International Journal of Trichology International Journal of Trichology
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Year : 2018  |  Volume : 10  |  Issue : 4  |  Page : 172-174

Lichen planopilaris caused by wig attachment: A Case of Koebner phenomenon in Frontal Fibrosing Alopecia

1 Department of Dermatology, University Hospital of the North Parana, State University of Londrina, State University of Londrina, Parana, Brazil
2 Center for Dermatology and Hair Diseases Professor Trüeb, Zurich-Wallisellen, Switzerland

Correspondence Address:
Prof. Ralph Michel Trüeb
Center for Dermatology and Hair Diseases, Bahnhofplatz 1A, CH-8304, Wallisellen
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijt.ijt_48_18

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Frontal fibrosing alopecia (FFA) represents a distinctive condition with a marginal scarring alopecia along the frontal and temporal hairline. Since its original description, the condition has been recognized to represent a more generalized than localized process, with extension beyond the frontotemporal hairline to include the parieto-occipital hairline and involve peculiar facial papules as evidence of facial vellus hair involvement and loss of peripheral body hair. Finally, the association of FFA with oral lichen planus, nail involvement, and concomitant lichen planopilaris (LPP) points to a close relationship to lichen planus. The Koebner phenomenon or isomorphic reaction has been described in lichen planus, LPP, and ultimately FFA, with face-lift procedures and hair restoration surgery having been implicated as the culprits in the latter. We report the first case of FFA in whom LPP developed at the sites of wig attachments, providing the evidence for Koebner phenomenon. Therefore, wigs are to be included to the list of procedures for hair restoration at risk of eliciting an isomorphic reaction in patients with FFA. Ultimately, the association of Koebner phenomenon with LPP-type lesions in FFA may provide further insight into the underlying pathology and nosology of the condition.

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