Histological evidence for epidermal and dermal atrophy of the alopecic band in treatment‐naïve patients with Frontal Fibrosing Alopecia

Saceda‐Corralo, David; Desai, Karishma; Pindado‐­Ortega, Cristina; Moreno‐Arrones, O.M.; Vañó‐Galván, Sergio; Miteva, Mariya

doi:10.1111/jdv.16792

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Perifollicular lymphocytic inflammation around the isthmus/infundibulum in “healthy scalp” was found, in accordance with previous reports [ 11 , 12 , 14 ]. Around 86% of patients showed this feature, a higher percentage than that reported by Doche et al (64.3%) [ 14 ].…”

Section: Discussionsupporting

confidence: 92%

“…Dermatologists can assess by the “naked-eye” and trichoscopy the “clinically affected area”, evaluating the size of the scarring area and the presence or absence of inflammatory trichoscopic signs. However, sonographic and histopathological abnormalities have been found in “normal-appearing” areas in FFA patients, suggesting that subclinical inflammation may exist [ 10 , 11 , 12 , 13 , 14 ]. The presence of the inflammatory infiltrate, sebaceous gland atrophy, and perifollicular fibrosis were the histopathological features found in the normal-appearing scalp; all of them are typical features found in the frontal hairline area in patients with FFA.…”

Section: Introductionmentioning

confidence: 99%

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Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp

Porriño‐Bustamante

Moraleda

Fernández-Flores

et al. 2022

JCM

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Frontal fibrosing alopecia is characterized by the presence of a lymphocytic inflammatory infiltrate around the upper follicle and by perifollicular fibrosis, which results in the destruction of the hair follicle. Recent reports have also found the presence of those findings in clinically unaffected areas. The aim of this report is to perform a deeper analysis of the histopathological features of this apparently unaffected scalp. A cross-sectional study including 52 women with frontal fibrosing alopecia was performed. Two areas were biopsied: the frontal hairline and a normal-appearing scalp area. Sebaceous glands were reduced/absent in 80.8% of the frontal hairline samples compared to 42.3% of the “healthy scalp” samples (p = 0.001). Inflammatory infiltrate was observed in 92.3% of patients in the frontal hairline and in 86.5% of them in the “healthy scalp” area (p = 0.508), although the severity was higher in the former (p = 0.013). Follicular epithelium changes were seen in 70.6% of the frontal hairline biopsies compared to 48.1% of the “healthy scalp” biopsies (p = 0.012). Fibrous tissular changes were noted in 80.8% and 53.8% of the frontal hairline and “healthy scalp” biopsies, respectively (p = 0.003). In conclusion, the histopathological features of frontal fibrosing alopecia are shared by both affected and clinically unaffected areas.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp

Porriño‐Bustamante

Moraleda

Fernández-Flores

et al. 2022

JCM

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“…Few histological abnormalities have been described in clinically unaffected scalp in FFA and LPP, such as infundibular lymphocytic inflammation [ 174 , 175 , 176 ] and early sebaceous gland atrophy [ 165 ]. Perifollicular fibrosis and mucin deposits have also been noted in unaffected scalp [ 176 ].…”

Section: Histopathologymentioning

confidence: 99%

“…The presence of direct immunofluorescence deposits is more frequent in LPP [ 167 , 184 ]; in FFA, it is usually negative, although IgM deposits over the basement membrane and cytoid bodies in the papillary dermis have been described [ 133 , 185 ]. Moreover, the epidermis is thinner in FFA than in LPP [ 30 ]; this reduction in the epidermal thickness (and also dermal) has been noted in the alopecic band of FFA naïve patients [ 174 ]. A recent study has found that macrophages exist in different functional phenotypes in LPP and FFA; CD86 is downregulated in LPP compared with FFA, whereas CD163 is increased in LPP and decreased in FFA [ 37 ].…”

Section: Are Lpp and Ffa The Same Disease?mentioning

confidence: 99%

Frontal Fibrosing Alopecia: A Review

Porriño‐Bustamante

Fernández‐Pugnaire

Arias‐Santiago

2021

JCM

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Frontal fibrosing alopecia is a scarring alopecia, the prevalence of which is increasing worldwide since its first description in 1994. The reason for this emerging epidemic may be a higher exposure to an unknown trigger, although its aethiology and pathogenesis still remain enigmatic. Clinical, trichoscopic, sonographic, and histopathologic findings are allowing clinicians to understand more aspects about this type of cicatricial alopecia. Several treatments have been used in frontal fibrosing alopecia, although the 5-alpha reductase inhibitors seem to be the most promising. The aim of this report is to provide a compilation about the published data regarding frontal fibrosing alopecia in a narrative review.

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“…2a, b). LPPigm is characterized by interface dermatitis with pigment incontinence and melanophages in the dermis which results in clinical hyperpigmentation [3]. It could be that for some unknown reason these areas are not affected by LPPigm or, alternatively, the local reduction of melanocyte counts would lead to decreased pigment incontinence in these areas.…”

mentioning

confidence: 99%