Abstract

Frontal fibrosing alopecia (FFA), considered to be a variant of lichen planopilaris, is a primary lymphocytic scarring alopecia clinically characterized by perifollicular scale, erythema, and loss of follicular ostia involving the frontal hairline. In contrast, folliculitis decalvans (FD) is a primary neutrophilic scarring alopecia that presents with pustular and papules on alopecic patches predominantly involving the vertex scalp. Here we report a case of a neutrophilic scarring alopecia in a 30-year-old man with a distribution more clinically consistent with FFA. Physical examination revealed a linear band of scarring alopecia involving the fronto-lateral scalp with loss of follicular ostia, lonely hairs, and perifollicular pustules and erythematous papules at the advancing margin. A punch biopsy revealed polytrychia and perifollicular fibrosis with neutrophils seen within and around the hair follicle. A subtle and patchy lymphohistiocytic infiltrate was seen along the basal layer of the follicular epithelium at the level of the infundibulum and isthmus. Gram and periodic acid-Schiff stains were negative for microorganisms. The combined clinical and histopathologic features of both FFA and FD in this case may represent a new variant of scarring alopecia within the FFA and FD phenotypic spectrum. Continued recognition and reporting of similar cases is needed to further characterize this peculiar clinical presentation.