International Journal of Trichology International Journal of Trichology
 Print this page Email this page Small font sizeDefault font sizeIncrease font size
 
 
  Home | About IJT | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submission | Subscribe | Advertise | Contact us | Login   
 


 
 Table of Contents  
CLINICAL CHALLENGE
Year : 2015  |  Volume : 7  |  Issue : 1  |  Page : 41-42  

Vitiliginous alopecia masquerading as frontal fibrosing alopecia


1 Department of Dermatology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
2 Department of Pathology, Melanoma Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain

Date of Web Publication18-Mar-2015

Correspondence Address:
Ramon Pigem
Department of Dermatology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona
Spain
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7753.153462

Rights and Permissions

How to cite this article:
Pigem R, Villablanca S, Podlipnik S, AlÓs L, Puig S. Vitiliginous alopecia masquerading as frontal fibrosing alopecia. Int J Trichol 2015;7:41-2

How to cite this URL:
Pigem R, Villablanca S, Podlipnik S, AlÓs L, Puig S. Vitiliginous alopecia masquerading as frontal fibrosing alopecia. Int J Trichol [serial online] 2015 [cited 2020 Aug 12];7:41-2. Available from: http://www.ijtrichology.com/text.asp?2015/7/1/41/153462


   Introduction Top


A 73-year-old female presented at the Dermatology Department with a white shiny band-like patch on the temporal and forehead zones [Figure 1]. She had a 4-year history of vulvar lichen scleroatrophicus (LSA) [Figure 2]. Polarized dermoscopy examination revealed follicular ostium preservation, yellow dots and poliosis of vellus hair [Figure 3]. A biopsy specimen was obtained, and histopathological examination revealed no inflammatory cells, with preservation of the hair follicle and almost no melanocytes were present [Figure 4].
Figure 1: White patch on the frontotemporal region. Madarosis not observed

Click here to view
Figure 2: Characteristic brightness and whitish color of the introit and the mucosa is observed

Click here to view
Figure 3: Dermoscopy view shows preservation of the follicular openings and poliosis of vellus hair. Absence of scar, erythema, and scale. Skin and hair were normal except for the decrease of pigmentation when compared with other normal areas

Click here to view
Figure 4: Preservation of hair follicles without inflammatory infiltrate or fibrosis. Note the absence of melanocytes (H and E original magnification, ×40 and Melan A original magnification, ×20).

Click here to view


What is your diagnosis?

Vitiligo.


   Discussion Top


Despite the initial clinical suspicion of frontal fibrosing alopecia (FFA), a complete physical examination was performed finding a hypopigmented macula in the middle of the chest, which led us to consider in the differential diagnosis vitiligo. In addition, the histologic findings supported this diagnosis because of the decreased number of melanocytes and the absence of inflammatory or cicatricial changes.

Alopecia is classified into two major groups, cicatricial and noncicatricial. Usually clinical findings are enough to make a correct diagnosis, but some skin diseases can simulate cicatricial alopecia, being in these cases very difficult to differentiate. In our case, the patient has a LSA that has been associated either to FFA and vitiligo. [1],[2] A dermoscopic clue, for suspect a primary cicatricial alopecia, is the loss of follicular ostia reflecting the cicatricial phenomenon that were absent. In this case, the first diagnostic hypothesis was of FFA, because of the clinical characteristics and the LSA background. However, vitiligo was considered after trichoscopy examination because of to the presence of poliosis and the finding of the hypopigmented macula on the patient's chest.

We conclude that trichoscopy is a useful technique for the assessment of scalp diseases. It allows the specialist to confirm clinical findings, identifying subtle sub-clinical signs and guiding a biopsy if necessary.

 
   References Top

1.
Bjekic M, Šipetic S, Marinkovic J. Risk factors for genital lichen sclerosus in men. Br J Dermatol 2011;164:325-9.  Back to cited text no. 1
    
2.
Feldmann R, Harms M, Saurat JH. Postmenopausal frontal fibrosing alopecia. Hautarzt 1996;47:533-6.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Introduction
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1364    
    Printed31    
    Emailed0    
    PDF Downloaded32    
    Comments [Add]    

Recommend this journal