Track

Case Reports

Abstract

Fibrosing alopecia in a pattern distribution (FAPD) is a scarring alopecia with features of both lichen planopilaris and androgenetic alopecia (AGA), often presenting with scalp pruritus or pain and examination findings of perifollicular scale, erythema, tufting, and loss of ostia. FAPD has been reported most frequently in Caucasian women. We highlight three cases of FAPD in young male patients of different races that were clinically and histopathologically pauci-inflammatory. A 22-year-old Caucasian male (case 1), an 18-year-old Hispanic male (case 2), and an 18-year-old Southeast Asian male (case 3) presented with diffuse hair thinning over the frontal and vertex scalp. Case 1 reported mild scalp pruritus; case 2 and 3 were asymptomatic. Trichoscopy revealed diffuse miniaturization and subtle irregularities in interfollicular distance corresponding to loss of follicular ostia (all cases), with faint background erythema, scant perifollicular scale, and rare solitary terminal hairs (case 1). Scalp biopsy demonstrated miniaturization and mild perifollicular lymphocytic infiltrate with concentric fibroplasia involving few follicular units at the infundibulum (all cases) and upper isthmus (case 1 and 3). Case 1 showed follicular scar and lichenoid dermatitis as well. These cases demonstrate the importance of histopathology in the diagnosis of FAPD. FAPD may affect patients of varying age, sex, and race, and is challenging to diagnose due to shared distribution with AGA and paucity of inflammatory symptoms. Careful trichoscopic examination of different regions of the scalp can identify subtle variations in interfollicular distance suggestive of scarring. A biopsy in an area of suspected scar is warranted.