients, who may attribute this roughness to aging or hormonal changes associated with menopause. Further studies are needed to determine the prevalence of this involvement in patients with frontal fibrosing alopecia.
authors.affiliation: Department of Dermatology, University of São Paulo, São Paulo 05403-900, Brazil. aline@donati.com.br
authors.forename: Aline
authors.initials: A
authors.lastname: Donati
authors.forename: Luciana
authors.initials: L
authors.lastname: Molina
authors.forename: Isabella
authors.initials: I
authors.lastname: Doche
authors.forename: Neusa S
authors.initials: NS
authors.lastname: Valente
authors.forename: Ricardo
authors.initials: R
authors.lastname: Romiti
mesh_terms: D000505:Alopecia / Q000175:diagnosis / Q000473:pathology*; D005145:Face; D005260:Female; D018859:Hair Follicle / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000473:pathology*; D008010:Lichen Planus / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D017698:Postmenopause